Unravelling the fetal origins hypothesis: is there really an inverse association between birthweight and subsequent blood pressure? Feeding Preterm Infants after Hospital Discharge: Effect of Diet on Body Composition Growth of very low birth weight infants to age 20 years. Optimal Growth and Lower Fat Mass in Preterm Infants Fed a Protein-enriched Postdischarge Formula Randomized outcome trial of nutrient-enriched formula and neurodevelopment outcome in preterm infants Randomized diet in the neonatal period and growth performance until 7.5-8 y of age in preterm children. Associations between prenatal and infancy weight gain and BMI, fat mass, and fat distribution in young adulthood: a prospective cohort study in males and females born very preterm. Posthospital discharge feeding for preterm infants: effects of standard compared with enriched milk formula on growth, bone mass, and body composition. Bone mineralization and growth are enhanced in preterm infants fed an isocaloric, nutrient-enriched preterm formula through term. Effects of human milk or formula feeding on the growth, behavior, and protein status of preterm infants discharged from the newborn intensive care unit. Randomized trial of nutrient-enriched formula versus standard formula for postdischarge preterm infants. Feeding with premature or infant formula in premature infants after discharge: comparison of growth and nutrition status. Feeding Preterm Infants after Hospital Discharge: Growth and Development at 18 Months of Age Increased bone mineral content of preterm infants fed with a nutrient enriched formula after discharge from hospital. GRADE guidelines: 4. Rating the quality of evidence--study limitations (risk of bias). Multicentre trial on feeding low birthweight infants: effects of diet on early growth. Growth and Fat-Free Mass Gain in Preterm Infants After Discharge: A Randomized Controlled Trial Very low birth weight and growth into adolescence. Comparing Growth Rates after Hospital Discharge of Preterm Infants Fed with Either Post-Discharge Formula or High-Protein, Medium-Chain Triglyceride Containing Formula. Randomised trial of nutrition for preterm infants after discharge. Feeding Preterm Infants after Hospital Discharge: Effect of Dietary Manipulation on Nutrient Intake and Growth Effect of caloric density on gastric emptying in premature infants. Post‐discharge nutrition of the very low‐birthweight infant: interim results of the multicentric GAMMA study Small for gestational age preterm infants: nutritional strategies and quality of growth after discharge [Quality of post-discharge growth in small for gestational age preterm infants: an explorative study]. Enriched post-discharge formula versus term formula for bone strength in very low birth weight infants: a longitudinal pilot study Growth in 10- to 12-Year-Old Children Born at 23 to 25 Weeks' Gestation in the 1990s: A Swedish National Prospective Follow-up Study Growth of Preterm Infants Fed Nutrient-Enriched or Term Formula After Hospital Discharge Feeding the premature infant after hospital discharge: growth and biochemical responses. Growth and bone mineral status of discharged very low birth weight infants fed different formulas or human milk. Body composition in preterm infants fed standard term or enriched formula after hospital discharge Growth and body composition in infants with bronchopulmonary dysplasia up to 3 months corrected age: a randomized trial of a high-energy nutrient-enriched formula fed after hospital discharge. Postnatal malnutrition and growth retardation: an inevitable consequence of current recommendations in preterm infants? Preterm infants fed nutrient-enriched formula until 6 months show improved growth and development.
BACKGROUND The association between birthweight and subsequent blood pressure levels  has been considered to provide some of the strongest , and most consistent , support for the " fetal origins " hypothesis of adult disease . It had been estimated that a 1 kg higher birthweight is typically associated with a 2 - 4 mm Hg lower systolic blood pressure . METHODS 55 studies that had reported regression coefficients of systolic blood pressure on birthweight ( with 48 further studies that reported only the direction of this association ) , and seven such studies within twin pairs , were identified . Each study was weighted according to the inverse of the variance of the regression coefficient ( ie , " statistical size " ) , and combined using a " fixed effects " approach . FINDINGS Among the 55 studies that reported regression coefficients , there was a clear trend ( p<0.0001 ) towards weaker associations in the larger studies : -1.9 mm Hg/kg in those with less than about 1000 participants ; -1.5 mm Hg/kg with about 1000 - 3000 participants ; and -0.6 mm Hg/kg with more than 3000 participants . By contrast with the inverse associations reported in 52 of these 55 studies , only 25 of the 48 studies that did not report regression coefficients found an inverse association ( p<0.0001 for heterogeneity ) . Almost all of these regression coefficients had been adjusted for current weight ( whereas few were adjusted for potential confounding factors ) , and removal of this adjustment in the larger studies reduced the estimated association to -0.4 mm Hg/kg . For studies within monozygotic twin pairs , the combined estimate was -0.6 mm Hg/kg with adjustment for current weight , and was also reduced without this adjustment . INTERPRETATION Cl aims of a strong inverse association between birthweight and subsequent blood pressure may chiefly reflect the impact of r and om error , selective emphasis of particular results , and inappropriate adjustment for current weight and for confounding factors . These findings suggest that birthweight is of little relevance to blood pressure levels in later life Our purpose in this study was to examine whole body composition , using dual energy x-ray absorptiometry ( DEXA ) during dietary intervention in preterm infants ( ≤1750 g birthweight , ≤34 wk gestation ) . At discharge , infants were r and omized to be fed either a preterm infant formula ( discharge–6 mo ; group A ) or a term formula ( discharge–6 mo ; group B ) , or the preterm formula ( discharge – term ) and the term formula ( term–6 mo ; group C ) .  