Nutritional practices and outcome of extremely premature infants
A. Unger, B. W. Goetzman, C. Chan, A. B. Lyons 3rd and M. F. Miller
We analyzed the records of 182 newborns with birth weights under 1000 g,
who survived longer than seven days, to determine risk factors for subacute
mortality and morbidity. Statistical analysis using logarithm-linear
modeling was used to identify complex interactions and to minimize
confounding. Nosocomial infection, necrotizing enterocolitis, male gender,
and chronic lung disease (CLD) were identified as independent risk factors
for subacute mortality. Male gender and CLD were associated with increased
mortality only among patients who received parenteral nutrition (PN).
Moreover, PN, rather than enteral nutrition (EN), was a risk factor for
delayed growth, nosocomial infection, and CLD. Delayed initiation of EN was
associated with decreased necrotizing enterocolitis risk only among male
infants with birth weights under 775 g. Our results do not support elective
withholding of EN in other groups of extremely low-birth-weight infants. We
conclude that indications for PN and for withholding initiation of EN in
very-very-low-birth-weight infants need to be established by prospective
studies.
