Nutritional practices and postnatal growth restriction in preterm newborns.

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 1,499 g admitted to NICU. Evolution of growth and parenteral (PN) and enteral (EN) nutrition practices were analyzed.

Results: among 184 preterm infants divided into G1 (500 to 990 g; n=63) and G2 (1000 to 1499 g; n=121), 169 received PN (G1=63, G2=106). Compared with the recommendations, PN was started late, its progress was slow and the maximum 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 possible 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, sepsis 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.