RAMB Novembro/Dezembro 2015

ima

504

ssoc

ras

2015; 61(6):500-506

ta-analysis showed no differences between groups who

received an early supply and those who did not receive an

early supply of lipids in terms of growth, death and chron-

ic lung disease outcomes.

In the present study, EN was in line with the recom-

mendations for best practices.

Minimum EN was start-

ed early, its duration was short and the progression to ex-

clusive EN was quick. EN in newborns of very low birth

weight is often delayed for several days or weeks after birth,

due to cardiorespiratory complications and concern about

necrotizing enterocolitis.

However, minimal enteral nu-

trition, especially human milk, provides numerous ben-

efits and has been associated with a shorter time to reach

exclusive EN, as well as reduced infection associated with

central venous catheter, without increasing the incidence

of necrotizing enterocolitis.

The proposed increment of 20 mL/kg/day for EN is

considered safe according to studies showing that incre-

ments of up to 30 mL/kg/day were not associated with

increased incidence of necrotizing enterocolitis.

With

the increase in volume adopted, the time to achieve ex-

clusive enteral nutrition was appropriate.

The frequency of interruptions in EN was high (29.9%),

but similar to those observed by Caple et al. of 26.8 and

29.6% for infants with low birth weight with increases in

volume of 20 to 30 mL/kg/day, respectively.

The diag-

nosis of necrotizing enterocolitis was frequent in this

study (12.5%). The use of human milk was common, es-

pecially among newborns of extremely low birth weight,

and may be a protective factor for enterocolitis;

34,35

how-

ever, the mother’s own milk or that from a donor was al-

ways pasteurized, which may have compromised its im-

munological capacity.

In addition to stimulating the

use of raw human milk from the actual mother, we should

pay attention to some aspects of routine EN. As observed

by Henderson et al., a shorter duration of minimal enter-

al nutrition and greater speed for attaining exclusive EN

may be modifiable risk factors for the development of

necrotizing enterocolitis.

On the other hand, the time to reach 120 kcal/kg/day

was long and may be related to the high frequency of feed-

ing interruptions and diagnosis of necrotizing enteroco-

litis. The delay in attaining this energy supply was asso-

ciated with greater weight loss and longer time to regain

birth weight.

The delay in regaining birth weight was

also associated with low energy supply via PN, and the

time to regain birth weight is a significant predictor of

poor postnatal growth.

The low energy supply via PN

and the delay in achieving the maximum recommended

supply in this population may be markers of an accumu-

lated energy deficit and explain the higher percentage of

weight loss and slower weight gain.

40,41

Logistic regression analysis also showed that respira-

tory distress syndrome is associated with increased weight

loss, which may be secondary to an inadequate supply of

nutrients; this is especially difficult in children with respi-

ratory failure.

Sepsis increased the risk of delayed recov-

ery of birth weight, and has been associated with slower

weight gain during hospitalization;

newborns with sep-

sis may develop intolerance to glucose and lipids, limiting

the supply of these nutrients. As described by other re-

searchers,

43,44

SGA infants recovered their birth weight ear-

lier. In this study, the SGA preterm infants had a greater

gestational age than those of suitable weight for age (27.7

. 30.6 weeks) and may have presented a lower frequency

of conditions that interfere with nutritional therapy.

The restriction of intrauterine growth is extremely

common in children with very low birth weight.

6,14,44,45

our population, the frequency of newborns with weight

below the 10

percentile for age increased from 30.4% at

birth to 76.1% at post-conceptual age of term, and the as-

sociated factors were SGA, sepsis and higher time for at-

taining exclusive enteral nutrition. The association between

restriction of extra-uterine growth, SGA, bronchopulmo-

nary dysplasia, number of days of parenteral nutrition and

age to attain exclusive enteral nutrition has also been shown

in other studies.

6, 40-42

Nutritional practices for preterm infants vary con-

siderably between NICU and there is no definite strategy

with proven capacity to safely optimize nutrition, growth

and development.

However, the implementation of a

program with potentially better nutritional practices can

promote a more adequate supply of nutrients and stim-

ulate growth.

esumo

Práticas nutricionais e restrição de crescimento pós-na-

tal em prematuros

Objetivo:

avaliar as práticas nutricionais em unidade de

cuidados intensivos neonatais (UCIN) associadas a défi-

cit de crescimento em recém-nascidos pré-termo (RNPT).

Métodos:

estudo retrospectivo de RNPT com peso entre

500 e 1.499 g internados em UCIN. Analisaram-se: evo-

lução do crescimento e práticas de nutrição parenteral

(NP) e enteral (NE).

Resultados:

dentre 184 RNPT divididos em G1 (500 a

990 g; n=63) e G2 (1.000 a 1.499 g; n=121), 169 recebe-

ram NP (G1=63; G2=106). Comparando-se com as reco-