Effect of standardized feeding protocol on nutrient supply and postnatal growth of preterm infants: A prospective study

Z. Khan*, N. Morris, H. Unterrainer, N. Haiden, S. J. Holasek, B. Urlesberger | JNPM 2018;

BACKGROUND: Preterm birth is a medical emergency and it is becoming evident that adequate nutrition starting in the first hours of life is of major importance for short and even more so for long-term health outcomes of the premature newborn. The aim was to analyze postnatal nutrient supply and growth patterns of preterm infants in response to a standardized feeding protocol during stay at neonatal intensive care unit (NICU).
METHODS: A prospective cohort study was conducted at NICU, Children Hospital Graz. Infants were divided in two groups:<28 weeks (Extremely preterm infants, EPI); ≥28 weeks (very preterm infants, VPI).
RESULTS: EPI compared to VPI stayed longer on parenteral nutrition and needed more time to reach full enteral nutrition, required more days on ventilation and had a higher corrected age at discharge. Moreover, fortification of enteral feeds was initiated later in EPI group (p < 0.001). As a consequence, cumulative supply of protein, fat and energy was significantly lower in EPI. However, both groups exceeded the European Society of Gastroenterology, Hepatology and Nutrition (ESPGHAN) recommended glucose intake in week 5. At discharge, we found significant differences in all growth parameters (weight Z scores: EPI = – 1.19 vs VPI = – 0.71, length Z scores: EPI = – 1.62 vs VPI = – 0.84; HC Z scores: EPI = – 1.19 vs VPI = – 0.46). 
CONCLUSIONS: Provision of aggressive parenteral nutrition during first 3 weeks of life and earlier fortification should be ensured. The use of mother milk fortifier resulted in glucose intake above the ESPGHAN recommendations in later weeks – this needs to be evaluated in future studies.

*Corresponding Author: 

Zahra Khan, Division of Neonatology, Children Hospital, Medical University Graz, Auenbruggerplatz 34/2. A-8036 Graz, Austria. Tel.: +43 316 385 13830; Fax: +43 316 385 13953; E-mail: great.future85@gmail.com.