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Low energy intake during the first 4 weeks of life increases the risk for severe retinopathy of prematurity in extremely preterm infants
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
Department of Neuroscience, Ophthalmology, Uppsala University, Uppsala, Sweden.
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2016 (English)In: Archives of Disease in Childhood: Fetal and Neonatal Edition, ISSN 1359-2998, E-ISSN 1468-2052, Vol. 101, no 2, F108-F113 p.Article in journal (Refereed) Published
Abstract [en]

Objectives: Poor weight gain during the first weeks of life in preterm infants is closely associated with the risk of developing retinopathy of prematurity (ROP) and insufficient nutrition might be an important contributing factor. This study aimed to evaluate the effect of energy and macronutrient intakes during the first four weeks of life on the risk for severe ROP.

Study design: Population-based study including all Swedish extremely preterm infants born before 27 gestational weeks during a 3-year period. Each infant was classified according to the maximum stage of ROP in either eye as assessed prospectively until full retinal vascularization. Detailed daily data of actual intakes of enteral and parenteral nutrition as well as growth data were obtained from hospital records.

Results: Of the included 498 infants, 172 (34.5 %) had severe ROP (stages 3-5) and 96 (19.3 %) were treated. Energy and macronutrient intakes were less than recommended and the infants showed severe postnatal growth failure. Higher intakes of energy, fat and carbohydrates, but not protein, were significantly associated with a lower risk of severe ROP. Adjusting for morbidity, an increased energy intake of 10kcal/kg/d was associated with a 24 % decrease in severe ROP (p<0.01).

Conclusions: We showed that energy intake during the first four weeks of life was an independent risk factor for severe ROP. This implies that provision of adequate energy from parenteral and enteral sources during the first four weeks of life may be an effective method for reducing the risk of severe ROP in extremely preterm infants.

Place, publisher, year, edition, pages
2016. Vol. 101, no 2, F108-F113 p.
Keyword [en]
Growth failure, Macronutrients, Malnutrition, Nutritional intakes, Preterm infants
National Category
Nutrition and Dietetics Pediatrics
Research subject
URN: urn:nbn:se:umu:diva-88459DOI: 10.1136/archdischild-2014-306816ISI: 000371325900005OAI: diva2:715730
Available from: 2014-05-06 Created: 2014-05-06 Last updated: 2016-05-16Bibliographically approved
In thesis
1. The impact of early nutrition on extremely preterm infants
Open this publication in new window or tab >>The impact of early nutrition on extremely preterm infants
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background Modern neonatal care has improved the survival rate of extremely preterm infants. These infants are at high risk of malnutrition and growth failure during 3-4 months of hospital care. The objectives of this study was to investigate nutritional intakes during hospitalization and explore associations between nutritional intakes, postnatal growth and retinopathy of prematurity (ROP). Perioperative nutrition in infants undergoing surgery for patent ductus arteriosus (PDA) was also investigated.

Methods This is a population-based study of Swedish extremely preterm infants (<27 weeks) born during 2004-2007 (n=602). Detailed data on nutritional supply and anthropometric measurements during hospitalization were retrospectively retrieved from hospital records. Comprehensive data on cohort characteristics, neonatal morbidity and infant mortality were obtained from the Extremely Preterm Infants in Sweden Study (EXPRESS).

Results During the first 70 days of life, intakes of energy, protein and several micronutrients, with the exception of iron and some vitamins, were less than estimated requirements, and infants showed severe postnatal growth failure. Energy and protein intake predicted growth in all anthropometric outcomes even when adjusting for severity of illness, and fat intake was positively associated with head growth. Low folate intake was positively correlated with poor weight and length gain while high iron intake, mainly explained by blood transfusions, was negatively associated with poor length gain. Furthermore, a low energy intake was associated with severe ROP (stage 3-5). An increased energy intake of 10 kcal/kg/d was associated with 24% decrease in severe ROP (p=0.01). During the first month, 99% of the infants were exclusively fed human milk. Infants who underwent surgery for PDA (n=140) were malnourished, with energy and macronutrient intakes below minimum estimated requirements before, during and after surgery.

Conclusions The severe postnatal growth failure observed in Swedish extremely preterm infants may be prevented by improved intakes of energy, protein, fat and folate and a reduction of the number of blood transfusions. Human milk is the main enteral food source and analyses of human milk macronutrient contents facilitates individualized fortification. Provision of adequate energy intakes during the first four weeks of life may be an effective way to reduce the risk of severe ROP. Perioperative nutrition in infants undergoing PDA surgery needs to be improved. The study results have important implications for nutritional regimens, postnatal growth and health outcome in this new generation of survivors.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2014. 65 p.
Umeå University medical dissertations, ISSN 0346-6612 ; 1642
Energy intake, enteral intake, extremely preterm infants, folate, growth failure, human milk, iron, macronutrients, malnutrition, micronutrients, nutrient intake, patent ductus arteriosus, protein, retinopathy of prematurity, surgery
National Category
Pediatrics Nutrition and Dietetics
urn:nbn:se:umu:diva-88461 (URN)978-91-7601-039-6 (ISBN)
Public defence
2014-05-28, Sal 135, by 9A, Norrlands Universitetssjukhus, Umeå, 13:00 (English)
Available from: 2014-05-07 Created: 2014-05-06 Last updated: 2014-05-07Bibliographically approved

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