Preemies receive less protein, energy with early fortification

Very low birth weight infants receiving care in a neonatal ICU received less energy and protein when their feeds were fortified during the transition from enteral to parenteral delivery of nutrition, according to research published in The Journal of Pediatrics.

Researchers recommended that more data are needed on nutritional delivery methods for this population.

“Growth and nutrition are essential for premature babies because they generally require less intervention as they get bigger,” Gustave Falciglia, MD, MSc, a neonatologist at the Ann & Robert H. Lurie Children’s Hospital of Chicago and assistant professor of neonatal-perinatal medicine at Northwestern University Feinberg School of Medicine, said in a press release. “Our study provides important information to help neonatologists assess the total nutritional effects of their combined orders as they gradually decrease intravenous nutrition and increase enteral feeds.”

Falciglia and colleagues conducted a retrospective analysis of 115 children receiving care at the Lurie Children’s Hospital NICU. The researchers assessed changes in the infants’ protein intake in five phases: 100% parenteral nutrition (phase one), up to 33% enteral feeds (phase two), up to 66.7% enteral feeds (phase three), less than 100% enteral feeds (phase four) and 100% enteral feeds (phase five).

Neonates whose feeds were fortified consumed less protein (–1.1 g/kg per day) compared with infants who received unfortified feeds (–0.3 g/kg per day) in the second and third phases. The researchers wrote that although a negative trend was observed in these two stages, no negative associations between fortification and reduced protein intake were observed in the other phases when adjustments were made for relevant nutrition delivery practices.

Falciglia and colleagues said infants consumed more protein through enteral feeds during the second (0.3 g/kg per day) and third (0.8 g/kg per day) phases, but parenteral protein intake during this time was less among infants receiving early fortification (–1.4 g/kg per day vs. –1.1 g/kg per day). When the researchers examined energy intake, similar trends were observed.

By the third and fourth phases, Falciglia and colleagues noted a decrease in the amount of protein consumed by the very low birth weight infants.

“Ultimately, we would like to develop an automated tool to provide immediate feedback on the calories and protein the baby is getting through multiple vehicles used to deliver nutrition during the transitional stages,” Falciglia said. “This would substantially help clinicians optimize nutrition and growth in very low birth weight infants.” – by Katherine Bortz

Disclosures: Falciglia reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.