Nutrient intake was measured between each clinic visit . To measure body composition , DEXA was used at discharge , term , 12 wk , 6 mo , and 12 mo corrected age . The data were analyzed by ANOVA . At discharge , no differences were noted in patient characteristics between groups A , B , and C. Although energy intakes were similar , protein and mineral intakes differed between groups ( A > C > B;p < 0.0001 ) . During the study , weight gain and LM gain were greater in group A than B. At 12 mo , weight , LM , FM , and BMM but not % FM or BMD were greater in group A than B. However , the effects of diet were confined to boys , with no lasting effects seen in girls . In summary , therefore , DEXA was precise enough to detect differences in whole body composition during dietary intervention . Increased weight gain primarily reflected an increase in LM and is consistent with the idea that the preterm formula more closely met protein and /or protein-energy needs in rapidly growing preterm male infants 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 Background and Objectives : Postdischarge formulas with extra energy and protein improve short-term growth but may also influence long-term body composition in an unwanted manner . Energy- and protein-enriched formulas with an increased protein-to-energy ratio improves gain of lean mass . The objective of the study was to investigate whether feeding a nutrient-enriched formula without extra energy after term , usually 3 to 4 weeks after discharge , would influence growth and body composition in infancy . Methods : In this r and omized controlled trial preterm infants were fed fortified human milk or preterm formula until term . At term , 102 infants were r and omized to a nutrient-enriched formula without extra energy or st and ard formula until 6 months corrected age . Twenty-six infants received unfortified human milk after term . At term and 6 months corrected age , anthropometry and a dual-energy x-ray absorptiometry ( DEXA ) scan were performed . Lean and fat mass ( FM ) were corrected for height . Results : There were no differences in growth or body size between the feeding groups . Infants fed the enriched formula gained less FM and had lower FM corrected for body size at 6 months corrected age than infants fed st and ard formula . Infants fed human milk had lower lean mass and higher FM corrected for body size at 6 months corrected age than formula-fed infants . Conclusions : Feeding nutrient-enriched formula without extra energy after term does not change quantity of growth but does influence type of weight gain and body composition of preterm infants . Infants fed the nutrient-enriched formula had lower FM corrected for body size at 6 months corrected age than infants fed st and ard formula or human milk Background Preterm infants are at risk for adverse neurodevelopment . Furthermore , nutrition may play a key role in supporting neurodevelopment . The aim of this study was to evaluate whether a nutrient-enriched formula fed to preterm infants after hospital discharge could improve their neurodevelopment at 24 months ( term-corrected age ) . Methods We conducted an observer-blinded , single-center , r and omized controlled trial in infants admitted to the Fondazione IRCCS Cà Gr and a Ospedale Maggiore Policlinico , University of Milan , Italy between 2009 and 2011 . Inclusion criteria were gestational age < 32 weeks and /or birth weight < 1500 g , and being fed human milk for < 20 % of the total milk intake . Exclusion criteria were congenital malformations or conditions that could interfere with growth or body composition . Included infants were r and omized to  receive a st and ard full-term formula or a nutrient-enriched formula  up until 6 months of corrected age , using two computer-generated r and omization lists ; one appropriate for gestational age ( AGA ) and one for small for gestational age ( SGA ) infants . We assessed neurodevelopment at 24 months of corrected age using the Griffiths Mental Development Scale and related subscales ( locomotor , personal-social , hearing and speech , h and and eye coordination , and performance ) . Results Of the 207 r and omized infants , 181 completed the study . 52 AGA and 35 SGA infants were fed a nutrient-enriched formula , whereas 56 AGA and 38 SGA infants were fed a st and ard full-term formula . The general quotient at 24 months of corrected age was not significantly different between infants r and omized to receive a nutrient-enriched formula compared with a st and ard term formula up until 6 months of corrected age ( AGA infants : 93.8 ± 12.6 vs. 92.4 ± 10.4 , respectively ; SGA infants : 96.1 ± 9.9 vs. 98.2 ± 9 , respectively ) . The scores of related subscales were also similar among groups . Conclusions This study found that feeding preterm infants a nutrient-enriched formula after discharge does not affect neurodevelopment at 24 months of corrected age , in either AGA or SGA infants , free from major comorbidities . Trial registration Current Controlled Trials ( http://www.controlled-trials.com/IS RCT N30189842 ) London , UK BACKGROUND Preterm children are at high risk of poor growth performance . In 2 r and omized trials , preterm infants fed preterm formula grew better in the neonatal period than those fed banked donor breast milk or st and ard term formula . OBJECTIVE Our objective was to test the hypothesis that for preterm infants , the neonatal period is a critical one for programming growth performance and