ESPE Abstracts

Background: Very low birth weight (VLBW) infants tend to have slower postnatal growth than the fetuses of the same gestational age (GA)¹. Higher nutrient intake and better early growth are associated with better neurocognitive outcomes; excessive nutrient intakes may lead to metabolic consequences. Nutrient intakes for optimal growth, body composition and neurodevelopment are not known.

Objectives: To assess growth and neurodevelopment of VLBW infants during the first year of life and its relationship with early nutrition.

Methods: 120 VLBW infants were divided into 2 groups: extremely preterm (EP, <28 weeks) and very/moderately preterm (VP). 92 infants completed 12 months follow-up. Nutrient intake was calculated for the first 4 weeks. Growth (weight, length, and head circumference (HC)) was measured weekly until discharge, and at 3,6,9,12 months corrected GA (CGA) and related to healthy infants². Body composition was assessed at discharge by dual X-ray absorptiometry (DXA). Neurodevelopment was assessed at 12 months using Bayley-II.

Results: At birth, weightSDS and length SDS were higher in EP than VP (P<0.001, and P=0.019, respectively), HCSDS did not differ (P=0.137). There was no difference in weightSDS, lengthSDS and HCSDS at discharge or at 12 months CGA. EP infants had higher BMI and body fat at discharge (P<0.001), but BMI did not differ at 12 months (P=0.545). Acceleration of weight gain and HC growth occurred between 4 weeks and discharge in EP and between discharge and 3 months CGA in VP, while length growth accelerated most between discharge and 3 months in both groups. Nutrient intake during first 4 weeks and neurodevelopment scores at 12 months did not differ between groups. Higher nutrient intake was associated with better in-hospital growth and neurodevelopment scores in EP, but not in VP. In EP higher nutrient intake was not associated with higher BMI or DXA fat mass at discharge, but carbohydrates and fat intake was positively associated with BMI at 12 months CGA (P=0.003 and P=0.013, respectively). In VP group, protein intake correlated positively with BMI at discharge (P = 0.029), fat intake - with DXA fat mass (P=0.021) but no correlation was found between nutrient intake and BMI at 12 months CGA.

Conclusion: Weight, length, and HC growth patterns are different in GA groups and should be considered when choosing feeding strategies. Nutrient intake should be balanced between improving neurodevelopmental outcomes and potential risk of metabolic syndromes.

References:

1. Brinkis R et al Nutrients. 2022; 14: 1181

2. Niklasson A & Albertsson-Wikland K. BMCPediatr. 2008; 8: 8