The Status Of Nutritional Support And Its Effect On Growth And Development Of VLBWI During NICU

Objective:to assess the incidences of extra-uterine growth restriction?EUGR?in very low birth weight infants?VLBWI?and the effects of actual energy and protein intake on EUGR.Methods:retrospective study of VLBWI weighing between 1000 and 1499g admitted to the neonatal intensive care unit?NICU?of Xin Hua Hospital from October 1,2012 to September 1,2016.The VLBWI were divided into EUGR-group?n=87?and NON-EUGR-group?n=41?according to whether the weight at discharge?10th weight-for-age percentile.The nutritional intake of EUGR group and NON-EUGR group were compared from the nutritional intake of the whole hospitalization and different nutrition support stage respectively,and also the cumulative deficits.Further analysis was made on the effect of cumulative nutritient deficits on the growth and development of VLBWI.results:128 VLBWI were eligible for inclusion.The incidence of intrauterine IUGR at birth was21.9%?28/128?,while the incidence of EUGR increased to 68%?87/128?at discharge.The energy and protein intake in two groups were generally below recommendation during hospitalization,which was even lower in the EUGR group.The energy and protein intake in the 1^stt week after birth in EUGR-group was significantly lower than that of NON-EUGR group?59.6±10.3%vs 64.6+11.1%,58.4+9.5%vs 61.7+10.0%,P<0.05?;During the periods of parenteral and enteral nutrition?PN and EN?support and total enteral nutrition?TEN?support,The energy,protein and lipids in the EUGR group were significantly lower than those of group NON-EUGR?P<0.05?;The average cumulative deficits of energy and protein of EUGR group in the first 8weeks and the 3^rd to 7^th weeks were significantly higher than the NON-EUGR group respectively?P<0.05?,The cumulative energy and protein in the first 10 weeks after birth in the EUGR and NON-EUGR groups was 1613.5 kcal/kg vs 997.8kcal/kg,49.5g/kg vs 41.4g/kg.There was a significant negative correlation between the cumulative deficit of energy and changes of weight Z scores in multiple regression analysis?r=-0.001,P<0.05?.Conclusion:the incidence of EUGR in VLBWI is still high during NICU.The energy and protein intake in two groups were generally below recommendation during hospitalization.There was a significant negative correlation between the increases of cumulative energy deficit with the decreases of weight Z scores.PN support should be strengthened as far as possible in the 1st week after birth,while EN support should be increased at the later stage of hospitalization,and PN should be avoided to stop premature during the transition period from PN to EN.