Influence of morbidity, early nutritional intake, and total energy: protein ratio on longitudinal extrauterine growth restriction of very preterm newborns at term-equivalent age: an observational study.

To evaluate the influence of early nutritional intake on the growth pattern of very preterm infants. This was an observational study including 109 newborns (< 32 weeks gestational age). Perinatal morbidities, nutritional therapy (first four weeks of life), and weight, length, and head circumference (HC) growth at term-equivalent age were evaluated. Growth restriction was defined as a difference > 1.2 SD between the birth and term age measurements. Growth restriction at term-equivalent age: 52.3% (weight), 42.9% (length), and 22% (HC). Morbidities were positively correlated with nutrition therapy and negatively correlated with the total energy provision: protein ratio. The duration of parenteral nutrition, the time to reach full enteral feedings, and the total energy provision: protein ratio were significantly correlated. Nutrient intake influenced weight, length, and HC growth, and cumulative energy deficit was significantly associated with HC growth restriction.   Conclusion: Perinatal morbidities interfere with nutritional therapy and early nutrient intake, leading to insufficient energy and energy provision: protein ratio for growth. What is Known: • The intake of macronutrients early in life, mainly protein, is important for the optimal growth of pretem infants. • The severity of morbidities and low gestational ages impact the nutritional management of preterm infants. What is New: • The number of morbidities, reflecting the severity of the neonatal clinical course, had a detrimental effect on the nutritional therapy and nutrients intake. • The inadequate energy provision per gram of protein ratio was significantly associated with growth restriction in all growth measures at the second week of life, persisting for head circumference up to the fourth week, highlighting the importance of its measurement, as it could be a precocious sign of development risk.

Energy expenditure and body composition in infants with bronchopulmonary dysplasia at term age.

In this cross-sectional study, conducted in a cohort of infants with a gestational age of < 32 weeks, we aimed to evaluate and compare resting energy expenditure (REE) and body composition between infants who developed bronchopulmonary dysplasia (BPD) and those who did not. REE and body composition were assessed at term equivalent age using indirect calorimetry and air displacement plethysmography. Anthropometric measurements (weight, head circumference, and length) were obtained and transformed into Z-scores per the Fenton (2013) growth curve, at birth and at term equivalent age. Forty-two infants were included in this study, of which 26.2% developed BPD. Infants with BPD had significantly higher energy expenditure at term equivalent age, with no difference in body composition between the two groups. CONCLUSION: Despite expending more energy, infants with BPD maintained a similar body composition distribution to those without BPD, and this is likely due to the recommended nutritional approach. WHAT IS KNOWN: • Greater resting energy expenditure impairs growth of preterm infants with bronchopulmonary dysplasia. WHAT IS NEW: • Although preterm infants with bronchopulmonary dysplasia had a higher resting energy expenditure at the corrected term age, this did not affect their body composition and growth.

Avaliação do aporte nutricional dos recém-nascidos pré-termos e sua associação com o desenvolvimento da displasia broncopulmonar / Evaluation of the nutritional intake of preterm newborns and its association with the development of bronchopulmonary dysplasia

Apesar dos avanços tecnológicos no cuidado neonatal, a displasia broncopulmonar (DBP) permanece como uma morbidade frequente entre os recém-nascidos pré-termos. A DBP é resultado de um processo multifatorial onde inúmeros fatores, como o estado nutricional, atuam comprometendo o desenvolvimento do pulmão imaturo. Há muitos desafios em estabelecer um aporte nutricional adequado a estes recém-nascidos, especialmente nas primeiras semanas de vida, e não existe uma definição exata de qual seria a quantidade suficiente de proteínas e calorias para diminuir o risco de DBP. Desta forma, torna-se necessário avaliar o aporte nutricional e o impacto que ele pode ter no surgimento da doença e no crescimento desses recém-nascidos. Objetivo: Avaliar o aporte nutricional dos recém-nascidos com idade gestacional menor do que 32 semanas ao nascer, nas primeiras quatro semanas de vida e sua associação com o desenvolvimento de DBP com 36 semanas de idade gestacional corrigida. Métodos: Estudo de coorte em recém-nascidos com idade gestacional inferior a 32 semanas. O critério de definição de DBP foi estar em uso de oxigênio com 36 semanas de idade gestacional corrigida. Informações sobre variáveis perinatais foram coletadas do prontuário e o aporte nutricional recebido nas quatro primeiras semanas foi obtido prospectivamente e registrado em um software. Foram realizadas medidas antropométricas ao nascimento, no momento da alta hospitalar e na idade corrigida de termo, e transformadas em escore Z, utilizando-se a curva de referência de Fenton (2013). Resultados: Foram incluídos 78 recém-nascidos no estudo e a prevalência de DBP foi de 20,5%. O grupo de crianças com DBP necessitou com maior frequência de ventilação mecânica invasiva e não invasiva, e apresentou maior incidência de sepse neonatal. O tempo de dieta zero, de nutrição parenteral e para alcançar dieta plena foram maiores no grupo de pacientes com DBP. Houve diferença entre os dois grupos de pacientes quanto à taxa hídrica e calórica recebidas na terceira e quarta semana, e de lipídios na quarta semana. O crescimento foi analisado por meio de valores de escore Z de peso ao final das primeiras quatro semanas de vida e com idade corrigida de termo. Ao final da primeira semana, essas medidas eram semelhantes entre os dois grupos, porém na idade corrigida de termo os pacientes com DBP apresentaram menores escores em todas as medidas, que foi ainda mais acentuado nos recém-nascidos com idade gestacional igual ou inferior a 29 semanas. Utilizando o modelo de regressão logística e considerando os fatores neonatais e a razão caloria/proteína, observou-se que os fatores que melhor prediziam a DBP foram a sepse, com um risco de 11 vezes, e a razão caloria/proteína menor do que 25 kcal/grama, com um risco de 2,1 vezes. Conclusão: O aporte nutricional, especialmente a oferta calórico proteica, influenciou no desenvolvimento de DBP com 36 semanas de idade gestacional corrigida. Os recém-nascidos com DBP apresentam comprometimento do crescimento, de acordo com os escores Z de peso na idade corrigida de termo, sendo mais acentuado nos pré-termos extremos, quando comparado ao grupo de recém-nascidos sem a doença.

