Changes in nutritional management and outcome of very-low-birth-weight infants
M. K. Georgieff, M. M. Mills, L. Lindeke, S. Iverson, D. E. Johnson and T. R. Thompson
Department of Pediatrics, University of Minnesota Hospital and Clinic, Minneapolis 55455.
We compared the in-hospital and postdischarge growth of 47 preterm
very-low-birth-weight infants born in 1982 with that of 29 born in 1986.
Infants in the two groups were of comparable gestational age, size, and
illness at birth. During hospitalization, the 1986 infants began parenteral
and enteral nutrition earlier, had fewer days when they received less than
252 kJ/kg, were treated earlier for patent ductus arteriosus (6.1 +/- 4.5
days vs 14.5 +/- 7.7 days), and had a lower prevalence of severe medical
complications. By hospital discharge, these infants had significantly
higher mean growth percentiles and fewer of them had weights and
occipitofrontal circumferences below the fifth percentile. Follow-up at 4
and 12 months corrected age showed that these infants continued to have
significantly higher growth percentiles, and fewer of them had weights
below the fifth percentile (49% vs 24%) or major neurologic abnormalities.
Infants whose weights were below the fifth percentile had significantly
poorer 12-month developmental outcomes. We speculate that more aggressive
early neonatal nutritional management, changes in cardiopulmonary
management, and lower incidences of chronic disease promote earlier onset
of and more rapid rates of postnatal growth, which extend through the first
year of follow-up.
