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Influence of morbidity, early nutritional intake, and total energy: protein ratio on longitudinal extrauterine growth restriction of very preterm newborns at term-equivalent age: an observational study

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Abstract

To evaluate the influence of early nutritional intake on the growth pattern of very preterm infants. This was an observational study including 109 newborns (< 32 weeks gestational age). Perinatal morbidities, nutritional therapy (first four weeks of life), and weight, length, and head circumference (HC) growth at term-equivalent age were evaluated. Growth restriction was defined as a difference > 1.2 SD between the birth and term age measurements. Growth restriction at term-equivalent age: 52.3% (weight), 42.9% (length), and 22% (HC). Morbidities were positively correlated with nutrition therapy and negatively correlated with the total energy provision: protein ratio. The duration of parenteral nutrition, the time to reach full enteral feedings, and the total energy provision: protein ratio were significantly correlated. Nutrient intake influenced weight, length, and HC growth, and cumulative energy deficit was significantly associated with HC growth restriction.

   Conclusion: Perinatal morbidities interfere with nutritional therapy and early nutrient intake, leading to insufficient energy and energy provision: protein ratio for growth.

What is Known:

• The intake of macronutrients early in life, mainly protein, is important for the optimal growth of pretem infants.

• The severity of morbidities and low gestational ages impact the nutritional management of preterm infants.

What is New:

• The number of morbidities, reflecting the severity of the neonatal clinical course, had a detrimental effect on the nutritional therapy and nutrients intake.

• The inadequate energy provision per gram of protein ratio was significantly associated with growth restriction in all growth measures at the second week of life, persisting for head circumference up to the fourth week, highlighting the importance of its measurement, as it could be a precocious sign of development risk.

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Data availability

The data presented in this study are available upon request from the corresponding author.

Abbreviations

BPD:

Bronchopulmonary dysplasia

ESPGHAN:

The European Society of Pediatric Gastroenterology, Hepatology and Nutrition

EUGR:

Extrauterine growth restriction

GA:

Gestational age

HC:

Head circumference

IFF/FIOCRUZ:

Instituto Fernandes Figueira

IMV:

Invasive mechanical ventilation

IVH:

Intraventricular hemorrhage

NB:

Newborns

NEC:

Necrotizing enterocolitis

NICU:

Neonatal intensive care unit

PMA:

Postmenstrual age

PN:

Parenteral nutrition

ROP:

Retinopathy of prematurity

SGA:

Small for gestational age

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Funding

Partial financial support was received from Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro – FAPERJ – Grant number E-26/201.116/2021.

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Authors and Affiliations

  1. Neonatology, Instituto Nacional da Mulher, da Criança e do Adolescente Fernandes Figueira, Oswaldo Cruz Foundation, FIOCRUZ, Av. Rui Barbosa, 716, Flamengo, Rio de Janeiro, RJ, Brasil, CEP 22250-020

    Maria Dalva Barbosa Baker Méio, Giovana Gleysse de Miranda Salgado, Letícia Duarte Villela, Ana Carolina Carioca da Costa, Paola Azara Tabicas Lima, Brunna Grazziotti Milanesi & Maria Elisabeth Lopes Moreira

  2. Postgraduation on Applied Clinical Research, Instituto Nacional da Mulher, da Criança e do Adolescente Fernandes Figueira, Oswaldo Cruz Foundation, FIOCRUZ, Av. Rui Barbosa, 716, Flamengo, Rio de Janeiro, RJ, Brasil, CEP 22250-020

    Maria Dalva Barbosa Baker Méio, Letícia Duarte Villela, Ana Carolina Carioca da Costa & Maria Elisabeth Lopes Moreira

Authors
  1. Maria Dalva Barbosa Baker Méio
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  2. Giovana Gleysse de Miranda Salgado
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Contributions

Méio MDBB contributed to the conception of the study and was responsible for the coordination of the study, contributing to the analysis and interpretation of the data, the writing of the manuscript and its critical revision. Salgado GGM and Villela LD contributed to the analysis and interpretation of the data, the writing of the manuscript and its critical revision. Salgado GGM, Villela LD, Lima PAT, and Milanesi BG contributed to the material preparation and data collection. da Costa ACC performed the statistical analysis and contributed to the interpretation of the results and the writing of the manuscript. Moreira MEL contributed to the acquisition of financial resources for the study, the interpretation of the results and the critical revision of the manuscript. All the authors have read and approved the final manuscript and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Maria Dalva Barbosa Baker Méio.

Ethics declarations

Informed consent

Informed consent was obtained from all subjects involved in the study. This study was approved by the Ethics Committee of Instituto Fernandes Figueira (IFF/FIOCRUZ) on December 11th, 2015, under protocol code number CAAEE 50243615.0.0000.5269, in accordance with the Declaration of Helsinki.

Competing interests

The authors declare no competing interests.

Disclosure

All the authors state that artificial intelligence was not used during the entire process of interpreting the data, discussing the results, or writing the manuscript.

Additional information

Communicated by Daniele De Luca

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Méio, M.D.B.B., de Miranda Salgado, G.G., Villela, L.D. et al. Influence of morbidity, early nutritional intake, and total energy: protein ratio on longitudinal extrauterine growth restriction of very preterm newborns at term-equivalent age: an observational study. Eur J Pediatr (2024). https://doi.org/10.1007/s00431-024-05595-3

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  • DOI: https://doi.org/10.1007/s00431-024-05595-3

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