Optimizing the growth of very-low-birth-weight infants requires targeting both nutritional and nonnutritional modifiable factors specific to stage of hospitalization

被引：27

作者：

Asbury, Michelle R. ^{[1
,2
]}

Unger, Sharon ^{[1
,3
,4
,5
]}

Kiss, Alex ^{[6
,7
]}

Ng, Dawn V. Y. ^{[1
,2
]}

Luk, Yunnie ^{[1
,2
]}

Bando, Nicole ^{[2
]}

Bishara, Rosine ^{[8
]}

Tomlinson, Christopher ^{[1
,2
,3
,4
]}

O'Connor, Deborah L. ^{[1
,2
,5
]}

Brennan, Joan ^{[9
]}

Daneman, Alan ^{[9
]}

Francis, Jane ^{[9
]}

Jory, Michael ^{[9
]}

Ly, Linh ^{[9
]}

Plaga, Aneta ^{[9
]}

Rovet, Joanne ^{[9
]}

Kelly, Edmond ^{[10
]}

Kotsopoulos, Kirsten ^{[10
]}

O'Brien, Karel ^{[10
]}

Asztalos, Elizabeth ^{[11
]}

Church, Paige ^{[11
]}

Nash, Andrea ^{[11
]}

Ng, Eugene ^{[11
]}

Wong, Sabrina ^{[11
]}

Ekserci, Sue ^{[12
]}

Sit, Shirley ^{[12
]}

Arts-Rodas, Debby ^{[13
]}

AlMadani, Mahmud ^{[14
]}

Gryn, David ^{[15
]}

Singh, Munesh ^{[16
]}

Fusch, Christoph ^{[17
]}

Campbell, Douglas ^{[18
]}

Popovic, Jelena ^{[19
]}

Doctor, Shaheen ^{[20
]}

Stone, Debbie ^{[21
]}

Azzopardi, Peter ^{[22
]}

Chang, Karen ^{[22
]}

van Schaik, Charmaine ^{[23
]}

Williams, Carol ^{[23
]}

Asady, Anwar ^{[24
]}

Bayliss, Ann ^{[24
]}

Gabriele, Sandra ^{[24
]}

Burkot, Ilona ^{[25
]}

Gibson-Stoliar, Judy ^{[25
]}

Vaz, Simone ^{[25
]}

机构：

[1] Univ Toronto, Dept Nutr Sci, Toronto, ON, Canada

[2] Hosp Sick Children, Translat Med Program, Toronto, ON, Canada

[3] Univ Toronto, Dept Pediat, Toronto, ON, Canada

[4] Hosp Sick Children, Div Neonatol, Toronto, ON, Canada

[5] Mt Sinai Hlth Syst, Dept Pediat, Toronto, ON, Canada

[6] Univ Toronto, Inst Hlth Policy Management & Evaluat, Toronto, ON, Canada

[7] Sunnybrook Res Inst, Evaluat & Clin Sci, Toronto, ON, Canada

[8] Sunnybrook Hlth Sci Ctr, Women & Babies Program, Toronto, ON, Canada

[9] Hosp Sick Children, Toronto, ON, Canada

[10] Mt Sinai Hlth Syst, Toronto, ON, Canada

[11] Sunnybrook Hlth Sci Ctr, Toronto, ON, Canada

[12] Humber River Hosp, Toronto, ON, Canada

[13] St Josephs Hlth Ctr, Toronto, ON, Canada

[14] Lakeridge Hlth, Oshawa, ON, Canada

[15] Mackenzie Hlth, Richmond Hill, ON, Canada

[16] Markham Stouffville Hosp, Markham, ON, Canada

[17] McMaster Childrens Hosp, Hamilton, ON, Canada

[18] St Michaels Hosp, Toronto, ON, Canada

[19] Michael Garron Hosp, Toronto, ON, Canada

[20] North York Gen Hosp, Toronto, ON, Canada

[21] Rogers Hixon Ontario Human Milk Bank, Toronto, ON, Canada

[22] Scarborough Hlth Network, Scarborough, ON, Canada

[23] Southlake Reg Hlth Ctr, Newmarket, ON, Canada

[24] Trillium Hlth Partners, Mississauga, ON, Canada

[25] William Osler Hlth Syst, Brampton, ON, Canada

来源：

AMERICAN JOURNAL OF CLINICAL NUTRITION | 2019年 / 110卷 / 06期

基金：

加拿大健康研究院;

关键词：

very low birth weight; growth; macronutrient intakes; preterm infant; morbidity; patent ductus arteriosus; acuity; weight; length; head circumference; EXTREMELY PRETERM INFANTS; PATENT DUCTUS-ARTERIOSUS; PREMATURE-INFANTS; PROTEIN-INTAKE; VELOCITY; OUTCOMES; FAILURE; NEURODEVELOPMENT; RESTRICTION; ASSOCIATION;

D O I：

10.1093/ajcn/nqz227

中图分类号：

R15 [营养卫生、食品卫生]; TS201 [基础科学];

学科分类号：

100403 ;

摘要：

Background: Data on how baseline characteristics, acuity, morbidity, and nutrition work in combination to affect the growth of very-low-birth-weight (VLBW, <1500 g) infants are limited. Objective: We aimed to determine factors associated with in-hospital weight, length, and head circumference (HC) trajectories of VLBW infants. Methods: VLBW infants (n = 316) from the GTA-DoMINO trial were included. Linear mixed-effects models assessed relations of baseline characteristics, acuity (at birth, across hospitalization), major morbidities, and nutrition (enteral feeding type, macronutrient/energy intakes) with changes in anthropometrics over hospitalization (days 1-8, 9-29, 30-75). Results: Specific factors and the strength of their associations with growth depended on in-hospital time interval. Small-for-gestational-age infants experienced weight gain (4.3 g.kg(-1).d(-1); 95% CI: 2.0, 6.5 g.kg(-1).d(-1)) during days 1-8, versus weight loss (-4.6 g.kg(-1).d(-1); 95% CI: -5.6, -3.7 g.kg(-1).d(-1)) among appropriate-for-gestational-age infants (P < 0.001). Positive-pressure ventilation (versus oxygen/room air) was associated with slower weight (-1.8 g.kg(-1).d(-1)) and HC (-0.25 cm/wk) gain during days 9-29 (P < 0.001). Morbidities were negatively associated with growth after days 1-8, with patent ductus arteriosus (PDA) showing negative associations with weight (-2.7 g.kg(-1).d(-1)), length (-0.11 cm/wk), and HC (-0.21 cm/wk) gain during days 9-29 (P < 0.001). Macronutrient/energy intakes were associated with weight across hospitalization (P = 0.01), with greater weight gain (1.3-3.0 g.kg(-1).d(-1)) among infants achieving macronutrient/energy recommendations during days 9-29 and 30-75. Macronutrient/energy intakes were associated with HC during the first month (P = 0.013-0.003), with greater HC gain (0.07-0.12 cm/wk) among infants achieving protein, lipid, and energy recommendations during days 9-29. Conclusions: Baseline characteristics, acuity, morbidity, and nutrition factors were independently associated with VLBW infant growth. A focus on achieving macronutrient/energy recommendations and improving nutrient delivery to PDA-diagnosed infants may yield improvements to their growth.

引用

页码：1384 / 1394

页数：11

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