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Lima AM et al.
500 Rev Assoc Med Bras 2015; 61(6):500-506
ORIGINAL ARTICLE
Nutritional practices and postnatal growth restriction in preterm
newborns
Adriana Martins de Lima1*, Ana Lucia Goulart2, Adriana Bruscato Bortoluzzo3, Benjamin Israel Kopelman4
1MSc – Nutritionist of the Preterm Clinic of Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brazil
2PhD – Adjunct Professor of Neonatal Pediatrics at the Pediatrics Department, Vice Head of the Pediatrics Department, Unifesp, São Paulo, SP, Brazil
3PhD – Assistant Professor of the Research Center at Intituto de Ensino e Pesquisa (Insper), São Paulo, SP, Brazil
4PhD – Retired Full Professor of Neonatal Pediatrics at the Pediatrics Department, Universidade Federal de São Paulo, São Paulo, SP, Brazil
Summary
Study conducted at Universidade Federal
de São Paulo, São Paulo, SP, Brazil
Article received: 7/22/2014
Accepted for publication: 8/24/2014
*Correspondence:
Address: Rua Diogo de Faria, 764
Vila Clementino
São Paulo, SP – Brazil
Postal code: 04037-002
Objective: to assess the nutritional practices in neonatal intensive care units
(NICU) associated with growth retardation in premature (preterm) infants.
Methods: retrospective study of preterm infants weighing between 500 and
1,499g admitted to NICU. Evolution of growth and parenteral (PN) and enter-
al (EN) nutrition practices were analyzed.
Results: among 184 preterm infants divided into G1 (500 to 990g; n=63) and
G2 (1000 to 1499g; n=121), 169 received PN (G1=63, G2=106). Compared with
the recommendations, PN was started late, its progress was slow and the maxi-
mum glucose, amino acid, lipid and energy supplies were low in both groups.
The initial supply of amino acid and lipid and initial and maximum glucose and
energy were lower in G1. The onset of EN was early (1-2 days), the time to reach
exclusive EN was appropriate (11-15 days) and the use of human milk was pos-
sible in a reasonable amount of time (7-13 days). The multivariate analysis showed
that respiratory distress syndrome and obtaining a supply of 120 kcal/kg/day
too late increased the chance of weight loss greater than 10%. Sepsis, maximum
energy supply for PN <60 kcal/kg/day and obtaining a supply of 120 kcal/kg/
day too late increased the chance of regaining birth weight after 14 days, while
small for gestational age (SGA) at birth reduced this chance. SGA at birth, sep-
sis and achieving exclusive enteral nutrition after 14 days increased the chance
of being SGA at post-conceptual age of term.
Conclusion: improving nutritional practices in the NICU can reduce the growth
deficit in premature infants of very low birth weight.
Keywords: premature, enteral nutrition, parenteral nutrition, very low birth
weight.
Introduction
Postnatal growth is an important predictor of growth and
development throughout childhood in preterm infants 1-3
but despite knowing the importance of optimizing growth
rates in the neonatal period, reducing the rate of extra-uter-
ine growth restriction is still one of the great challenges
for neonatal intensive care units (NICU).4-6 The difficulties
in providing adequate nutritional support in the hospital-
ization phase7-11 of newborns with very low weight is one
of the main reasons for this postnatal growth deficit.
A study to assess the nutritional practices adopted by
four neonatal intensive care units, with different levels of
complexity and dimensions, showed that after analysis
and adaptation of the routines of each center to the rec-
ommendations established in the literature, there was a
reduction in the number of days for starting parenteral
and enteral nutrition, a shorter time for achieving exclu-
sive enteral nutrition and an energy supply of 120 kcal/
kg/day, reduced length of hospital stay, and reduced per-
centage of children with weight below the 10th percentile
upon discharge.1
The objective of this study was to assess the nutri-
tional practices in a NICU and their relationship to the
growth of preterm newborns during hospitalization.