53 - Discrepancy Between Recommended and Actual Dietary Intake For Preterm Infants Born Before 28 Weeks Gestation

Publication Number: 2050.53

Kaitlin Hannan, Emory University School of Medicine, Atlanta, GA, United States; Zhulin He, Emory University, Atlanta, GA, United States; Daniel T. Robinson, Northwestern University The Feinberg School of Medicine, Chicago, IL, United States; Brenda Poindexter, Children's Healthcare of Atlanta, Atlanta, GA, United States; Anthony J. Piazza, Emory University/Children's Healthcare of Atlanta, Atlanta, GA, United States; Kera M. McNelis, Emory University School of Medicine, Atlanta, GA, United States

Background: Early nutrition is critical for preterm infants with an association between adequate intake and decreased morbidity. Historical studies established early accumulated nutritional deficits of preterm infants and the correlation with growth. Since then, infants at earlier gestational ages are resuscitated more consistently. We aim to define the gap between consensus guideline target intake and actual intake in a contemporary cohort and to examine the sustained link to growth.

Objective: We hypothesize that infants born 22-28 weeks gestational age (GA) do not receive goal energy and protein for a majority of the first 14 days. We hypothesize that the deficits accumulated by more preterm infants, 22 0/7 to 24 6/7(group 1), accrue larger deficits than less preterm peers, 25 0/7 to 27 6/7(group 2). Lastly, we aim to correlate these deficits with growth through 36 weeks corrected GA.

Design/Methods: This is a retrospective study at two level III NICUs covered by the same faculty group. The primary outcome was the percentage of infants who did not meet goal intake for at least 7 days. Defined reference standards for goal intake included: energy initiation at 80kcals/kg/day and advancement to 110kcal/kg/day; protein initiation at 3.0g/kg/day and advancement to 3.5g/kg/day. We included infants born < 28 weeks GA and excluded those who died before 14 days. Exact parenteral and enteral intake was collected. The difference between intake and goal was calculated to determine cumulative deficit. ANOVA compared cumulative intake between subgroups. Linear regression explored the relationship between cumulative deficits and growth Z-score trends.

Results: For 117 infants included, 73% did not receive goal energy intake for the majority of the first 14 days and 12% did not receive goal protein intake. Group 1 had a cumulative energy deficit of 385 kcals/kg, while group 2 had a deficit of 124 kcals/kg(p < 0.001). In contrast, protein intake for both groups yielded a net positive status: with a protein accumulation of 2 g/kg in group 1 and 8g/kg in group 2(p=0.004). Cumulative energy deficit was compared to weight(p=0.412), length(p=0.013), and head circumference(p=0.203) growth trends. The protein intake and growth relationship was not statistically significant.

Conclusion(s): We found that infants born < 28 weeks GA did not meet goal energy intake for a majority of the first 14 days; however, this same population often met or exceeded goal protein intake. Infants born more preterm had larger cumulative energy deficits than less preterm peers. Energy deficits correlated with length growth trends through 36 weeks corrected GA.

Table 1: Patient Demographic and Clinical Data
Patient Demographic and Clinical Data.pdf

Figure 1: Cumulative energy deficit
Figure 1.pdfCumulative energy deficit relative to the study defined goal intake accrued by each gestationally divided subgroup over the first 14 days of life.

Figure 2: Cumulative protein intake
Figure 2.pdfCumulative protein intake relative to study defined goal intake accrued by each gestationally divided subgroup over the first 14 days of life.