that early diet influences long-term growth . DESIGN A total of 926 preterm infants were recruited into 2 parallel , r and omized trials of neonatal diet . In trial 1 , infants were fed either banked donor breast milk or preterm formula whereas in trial 2 , infants were fed either st and ard term formula or preterm formula . Within each trial , the allocated milk was the sole diet for some infants ( study A ) , whereas for others it was a supplement to maternal breast milk , given when not enough expressed breast milk was available ( study B ) . We followed up 781 of 833 survivors ( 94 % ) to age 7.5 - 8 y. Trained assessors obtained anthropometric measurements according to a st and ard protocol . RESULTS Despite significantly better neonatal growth performance in infants fed preterm formula ( compared with either banked donor breast milk or st and ard formula ) , early diet had no influence on weight , height , head circumference , or skinfold thicknesses at 9 or 18 mo postterm or at age 7.5 - 8 y. CONCLUSIONS These findings suggest that the preterm period is not a critical window for nutritional programming of growth , which contrasts with evidence from these trials showing that early diet influences later neurodevelopment BACKGROUND Increasing evidence indicates that adult body composition is associated with prenatal and infancy weight gain , but the relative importance of different time periods has not been eluci date d. OBJECTIVE The objective was to study the association between prenatal , early postnatal , and late infancy weight gain and body mass index ( BMI ) , fat mass , and fat distribution in young adulthood . DESIGN We included 403 men and women aged 19 y from a Dutch national prospect i ve follow-up study who were born at < 32 wk of gestation .  BMI , waist circumference , and waist-to-hip ratio SD scores and subscapular-to-triceps ratio , percentage body fat , fat mass , and fat-free mass at age 19 y were studied in relation to birth weight SD scores , weight gain from preterm birth until 3 mo postterm ( early postnatal weight gain ) , and weight gain from 3 mo until 1 y postterm ( late infancy weight gain ) . RESULTS Birth weight SD scores were positively associated with weight , height , BMI SD scores , and fat-free mass at age 19 y but not with fat mass , percentage body fat , or fat distribution . Early postnatal and late infancy weight gain were positively associated with adult height , weight , BMI , waist circumference SD scores , fat mass , fat-free mass , and percentage body fat but not with waist-to-hip ratio SD scores or subscapular-to-triceps ratio . CONCLUSIONS In infants born very preterm , weight gain before 32 wk of gestation is positively associated with adult body size but not with body composition and fat distribution . More early postnatal and , to a lesser extent , late infancy weight gain are associated with higher BMI SD scores and percentage body fat and more abdominal fat at age 19 BACKGROUND Despite the theoretical benefits of nutrient-enriched formula given to preterm infants after hospital discharge , its role in reversing growth deficits after hospital discharge remains poorly defined . OBJECTIVE The aim was to determine the effect of different formulas on the growth , bone mass , and body composition of preterm infants after hospital discharge . DESIGN This was a r and omized , double blind comparison of a nutrient-enriched formula ( EF ) and a formula for term infants ( TF ) given for 1 y after hospital discharge . Compared with the TF , the EF had a higher energy density and higher contents of protein , calcium , and phosphorus ( by 10 % , 21 % , 44 % , and 11 % , respectively ) and higher contents of almost all other nutrients ( by > or=10 % ) . RESULTS  Birth weights of the infants were 630 - 1620 g ( median : 1250 g ) and gestational ages were 24 - 34 wk ( median : 29 wk ) . TF result ed in significantly greater weight , length , head circumference measurements , and their respective z scores on the basis of age- and sex-specific norms . At the end of the study , the mean z scores for the corrected age of infants in the TF group were -0.37 for weight , 0.001 for length , and 0.50 for head circumference . The TF group also had significantly greater dual-energy X-ray absorptiometry measured bone and lean and fat mass than did the EF group ( P < 0.05 for all comparisons ) . CONCLUSIONS The use of EF for preterm infants after hospital discharge shows no advantage over TF in growth , bone mineralization , and body composition . More studies are needed to determine the optimal postdischarge nutrition support for preterm infants BACKGROUND Because recent data on the effects of mineral concentrations in preterm infant formula on bone mineralization are lacking , recommendations for the mineral content of preterm infant formula differ greatly between committees . OBJECTIVE The goal of the study was to assess the effects of an isocaloric , nutrient-enriched preterm formula , which was fed from the age when full enteral feedings were tolerated through expected term , on bone mineralization in preterm infants . DESIGN We conducted a prospect i ve , r and omized , double-blind study in healthy , preterm infants ( gestational age of 28 - 32 wk ) who were fed either a control preterm formula ( n=20 ) or an isocaloric , nutrient-enriched preterm formula ( n=21 ) until 3 mo of age ( ie , approximate expected term ) .  