Growth of very low birth weight infants to age 20 years. Proactive enteral nutrition in moderately preterm small for gestational age infants: a randomized clinical trial. A randomized control trial comparing two enteral feeding volumes in very low birth weight babies. Effect of high volume intake of mother's milk with an individualized supplementation of minerals and protein on early growth of preterm infants <28 weeks of gestation. National Institute of Child Health and Human Development Retention of Nitrogen, Fat, and Calories in Infants of Low Birth Weight on Conventional and High-Volume Feed Longitudinal Growth of Hospitalized Very Low Birth Weight Infants A randomized trial of enteral feeding volumes in infants born before 30 weeks' gestation.
OBJECTIVE Intrauterine and neonatal growth failure of very low birth weight ( VLBW ; < 1500 g ) infants may influence adult growth attainment and have long-term implication s for adult health . As part of a longitudinal study of VLBW infants , we sought to examine gender-specific changes in growth from birth to 20 years old and to identify the correlates of growth attainment at 20 years old . DESIGN , SETTING , PARTICIPANTS A cohort of 103 male and 92 female VLBW infants who had a mean birth weight of 1189 g and mean gestational age of 29.8 weeks , were born from 1977 through 1979 and treated at Rainbow Babies and Children 's Hospital in Clevel and , Ohio , and were free of neurosensory impairment were followed prospect ively from birth and compared with a population -based sample of 101 male and 107 female normal birth weight ( NBW ) controls selected at 8 years old .  Maternal sociodemographic status and infant birth and neonatal data did not differ significantly between male and female VLBW subjects . However , male VLBW subjects had significantly higher rates of rehospitalization during infancy than female VLBW ( 39 % vs 21 % ) . At 20 years , their rates of chronic illness were similar ( 18 % vs 24 % ) . MAIN OUTCOME MEASURES Weight and height z scores were computed at birth , 40 weeks , 8 and 20 months , and 8 and 20 years among the VLBW subjects , and at 8 and 20 years among the NBW controls . Body mass index ( BMI ) z scores were computed at 8 and 20 years . Among the VLBW subjects , gender-specific longitudinal growth measures were examined at birth , at the expected term date ( 40 weeks corrected age ) , and at 8 and 20 months , and 8 and 20 years of age . In addition , we compared the weight , height , and BMI of the VLBW and NBW controls at 8 and 20 years . Predictors of 20-year growth were examined via multivariate analyses . RESULTS Among the VLBW males , mean weight for age z scores at birth , 40 weeks , and 8 years were -0.7 , -1.8 , and -0.5 ; and height for age z scores were -1.2 , -2.6 , and -0.5 , respectively . For VLBW females , mean weight for age z scores were -1.1 , -2.0 , and -0.2 and height for age z scores were -1.2 , -2.4 , and -0.2 , respectively . At 8 years of age , VLBW males had a significantly lower mean weight , height , and BMI than NBW controls , whereas VLBW females differed significantly from their NBW controls in mean weight and BMI but not in height . Catch-up growth in weight , height , and BMI occurred between 8 and 20 years among VLBW females but not among VLBW males who remained significantly smaller than their controls at 20 years old . At 20 years mean weight of VLBW males was 69 kg versus 80 kg for controls ( z score -0.4 vs + 0.5 ) ; mean height was 174 cm versus 177 cm ( z score -0.4 vs + 0.03 ) and mean BMI was 23 versus 26 , respectively . For VLBW females , mean weight was 65 kg versus 68 kg for controls ( z score + 0.3 vs + 0.5 ) , mean height was 162 versus 163 cm ( z score -0.3 vs -0.1 ) and mean BMI was 25 versus 25 , respectively . Rates of obesity ( BMI > 30 ) for VLBW males were 7 % compared with 15 % for controls and for VLBW females 15 % compared with 18 % for controls . Age of menarche was 12.4 years for VLBW females and 12.3 years for controls . Nineteen ( 18 % ) male and 20 ( 22 % ) female VLBW subjects were born small for gestational age ( SGA ; weight less than -2 st and ard deviation for gestational age ) . At 20 years , significantly more SGA than appropriate for gestational age VLBW males remained subnormal ( less than -2 st and ard deviation ) in weight ( 32 % vs 6 % ) and height ( 21 % vs 4 % ) , whereas rates of subnormal growth did not differ significantly between SGA and appropriate for gestational age females ( weight 5 % vs 1 % , height 0 % vs 7 % ) . Predictor variables included in the multivariate analyses of 20-year growth attainment were maternal education and height , race , birth weight z score ( a measure of intrauterine growth failure ) , neonatal hospital stay ( a measure of neonatal illness ) , and chronic illness at 20 years . Twenty-year weight was predicted by black race and chronic illness among females . Twenty-year height was predicted by maternal height and birth weight z score among both males and females and by duration of neonatal hospital stay among males only . In a separate model , when we examined the effect of being SGA at birth instead of the effect of birth weight z score , SGA birth was predictive of 20-year height among males but not among females . CONCLUSIONS VLBW females catch up in growth by 20 years of age whereas VLBW males remain significantly shorter and lighter