Nutrition practice, compliance to guidelines and postnatal growth in moderately premature babies: the NUTRIQUAL French survey

Background: The nutritional care provided to moderately premature babies is poorly studied. For a large cohort of such babies, we aimed to describe: nutrition practice intentions, comparison of the intended with the actual practice, compliance of actual practice to current nutrition guidelines, and postnatal growth. Methods: A questionnaire was sent out to 29 neonatal intensive care units in France, in order to address practice intentions. In the same units, retrospective patient's data were collected to assess actual practice, compliance to nutrition guidelines and infant postnatal growth. The cumulative nutritional deficit during the two first weeks of life was calculated and variables associated with Delta Z-score for weight at 36 weeks postconceptional age/discharge (Delta Z-score(w) 36PCA/DC) were analysed by multivariate linear regression. Results: 276 infants born 30 to 33 weeks of gestation were studied. Among them, 76 % received parenteral nutrition on central venous line after birth. On day of life 1 (DOL1), 93 % of infants had parenteral amino acids (AA), at an intake >= 1.5 g/kg in 27 % of cases. Lipids were started at <= DOL2 in 47 % of infants. There was a divergence between the intended and the actual practice for both AA and lipids intake. The AA and energy cumulative deficit (DOL1 to DOL14) were respectively 10.9 +/- 8.3 g/kg and 483 +/- 181 kcal/kg. Weight Z-score (mean +/- SD) significantly decreased from birth (-0.17 +/- 0.88) to 36 weeks PCA/DC (-1.00 +/- 0.82) (p < 0.0001), and the extra-uterine growth retardation (EUGR) rate at 36 weeks PCA/DC was 24.2 %. Independent variables associated with Delta Z-score(w) 36PCA/DC were AA cumulative intake and DOL of full enteral feeding. Conclusions: Nutrition intake was not in compliance with recommendations, and the rate of EUGR was considerable in this cohort. Efforts are needed to improve adherence to nutrition guidelines and growth outcome of moderately preterm infants.