Serum calcium indexes were taken throughout the study , and bone mass was determined by using dual-energy X-ray absorptiometry at hospital discharge and expected term . RESULTS A total of 37 infants ( experimental formula , n=19 ; control formula , n=18 ) completed the study . Compared with control subjects , infants fed the experimental formula had 25 % and 40 % higher intakes of calcium and phosphorus , respectively . Serum calcium , phosphorus , osteocalcin , and alkaline phosphatase concentrations and urinary collagen type I cross-linked N-telopetide concentrations were not significantly different between the groups at any time point . The bone mineral content of infants fed the experimental formula was 23 % ( P=0.039 ) and 35 % ( P=0.002 ) higher at hospital discharge and expected term , respectively . CONCLUSIONS Bone mineralization at hospital discharge and expected term was significantly higher in preterm infants fed the isocaloric , nutrient-enriched formula than in those fed control formula . Continuation of the experimental formula beyond hospital discharge , through expected term , further improved bone mineralization The growth , behavior , and protein status of 59 healthy preterm ( mean gestational age 30 wk ) infants fed either human milk or one of three infant formulas were studied post-discharge from the hospital . Formula-fed infants received either a st and ard term formula , a st and ard preterm formula , or an experimental preterm formula from discharge to 8 wk of age . From 8 to 16 wk , all formula-fed infants received the st and ard term formula . At 2 , 8 , and 16 wk , anthropometric , dietary intake , blood biochemistry , amino acid , and Brazelton Neonatal Behavioral Assessment measurements were evaluated . Weights , lengths , and head circumferences were similar for all feeding groups at discharge . After discharge all formula-fed infants were heavier than human milk-fed infants . Length and head circumference values and plasma urea nitrogen and retinol-binding protein concentrations were not different among dietary groups . Formula-fed infants had higher plasma concentrations of numerous amino acids compared with those of human milk-fed infants during the first 8 wk but not at 16 wk . There were no differences among the feeding groups in the Brazelton assessment . This study found little effect on the growth or behavioral or protein status of preterm infants discharged from the hospital who were fed either human milk or formulas design ed for term or preterm infants OBJECTIVES Preterm infants are frequently discharged from the hospital growth retarded and show reduced growth throughout childhood . In a large efficacy and safety trial , we tested the hypothesis that nutritional intervention in the first 9 months postterm would reverse postdischarge growth deficits and improve neurodevelopment without adverse safety outcomes . PARTICIPANTS AND INTERVENTION Two hundred eighty-four infants ( mean gestation : 30.9 weeks ) were studied ; 229 were r and omly assigned a  protein , energy , mineral , and micronutrient-enriched postdischarge formula ( PDF ; N = 113 ) or st and ard term formula  ( TF ; N = 116 ) from discharge ( mean 36.5 weeks ' postmenstrual age ) . A reference group ( N = 65 ) was  breastfed until at least 6 weeks ' postterm . Outcome measures . Anthropometry was performed at 6 weeks and 3 , 6 , 9 , and 18 months . Development was measured at 9 months ( Knobloch , Passamanick , and Sherrard 's developmental screening inventory ) and 18 months ( Bayley Scales of Infant Development II ; primary outcome ) postterm . RESULTS At 9 months , compared with the TF group , those fed PDF were heavier ( difference 370 g ; 95 % confidence interval [ CI ] : 84 - 660 ) and longer ( difference 1.1 cm ; 95 % CI : 0.3 - 1.9 ) ; the difference in length persisted at 18 months ( difference 0.82 cm ; 95 % CI : -0.04 - 1.7 ) . There was no effect on head circumference . The effect of diet was greatest in males ; at 9 months length deficit with TF was 1.5 cm ( 95 % CI : 0.3 - 2.7 ) , and this remained at 18 months ( 1.5 cm [ 95 % CI : 0.3 - 2.7 ] ) . There was no significant difference in developmental scores at 9 or 18 months , although PDF infants had a 2.8 ( -1.3 - 6.8 ) point advantage in Bayley motor score scales . At 6 weeks ' postterm , exclusively breastfed infants were already 513 g ( 95 % CI : 310 - 715 ) lighter and 1.6 cm ( 95 % CI : 0.8 - 2.3 ) shorter than the PDF group , and they remained smaller up to 9 months ' postterm . CONCLUSIONS 1 ) Improving postdischarge nutrition in the first 9 months may " reset " subsequent growth-at least until 18 months for body length . We intend to follow-up the children at older ages . The observed efficacy of PDF was not associated with adverse safety outcomes . 2 ) We can not reject the hypothesis that postdischarge nutrition benefits motor development and this requires additional study . 3 ) Our data raise the possibility that breastfed postdischarge preterm infants may require nutritional supplementation , currently under investigation We design ed this prospect i ve r and omized controlled study to evaluate the effects of  premature and st and ard term formula on growth , nutrient intake and biochemical response in premature infants from hospital discharge to 6 months of corrected age . Premature infants with a gestational age of < or = 35 weeks and a birth weight < or = 1850 gm were assigned to receive  premature infant formula ( n = 19  ) or a st and ard term infant formula  ( n = 15 ) . No differences were found between the two groups in weight , length , or head circumference at baseline or on follow-up . Infants fed premature formula had higher blood urea nitrogen and phosphorus at 3 months of corrected age . Those on the premature formula also had higher energy intake at 1 month of corrected age . We suggest that premature infants , especially very low birth weight infants , fed preterm infant formula after discharge until 6 months of corrected age tolerate the formula well and may benefit over those st and ard term formula We have shown that preterm infants fed a preterm formula grow better than those fed a st and ard term infant formula after hospital discharge . The purpose of this follow-up study was to determine whether improved early growth was associated with later growth and development . Preterm