than controls . Since catch-up growth may be associated with metabolic and cardiovascular risk later in life , these findings may have implication s for the future adult health of VLBW survivors OBJECTIVE To investigate the efficacy of a proactive feeding regimen ( PFR ) in reducing hospital length of stay in a population of moderately preterm small for gestational age ( SGA ) infants . STUDY DESIGN SGA infants ( z-score < -1.28 ) of gestational age ( GA ) 32 - 36 weeks and birth weight ( BW ) > 1499 g were allocated at r and om to receive either a PFR , starting with 100 mL/kg/day and gradually increasing to 200 mL/kg/day by day 4 , or a st and ard feeding regimen , starting with 60 mL/kg/day and gradually increasing to 170 mL/kg/day by day 9 . All infants received human milk . RESULTS A total of 72 infants were r and omized to the 2 groups , 36 to the PFR group ( mean GA , 35.1 ± 0.7 weeks ; mean BW , 1761 ± 177 g ) and 36 to the st and ard feeding regimen group ( mean GA , 35.5 ± 1.2 weeks ; mean BW , 1754 ± 212 g ) . Infants in the PFR group were discharged significantly earlier ( mean , 9.8 ± 3.1 days vs 11.9 ± 4.7 days ; P = .029 ) . The need for intravenous fluids ( 2.8 % vs 33.3 % ; P = .0013 ) and the incidence of hypoglycemia ( 0 vs 33.3 % ; P = .00016 ) were significantly lower in the PFR group . Feeding intolerance and fecal calprotectin levels did not differ between the 2 groups . CONCLUSION A PFR in moderately preterm SGA infants  is well tolerated and significantly reduces both the length of stay and the risk of neonatal hypoglycemia Poor post-natal growth of preterm neonates is common and fortification is recommended . However , this is not always practical in low-re source areas . Hypothesizing that increasing the volume of feeds would be safe and lead to better post-natal weight gain , we r and omized 64 babies with birth weight < 1500 g , once they reached full feeds , to continue feeds at 200 ml/kg/day ( st and ard volume ) or increase to 300 ml/kg/day ( high volume ) of expressed breast milk . There was a significantly higher daily weight gain in the high-volume group as compared to the st and ard volume group ( 24.9 vs. 18.7 g/kg/day , p < 0.0001 ) . There were no differences in complications like feed intolerance , tachypnoea , sepsis , patent ductus arteriosus or necrotizing enterocolitis . High-volume feeds at 300 ml/kg/day was safe and result ed in better weight gain than st and ard volume feeds in very low birth weight babies OBJECTIVE A prospect i ve study was design ed to evaluate the effects of high volume intake of mother 's milk fortified ( FMM ) with an individualized supplementation of minerals and protein on tolerance , short-term somatic growth , serum concentrations of calcium , phosphorus , alkaline phosphatase , and total plasma protein in healthy preterm infants below 28 weeks of gestation . METHODS Sixty preterm infants were included in the FMM group , for having received > 80 % or more of the milk volume as their own mother 's milk at 3 weeks of postnatal age to 38 weeks of corrected gestational age . This group was compared with 60 preterm infants fed exclusively preterm formula milk ( PF ) . Intended fluid volume of the FMM group was approximately 200 and 150 - 170 mL/kg/d in the PF group . Mother 's milk was supplemented with the goal of a daily protein intake of 3.5 - 4 g/kg/d . Phosphorus was supplemented from 15.5 to 31 mg per 100mL mother 's milk . RESULTS Both feeding regimes were well tolerated . At the end of the study , nutritional management in both groups result ed in a body weight between the 25th and 50th percentiles of intrauterine growth expectations . Serum values of electrolytes , alkaline phosphatase , plasma protein , blood urea nitrogen , and urinary mineral excretion did not differ significantly between the two groups at study entry as well as at the end of the investigation . CONCLUSIONS Mother 's milk fed at higher volumes with an individualized fortification of minerals and protein provides sufficient nutrients to allow adequate growth of preterm infants < 28 weeks of gestation The National Institute of Child Health and Human Development conducts and supports research on all stages of human development from preconception to adulthood in order to better underst and the health of children , youths , adults , families , and communities . Health and human development information is made easily available on the site with a simple A to Z list , along with clinical trials and health education campaign information . Links to clinical trials , news releases , publications , and related web sites are also available , as well as information on research being conducted at present and supported by the National Institute of Child Health and Human Development Two balance studies were performed on each of five infants of low birth weight . About 230 ml/kg/day of S.M.A. S26 milk was given during one study and 180 ml/kg/day during the other . The proportion of nitrogen , fat , and calories retained was similar in the two studies , suggesting that the larger weight gains on the high-volume feeds were due to growth rather than retention of water or excessive deposition of fat Background . The interpretation of growth rates for very low birth weight infants is obscured by limited data , recent changes in perinatal care , and the uncertain effects of multiple therapies . Objectives . To develop contemporary postnatal growth curves for very low birth weight preterm infants and to relate growth velocity to birth weight , nutritional practice s , fetal growth status ( small- or appropriate-for-gestational-age ) , and major neonatal morbidities ( chronic lung disease , nosocomial infection or late-onset infection , severe intraventricular hemorrhage , and necrotizing enterocolitis ) . Design . Large , multicenter , prospect i ve cohort study . Methods . Growth was prospect ively assessed for 1660 infants with birth weights between 501 to 1500 g admitted by 24 hours of age to 1 of the 12 National Institute of Child Health and Human Development Neonatal Research Network centers between August 31 , 1994 and August 9 , 1995 . Infants were included if they survived > 7 days ( 168 hours ) and were free of major congenital anomalies .  Anthropometric measures ( body weight , length , head circumference , and midarm circumference ) were performed from birth until discharge , transfer , death , age 120 days , or a body weight of 2000 g. To obtain representative data , nutritional practice s were not altered by the study protocol . Results . Postnatal growth curves suitable for clinical and research use were constructed for body weight , length , head circumference , and midarm circumference . Once birth weight was regained , weight gain ( 14.4–16.1 g/kg/d ) approximated intrauterine rates . However , at hospital discharge , most infants born between 24 and 29 weeks of gestation had not achieved the median birth weight of the reference fetus at the same postmenstrual age . Gestational age , race , and gender had no effect on growth within 100-g birth weight strata . Appropriate-for-gestational age infants who survived to hospital discharge without developing chronic lung disease , severe intraventricular hemorrhage , necrotizing enterocolitis , or late onset-sepsis gained weight faster than comparable infants with those morbidities . More rapid weight gain was also associated with a shorter duration of parenteral nutrition providing at least 75 % of the total daily fluid volume , an earlier age at the initiation of enteral feedings , and an earlier age at achievement of full enteral feedings . Conclusions . These growth curves may be used to better underst and postnatal growth , to help identify infants developing illnesses affecting growth , and to aid in the design of future research . They should not be taken as optimal . R and omized clinical trials should be performed to evaluate whether different nutritional management practice s will permit birth weight to be regained earlier and result in more rapid growth , more appropriate body composition , and improved short- and long-term outcomes OBJECTIVE To compare the effect of two volumes of enteral feeds on postnatal growth in infants born before 30 weeks gestation . METHODOLOGY Fifty-four infants , less than 30 weeks gestational age , who reached full enteral feeds were  r and omized  to remain on 150 mL/kg per day ( 150 group ) or increase to 200 mL/kg per day ( 200 group ) . The primary outcome measure was growth at 35 weeks corrected gestational age ( CGA ) . RESULTS There were no statistically significant differences in demographic or clinical parameters between the study groups at commencement of the study , although there was a trend for infants in the 150 group to be lighter ( 895 g vs 1020 g , P = 0.27 ) . Milk intakes were increased in 43 % of the infants in the 150 group , whereas 54 % of the infants in the 200 group required reduced intakes . Infants in the 200 group had greater daily weight gains ( 16.7 g/kg per day vs 15.2 g/kg per day , P = 0.047 ) and at 35 weeks CGA were heavier ( 2020 g vs 1885 g , P = 0.014 ) and had a greater arm fat area ( 282 mm2 vs 218 mm2 , P = 0.009 ) . There was no difference in length or head circumference at 35 weeks CGA , and no difference in any growth parameter at 1 year of age . Morbidity was not different between the groups . CONCLUSIONS The individual milk volume requirements for adequate weight gain without significant adverse effects vary between 150 and 200 mL/kg per day in extremely premature infants . For many infants in both groups , the assigned target volume was not appropriate . Increased milk intakes ( and therefore higher caloric and mineral intakes ) are associated with increased daily weight gains and a greater weight at 35 weeks CGA . The weight gain may be due to an increase in fat deposition
BACKGROUND Breast milk alone , given at st and ard recommended volumes ( 150 to 180 mL/kg/d ) , is not adequate to meet the protein , energy , and other nutrient requirements of growing preterm or low birth weight infants .
One strategy that may be used to address these potential nutrient deficits is to give infants enteral feeds in excess of 200 mL/kg/d ( ' high-volume ' feeds ) .
This approach may increase nutrient uptake and growth rates , but concerns include that high-volume enteral feeds may cause feed intolerance , gastro-oesophageal reflux , aspiration pneumonia , necrotising enterocolitis , or complications related to fluid overload , including patent ductus arteriosus and bronchopulmonary dysplasia .
OBJECTIVES To assess the effect on growth and safety of feeding preterm or low birth weight infants with high ( > 200 mL/kg/d ) versus st and ard ( ≤ 200 mL/kg/d ) volume of enteral feeds .