Oral or Poster Presentation
Plenary Session - Innovation & Outreach
Introduction: Approximately 43-65% of very low birth weight (VLBW) infants develop extra-uterine growth restriction (EUGR). EUGR is associated with significant increase in risk of neurodevelopmental impairment. Inadequate early postnatal nutrition results in excessive weight loss that cannot be explained by the physiologic contraction of body water alone. Growth trajectories after initial weight loss have similar slopes, which indicate that the early excessive weight loss is a lead cause for EUGR. We hypothesized that early higher parenteral lipid intake in the first week after birth would decrease the percentage of initial weight loss and subsequently the incidence of EUGR.
Methods: This was a randomized, open-label, control trial of appropriate-for-gestational age VLBW infants admitted to level III NICU. Lipid intake in the control group started at 0.5-1 g/kg/day and increased daily by 0.5-1 g/kg/day until 3 g/kg/day was reached. The intervention group was started on 2 g/kg/day then increased to 3 g/kg/day the following day. Triglyceride levels were measured the day after starting and after each increase in lipid intake.
Results: Among the 176 infants assessed for eligibility, eighty-three were included in the trial. Infants in the intervention group were started on lipid sooner (13.8±7.8 vs. 17.5±7.8 h; p=0.03) and had higher cumulative lipid intake in the first 7 days of age (13.5±4.2 vs. 10.9±3.5 g/kg; p=0.04). Infants in the intervention group had lower percentage of weight loss (10.4±3.6 vs. 12.7±4.6; p=0.02). Mean triglyceride level was higher in the intervention group (1.91±0.79 vs. 1.49±0.54 mmol/L; p= 0.01), however, hypertriglyceridemia was similar between the two groups. EUGR at 36 weeks gestation was significantly lower in the intervention group (38.6% vs. 67.6%; p=0.009).
Conclusion: In VLBW infants, the provision of an early and higher dose of parenteral lipids in the first week of life results in less weight loss and lower incidence of EUGR.