infants ( ≤1750 g birth weight , ≤34 wk gestation ) were r and omized to be fed either a preterm infant formula ( discharge to 6 mo corrected age ) , or a term formula ( discharge to 6 mo ) , or the preterm ( discharge to term ) and the term formula  ( term to 6 mo ) . Anthropometry was performed at 12 wk and 6 , 12 , and 18 mo . Mental and psychomotor development were assessed using the Bayley Scales of Infant Development II at 18 mo . Differences in growth observed at 12 wk were maintained at 18 mo . At 18 mo , boys fed the preterm formula were 1.0 kg heavier , 2 cm longer , and had a 1.0 cm greater occipitofrontal circumference than boys fed the term formula . Boys fed the preterm formula were also 600 g heavier and 2 cm longer than girls fed the preterm formula . However , no differences were noted in MDI or PDI between boys fed the preterm formula and boys fed the term formula or between the boys fed preterm formula and girls fed the preterm formula . Overall , boys had significantly lower MDI than girls ( mean difference , 6.0;p < 0.01 ) , primarily reflecting lower scores in boys fed the term formula . Thus , early diet has long-term effects on growth but not development at 18 mo of age . Sex remains an important confounding variable when assessing growth and developmental outcome in these high-risk infants Bone disease with persistent reduced bone mineralisation is common in premature infants . To test the hypothesis that enhancement of nutritional intake after discharge from hospital improves bone mineralisation , 31 formula fed preterm infants were r and omly assigned to receive st and ard or multinutrient enriched milk from the time of discharge . The calcium and phosphorus contents of the enriched milk were 70 and 35 mg/100 ml v 35 and 29 mg/100 ml for the st and ard formula . Bone mineral content was measured before discharge from hospital in 21 of the infants ; there was no difference in the bone mineral content between the groups at that time ( 35 mg/cm for the two groups ) . There was a significant increase in bone mineral content for those infants receiving the enriched v st and ard formula at 3 and 9 months corrected postnatal age : at 3 months the bone mineral content was 83 v 63 mg/cm and at 9 months 115 v 95 mg/cm . The difference between the groups was thus maintained although not increased at a corrected age of 9 months , when the bone mineral content of infants fed the enriched but not the st and ard formula was no longer significantly different from that of normal infants after adjusting for body size . The difference was not explained by the larger body size in infants fed the enriched formula . The results suggest that the use of a special nutrient enriched postdischarge formula has a significant positive effect on bone growth and mineralisation during a period of rapid skeletal development In the GRADE approach , r and omized trials start as high- quality evidence and observational studies as low- quality evidence , but both can be rated down if most of the relevant evidence comes from studies that suffer from a high risk of bias . Well-established limitations of r and omized trials include failure to conceal allocation , failure to blind , loss to follow-up , and failure to appropriately consider the intention-to-treat principle . More recently recognized limitations include stopping early for apparent benefit and selective reporting of outcomes according to the results . Key limitations of observational studies include use of inappropriate controls and failure to adequately adjust for prognostic imbalance . Risk of bias may vary across outcomes ( e.g. , loss to follow-up may be far less for all-cause mortality than for quality of life ) , a consideration that many systematic review s ignore . In deciding whether to rate down for risk of bias -- whether for r and omized trials or observational studies -- authors should not take an approach that averages across studies . Rather , for any individual outcome , when there are some studies with a high risk , and some with a low risk of bias , they should consider including only the studies with a lower risk of bias A large multicentre study on the short and long term clinical and developmental outcome of infants r and omised to different diets is being undertaken . This report represents an interim analysis of the early postnatal growth performance of an unselected population of 194 preterm infants ( gestation , mean ( SD ) 31 . 0 ( 2 . 9 ) weeks ; birthweight , mean ( SD ) 1364 ( 294 ) g ) , both ill and well , examined in two ( of four ) parallel trials . One trial compared banked breast milk with a new preterm formula ( primary trial ) ; the other compared these diets as supplements to maternal milk ( supplement trial ) . A major dietary effect on the number of days taken to regain birthweight and subsequent gains in weight , length , and head circumference was observed in the primary trial . Infants fed banked breast milk  and weighing less than 1200 g at birth took a calculated additional three weeks to reach 2000 g compared with those fed on the preterm formula . A significant influence of diet on body proportions was seen in the relation between body weight , head circumference , and length . Similar though smaller differences in growth patterns were seen in the supplement trial . By the time they reach 2000 g , infants of birthweights 1200 to 1849 g fed on banked breast milk and infants below 1200 g fed on either banked breast milk or maternal milk supplemented ( as necessary ) with banked breast milk , fulfilled stringent criteria for failure to thrive ( weight less than 2 SD below the mean for age ) . Only infants fed the preterm formula as their sole diet had maintained their birth centile by discharge from hospital . The misleading nature of comparisons between extrauterine and intrauterine steady state weight gains is emphasised