Analysis Of Nutritional Support Status In VLBWIs During NICU

Objective:To evaluate the current nutritional support status of very low birth weight infants(VLBWIs)in neonatal intensive care unit(NICU)of our hospital,analyze and compare the effects of different nutritional support combinations and methods on the occurrence of extrauterine growth restriction(EUGR)in VLBWIs.Methods:This is a prospective observational study included VLBWIs admitted to NICU from February 2017 to December 2018 in our hospital.Actual nutrient intakes were recorded daily and growth parameters were measured regularly.The patients were divided into EUGR group and non-EUGR group according to whether their body weight reached the 10 th percentile of the growth curve at discharge,divided into breastfeeding group and formula feeding group according to the different feeding methods.The influencing factors of nutritional support for the corresponding clinical outcomes were compared and analyzed.Results:A total of 104 VLBWIs were enrolled.The average weight gain rate was 15.6 g/(kg.d)during hospitalization,the incidence of EUGR was 62.5% at discharge,and the breastfeeding rate was 41.3%.Compared with non-EUGR group,EUGR group had a later dairy age(6 days VS 4days,p=0.026),a longer cumulative fasting time(4 days VS 1 day,p<0.001),a later time to reach full feeds(41 days VS 27 days,p<0.001),and lower intake of enteral energy and three major nutrients.The total protein intake in both groups did not reach the recommended level.There was no significant difference in cumulative protein deficit at discharge [-46.6g/(kg.d)VS-37.1g/(kg.d),p=0.176].The cumulative energy deficit at discharge in EUGR group was significantly higher than that in non-EUGR group [-1107kcal/(kg.d)VS-550kcal/(kg.d),p<0.001].Higher weight for age Z-score at birth(OR0.015,95% CI0.002-0.095,p<0.001),enteral lipid intake(OR0.835,95% CI0.817-0.854,p< 0.001),parenteral lipid intake(OR0.545,95% CI0.420-0.708,p<0.001)and total lipid intake volume(OR0.744,95%CI0.718-0.772,p<0.001)were protective factors for EUGR.Longer cumulative fasting time(OR2.004,95% CI1.253-3.204,p=0.004)was a risk factor for EUGR.The growth rate of weight in breastfeeding group was slower than that in formula feeding group [14.4g/(kg.d)VS 15.9g/(kg.d),p=0.041].Enteral energy and three major nutrients intake were lower in breastfeeding group,butthere was no significant difference in Z-score changes during hospitalization and EUGR incidence at discharge between the two groups.Conclusion:Significant insufficient energy intake is the main cause of EUGR.Delay and insufficient EN intake aggravate the occurrence of EUGR.Insufficient protein intake is prevalent in VLBWIs.Although breastfeeding has no advantage in early weight gain,it is not associated with the occurrence of EUGR.