Suboptimal protein, energy intake contributes to severe PNGF in preterm VLBW infants

About one-third of preterm infants with very low birthweight (VLBW) in Asia develop severe postnatal growth faltering (PNGF), with contributing factors including suboptimal protein and energy intake while in the neonatal intensive care unit, a study has found.

The study included 236 VLBW infants admitted to two hospitals in Singapore (n=108) and Malaysia (n=128) and survived to discharge over a 2-year follow-up. Of these, 74 had extremely low birth weight (ELBW).

Compared with infants from Malaysia, those from Singapore had lower intake of total protein (2.69 vs 3.54 g/kg/day; p<0.001) and energy (92.4 vs 128.9 kcal/kg/day; p<0.001) in enteral feeds. The latter were predominantly fed fortified breast milk (45/48 vs 10/41; p<0.01). There was a significant difference observed in mean weight z-score from birth to 36 weeks’ corrected age between Singaporean and Malaysian babies (–2.2 vs –1.4; p=0.001).

Severe PNGF (more than –2 SDS z-score) occurred with markedly greater frequency in the subgroup of Singaporean vs Malaysian ELBW infants (55 percent vs 16 percent; p=0.001). Researchers explained that this difference in incidence might be attributed to the higher use of a diuretic in Singapore to treat haemodynamically significant patent ductus arteriosus (hsPDA).

VLBW infants achieved a mean growth velocity of ≥15 g/kg/day from day 14. This was attained by ELBW infants only from day 28, in comparison. Severe PNGF rates (z-score change more than –2 SDS at 36 weeks' corrected age) were 28.8 percent for VLBW infants and 36.5 percent for ELBW infants.

The present data provide the opportunity to look at the differences in therapies that may influence growth outcomes in VLBW infants, as well as to improve nutritional support to at-risk infants, according to the researchers.