OBJECTIVE : To investigate whether the consumption of a nutrient-enriched formula after hospital discharge determines different growth and weight gain composition in preterm infants according to intra- and extrauterine growth pattern . METHODS : Two hundred seven preterm infants were r and omized at term-corrected age to receive treatment A ( term formula ) or B ( nutrient-enriched formula )  up to 6 months of corrected age , using 2 computer-generated r and omization lists , 1 for adequate for gestational age ( AGA ) and 1 for small for gestational age ( SGA ) infants . Infants were weaned according to our clinical practice after 6 months ’ corrected age . Anthropometric parameters and body composition by an air displacement plethysmography system were assessed at term and 1 , 3 , and 6 months ’ corrected age . Anthropometric parameters were also assessed at 12 months . RESULTS : Protein intakes were higher in infants receiving treatment B than in infants receiving treatment A at each study point . There were no differences between the feeding groups in weight and length SD scores in either the AGA and SGA group through the study . The mean head circumference values were higher in AGA infants receiving treatment B than in AGA infants receiving treatment A at 6 and 12 months , whereas at 6 months , the percentage of fat mass was lower . No difference in body composition was detected among SGA infants through the study . CONCLUSIONS : This r and omized controlled trial demonstrates the beneficial effect of the consumption of a nutrient-enriched formula after hospital discharge by AGA infants both in terms of head circumference growth and fat-free mass gain OBJECTIVE To compare the growth and pubertal development of very low-birth-weight ( VLBW ) children ( birth weight < 1500 g ) and normal-birth-weight ( NBW ) children ( birth weight > 2499 g ) to adolescence to determine if , and at what age , VLBW children " catch up . " DESIGN Inception cohort study to age 14 years . SETTING Royal Women 's Hospital , Melbourne , Australia . PATIENTS Eighty-six consecutive survivors with a birth weight less than 1000 g , 120 consecutive survivors with a birth weight of 1000 to 1499 g , and 60 r and omly selected NBW controls . Children with cerebral palsy at age 14 years were excluded . MAIN OUTCOME MEASURES Weight , height , and head circumference measurements at birth and ages 2 , 5 , 8 , and 14 years converted to z ( SD ) scores . RESULTS At age 14 years , pubertal development was similar in NBW and VLBW children . At ages 2 , 5 , 8 , and 14 years , VLBW children were significantly shorter and lighter and had smaller head circumferences than NBW children . The differences in height and weight between VLBW and NBW children were less apparent as SD scores improved in VLBW children over time . Within the VLBW group , compared with children with a birth weight of 1000 to 1499 g , those with a birth weight less than 1000 g had significantly lower weight z scores earlier in childhood but not at age 14 years , significantly lower height z scores only at age 2 years , and significantly lower head circumference z scores throughout childhood . CONCLUSION This group of VLBW children experienced late catch-up growth to age 14 years but remain smaller than their NBW peers . Arch Pediatr Adolesc Med . 2000;154:778 - OBJECTIVE To evaluate whether a high energy , high-protein , MCT-containing formula ( HPMCT ) is as appropriate as a post-discharge formula ( PDF ) for feeding preterm infants after hospital discharge by comparing growth , adverse effects , and cost per gram of bodyweight gain . MATERIAL AND METHOD The present study was a r and omized controlled trial . The calculated sample size was 20 infants for each intervention group . After the consent procedure , preterm infants who had postconceptional age ( PCA ) 35⁺¹ to 36⁺⁰ weeks and weight between 1,800 and 3,000 g at hospital discharge were r and omly enrolled to receive either PDF or HPMCT starting from the discharge day . Intervention period lasted at least 28 days and until the infant 's weight was at least 3,000 g or PCA was at least 40⁺⁰ weeks . Body weight , length , and head circumference were measured on days 0 , 14 , 28 , 56 , and 84 after hospital discharge . Formula intakes and adverse symptoms ( abdominal distension , diarrhea , and constipation ) were recorded by parents before each visit in diaries provided by the study group . Cost was calculated from estimated actual formula intakes . RESULTS There were six and five infants enrolled into PDF and HPMCT  group , respectively . Demographic data were not different between the two groups . There were no significant differences of growth rates in both groups at days 28 , 56 , and 84 after hospital discharge . Adverse effects and costs were not different either . CONCLUSION PDF and HPMCT might be comparably appropriate for feeding catching-up preterm infants after hospital discharge , as noted from growth rates , adverse effects , and costs . However , further studies involving biochemical and neurodevelopmental evaluation , with long-term follow-up in larger population s are needed to clearly compare both formulas In a r and omised double blind trial , the effect on growth and clinical status of a nutrient enriched ' post-discharge ' milk formula versus a st and ard term formula , was compared in 32 exclusively bottle fed preterm infants . The formulas were used as the sole milk intake up to a postnatal age of 9 months . Significant increases in linear growth and weight gain were observed in the infants who received the enriched diet . There were no differences in vomiting , posseting , or bowel habit between the groups . Formula volumes ingested were similar between diet groups , indicating that the difference in formula composition did not affect the infants ' regulation of intake . These preliminary data suggest that there