Introduction: Despite technological advances in the neonatal care, bronchopulmonary dysplasia (BPD) remains a frequent morbidity among preterm newborns. BPD is the result of a multifactorial process where countless factors, such as nutritional status, act to compromise the development of the immature lung. There are many challenges in establishing an adequate nutritional supply for these newborns, especially in the first weeks of life, and there isn't an exact definition of which would be the adequate amount of protein and calories to reduce the risk of BPD. Thus, it is necessary to assess the nutritional intake and to evaluate its impact on the onset of the disease and on the growth of these newborns. Objective: To evaluate the nutritional intake in newborns with gestational age less than 32 weeks at birth, during the first four weeks of life and its association with the development of BPD at 36 weeks of corrected gestational age. Methods: Cohort study of newborns with gestational age less than 32 weeks. The criterion for defining BPD was the need of oxygen at 36 weeks of corrected gestational age. Information on perinatal variables were collected from medical files and prospective data of nutritional intake received in the first four weeks of life were recorded in a software. Anthropometric measurements were taken at birth, at hospital discharge and at term corrected age, and transformed into Z-score, using the Fenton's reference chart (2013). Results: 78 newborns were included in the study and the prevalence of BPD was 20.5%. The group of newborns with BPD required more frequently invasive and non-invasive mechanical ventilation and had a higher incidence of neonatal sepsis. The age of feeding initiation, to reach full feedings, and the duration of parenteral nutrition were greater in the BPD group. There was a difference between the two groups of patients regarding the fluid and caloric rate received in the third and fourth weeks, and lipids in the fourth week. Growth was analyzed using Z-score values for weight at the end of the first four weeks of life and with corrected age at term. At the end of the first week, these measures were similar between the two groups, but at term corrected age the patients with BPD showed lower Z-scores in all measurements, which was more pronounced in newborns with gestational age equal to or less than 29 weeks. Using the logistic regression model and considering neonatal factors and the calorie/protein ratio, it was observed that the factors that best predicted BPD were sepsis, with an 11 fold risk, and the calorie/protein ratio less than 25 kcal/gram, with a 2.1 fold risk. Conclusion: Nutritional intake, especially protein and calorie supply, influenced the development of BPD at 36 weeks of corrected gestational age. BPD patients showed growth impairment, according to the weight Z-score values at the term corrected age, being more pronounced in the extremely preterm infants, compared to the group of newborns without the disease.

Growth and body composition in preterm newborns with bronchopulmonary dysplasia: a cohort study.

Objective To compare growth and body composition of preterm infants (gestational age <32 weeks) with and without bronchopulmonary dysplasia (BPD). Methods A prospective cohort involving three neonatal units in the public health system of the Brazilian city of Rio de Janeiro. Inclusion: newborns with gestational age <32 weeks. EXPOSURE: BPD. Anthropometric measurements were performed at birth and at 1 month of infant corrected age. Body composition was measured using an air displacement plethysmography (ADP) (PEA POD®) at 1 month of infant corrected age. Results Ninety-five newborns were eligible, of which 67 were included, 32.8% of them with BPD. Newborns with BPD presented lower gestational age at birth, greater need for resuscitation in the delivery room, received parenteral nutrition (PN) for a longer period of time, achieved lower weights during hospital stay and required more time to reach a full enteral diet. No statistically significant differences were observed in relation to anthropometric measurements and body composition at 1 month of infant corrected age between the groups with and without BPD. Conclusion This study, unlike previous ones, has shown that children who developed BPD were able to regain growth, as measured by anthropometric measures, with no change in body composition at 1 month of infant corrected age.