期刊
AMERICAN JOURNAL OF CLINICAL NUTRITION
卷 110, 期 6, 页码 1384-1394出版社
OXFORD UNIV PRESS
DOI: 10.1093/ajcn/nqz227
关键词
very low birth weight; growth; macronutrient intakes; preterm infant; morbidity; patent ductus arteriosus; acuity; weight; length; head circumference
资金
- Canadian Institutes of Health Research [102638, 143233]
- Ontario Graduate Scholarship
- Peterborough KM Hunter Charitable Foundation Graduate Award
- Hilda and William Courtney Clayton Paediatric Research Fund
Background: Data on how baseline characteristics, acuity, morbidity, and nutrition work in combination to affect the growth of very-low-birth-weight (VLBW, <1500 g) infants are limited. Objective: We aimed to determine factors associated with in-hospital weight, length, and head circumference (HC) trajectories of VLBW infants. Methods: VLBW infants (n = 316) from the GTA-DoMINO trial were included. Linear mixed-effects models assessed relations of baseline characteristics, acuity (at birth, across hospitalization), major morbidities, and nutrition (enteral feeding type, macronutrient/energy intakes) with changes in anthropometrics over hospitalization (days 1-8, 9-29, 30-75). Results: Specific factors and the strength of their associations with growth depended on in-hospital time interval. Small-for-gestational-age infants experienced weight gain (4.3 g.kg(-1).d(-1); 95% CI: 2.0, 6.5 g.kg(-1).d(-1)) during days 1-8, versus weight loss (-4.6 g.kg(-1).d(-1); 95% CI: -5.6, -3.7 g.kg(-1).d(-1)) among appropriate-for-gestational-age infants (P < 0.001). Positive-pressure ventilation (versus oxygen/room air) was associated with slower weight (-1.8 g.kg(-1).d(-1)) and HC (-0.25 cm/wk) gain during days 9-29 (P < 0.001). Morbidities were negatively associated with growth after days 1-8, with patent ductus arteriosus (PDA) showing negative associations with weight (-2.7 g.kg(-1).d(-1)), length (-0.11 cm/wk), and HC (-0.21 cm/wk) gain during days 9-29 (P < 0.001). Macronutrient/energy intakes were associated with weight across hospitalization (P = 0.01), with greater weight gain (1.3-3.0 g.kg(-1).d(-1)) among infants achieving macronutrient/energy recommendations during days 9-29 and 30-75. Macronutrient/energy intakes were associated with HC during the first month (P = 0.013-0.003), with greater HC gain (0.07-0.12 cm/wk) among infants achieving protein, lipid, and energy recommendations during days 9-29. Conclusions: Baseline characteristics, acuity, morbidity, and nutrition factors were independently associated with VLBW infant growth. A focus on achieving macronutrient/energy recommendations and improving nutrient delivery to PDA-diagnosed infants may yield improvements to their growth.
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