is a role for specially design ed formulas for preterm infants after discharge from hospital The objective of this study was to compare  formula intake , the time of weaning , and growth in preterm infants ( ≤1750-g birth weight , ≤34-wk gestation ) fed a st and ard term or preterm infant formula after initial hospital discharge . Infants were r and omized at hospital discharge to be fed a  preterm infant formula from discharge to 6 mo corrected age  ( group A ) , a term formula from discharge to 6 mo ( group B ) , or the preterm formula ( discharge to term ) and the term formula ( term to 6 mo ( group C ) . Infants were seen biweekly(discharge to term ) and monthly ( term to 6 mo ) , when intake was measured and anthropometry and blood sampling were performed . The results were analyzed using ANOVA . Although nutrient intake was similar , at 6 mo girls were lighter(6829 versus 7280 g ) and shorter ( 64.4 versus 66.0 cm ) than boys ( p < 0.05 ) . Patient characteristics were similar between the treatment groups . Although the volume of intake differed ( B > C > A ; p < 0.001 ) , energy intake was similar in the groups . Because of differences in formula composition , protein , calcium , and phosphorus intakes differed ( B < C < A ; p < 0.001 ) . Lower protein intakes were related to lower blood urea nitrogen levels ( B < C < A ; p < 0.001 ) . At 6 mo , infant boys in B and C were lighter(6933 , 6660 < 7949 g ) , shorter ( 65.3 , 64.9 < 67.1 cm ) , and had a smaller head circumference ( 43.7 , 43.7 < 44.8 cm ; p < 0.05 ) than infants in group A. Preterm infants were found to increase their volume of intake to compensate for differences in energy density between formulas . After hospital discharge , infant boys fed a preterm formula grew faster than infant girls fed a preterm formula or infant boys fed a term formula The role of caloric density in the regulation of gastric emptying has been well documented in adults but studied to only a limited extent in young infants . Ten premature infants were each fed 22 ml/kg formula ( Similac Special Care ) , at concentrations of 24 , 20 , 13 , and 6.5 Cal/oz , as well as one feeding of distilled water . The volume of gastric contents was measured at 20-minute intervals by the double-aspiration technique using the marker polyethylene glycol 4000 . Analysis of variance demonstrated a significant inhibition of gastric emptying related to increasing caloric density ( P less than 0.001 ) when evaluated over the entire time of measurement . By 20 minutes , significant differences ( P less than 0.01 ) were present between 0 and 6.5 , 6.5 and 13 , and 13 and 20 Cal/oz . A volume difference between 20 and 24 Cal/oz ( P less than 0.05 ) was present only at 80 minutes . Despite the inhibition of emptying , higher caloric density feedings were associated with emptying of more calories over comparable periods ( P less than 0.001 ) . Regulation of gastric emptying by caloric density in premature infants is qualitatively similar to that in adults This report presents the interim results up to 12 mo corrected age ( c.a . ) of a multicentric , prospect i ve , controlled study on very low‐birthweight infants , r and omized at 40 wk post‐conception in two different groups of formula feeding : 80 Kcal/dL ( group A ) vs 70 Kcal/dL ( group B ) up to 55 wk of postconceptional age . Subsequently , all the babies were fed with a follow‐on formula , with the introduction of solid foods at 6 mo c.a . Weight , length , head circumference and neurological conditions with psychomotor development ( evaluated by the Griffiths’Developmental Scale ) were measured at regular intervals and all of these parameters were satisfactory in both groups . For growth , in group A there was a greater increase in weight in boys at 55 wk and at 6 mo c.a . , and small for gestational age ( SGA ) babies had a greater increase in length at 1 y of age , while head circumference caught up on growth from week 40 to week 55 . Measured by the Griffiths’Developmental Scale , the SGA group fed 80 Kcal/dL had a better score at 6 mo ; similarly boys fed 80 Kcal/dL had a better score at 6 and at 9 mo Infants born preterm are at high risk for poor growth achievement . Small for gestational age ( SGA ( birth weight below the 10th percentile ) preterm infants are even more prone to develop postnatal growth retardation in the early neonatal period , as they do not have a large storage of protein/energy . Both SGA and appropriate for gestational age ( AGA : birth weight between the 10th and 90th percentiles ) infants show persistent postnatal growth failure after discharge . Although the available data clearly demonstrate that preterm infants , especially if born SGA , exhibit postnatal growth retardation at the time of hospital discharge , the importance of the nutritional post discharge management has not been sufficiently taken into account . We have recently conducted a r and omized controlled trial to assess whether infants born SGA may benefit from an enriched post discharge formula . This study suggests that the growth pattern in SGA preterm infants is not affected by the consumption of an enriched post discharge formula . The ponderal and linear growth of these infants does not accelerate to achieve early catch up growth . However , as far as the quality of growth is concerned , the fat mass accretion after term decelerates , so that an increase of fat free mass accretion takes place . Future research effort should be directed toward longer follow up and personalized nutrition management OBJECTIVES The Preterm newborns , especially if born small for gestational age ( SGA ) , appear to be at risk for developing post-natal growth failure and an altered body composition . Nutrition-related growth during a critical window in infancy may affect the development of metabolic syndrome in adult life . Aim of the present study was to test the hypothesis that the post-discharge period is critical for programming the catch up growth and the later development of metabolic syndrome in small for gestational-age infants fed either st and ard or enriched formula . METHODS A clinic r and omized explorative study was conducted . Twenty-seven preterm SGA infants ( gestational age < or = 33 weeks ; birth weight < or = 1500 g ) underwent assessment of growth and body composition by means of an air displacement system at 36 weeks , 15 days and 1 months adjusted age . SGA infants were r and omized to receive st and ard formula ( Kcal : 67/100 ml , proteins : 1,4 g/100 ml ) or enriched formula ( Kcal : 75/100 ml , proteins : 2 g/100 ml ) after discharge . RESULTS No differences in weight , fat mass , length and head circumference were found in SGA infants fed st and ard formula as compared to those fed enriched formula at 15 day or 1 months adjusted age . CONCLUSIONS This explorative study suggests that in SGA infants growth , both in terms of quantity and quality , is not influenced by different nutritional management during the early post-discharge period Abstract Aim : To initiate a longitudinal pilot study comparing the effect of nutrient-enriched post-discharge formula ( PDF ) with st and ard term formula ( TF ) on bone strength of very low birth weight ( VLBW ) infants in the first six months post-term . Methods : Two matched groups of VLBW infants were r and omly assigned to enriched PDF ( n=10 ) or TF ( n=10 ) at corrected age of 40 weeks . Anthropometric measurements of growth and measurements of bone speed of sound ( SOS ) indicating bone strength and bone turnover markers ( bone-specific alkaline phosphatase and cross-linked carboxy terminal telopeptide of type I collagen ) were taken at term and at three and six months corrected age . Results : The anthropometric measurements of infants fed PDF and TF were comparable at three and six months corrected age . Bone SOS of the PDF group increased from 2760±113 m/s at term to 2877±90 m/s and 3032±60 m/s at three and six months corrected age , respectively ( P<0.001 ) . Likewise , bone SOS of the TF group increased from 2695±116 m/s at term to 2846±72 and 2978±83 m/s at three and six months , respectively ( P<0.001 ) . No statistically significant difference was found between the groups in terms of growth and bone SOS measurements . The levels of both bone turnover markers decreased significantly during the study period ( P<0.001 for both groups ) . Conclusion : Feeding with PDF after term had no short-term beneficial effect on bone strength and bone turn-over of VLBW infants BACKGROUND . Knowledge of long-term growth of extremely preterm infants in relation to gestational age is incomplete , and there are concerns regarding their poor growth in early childhood . As part of a longitudinal study of a national cohort of infants born at < 26 weeks ' gestation ( extremely immature ) , growth development from birth to the age of 11 years was examined , and correlates of growth attainment were analyzed . METHODS . Two hundred forty-seven extremely immature children were born alive from April 1990 through March 1992 in the whole of Sweden , and 89 ( 36 % ) survived .  Growth and neurosensory outcomes of all extremely immature survivors were evaluated at 36 months of age . Eighty-six ( 97 % ) extremely immature children were identified and assessed at 11 years of age . In this growth study , 83 extremely immature infants ( mean [ SD ] : birth weight , 772 g [ 110 g ] ; gestational age , 24.6 weeks [ 0.6 weeks ] ) without severe motor disability were followed up prospect ively from birth to 11 years old and compared with a matched group of 83 children born at term .  z scores for weight , height , head circumference , and BMI were computed for all children . We also examined gender-specific longitudinal growth measures . Predictors of 11-year growth were studied by multivariate analyses . RESULTS . Extremely immature children were significantly smaller in all 3 growth parameters than the controls at 11 years . Extremely immature children showed a sharp decline in weight and height z scores up to 3 months ' corrected age , followed by catch-up growth in both weight and height up to 11 years . In contrast to weight and height , extremely immature children did not exhibit catch-up growth in head circumference after the first 6 months of life . The mean BMI z scores increased significantly from 1 to 11 years in both groups . The mean BMI change between 1 and 11 years of age was significantly larger in extremely immature than in control participants . Extremely immature girls showed a faster weight increase than extremely immature boys , whereas catch-up growth in height and head circumference was similar in these groups . Multiple-regression analyses revealed that preterm birth and parental height were significant predictors of 11-year height , and group status ( prematurity ) correlated strongly with head circumference . CONCLUSIONS . Children born at the limit of viability attain poor growth in early childhood , followed by catch-up growth to age 11 years , but remain smaller than their term-born peers . Strategies that improve early growth might improve the outcome Objective . At hospital discharge , preterm infants may have low body stores of nutrients , deficient bone mineralization , and an accumulated energy deficit . This double-blind , r and omized study evaluated the growth of premature infants with birth weights < 1800 g who were fed a 22 kcal/fl oz nutrient-enriched postdischarge formula ( PDF ) or a 20 kcal/fl oz term-infant formula ( TF )  from hospital discharge to 12 months ' corrected age ( CA ) . Methods . Infants were r and omized to PDF or TF a few days before hospital discharge with stratification by gender and birth weight ( < 1250 g or ≥1250 g ) . The formulas were fed to 12 months ' CA . Growth was evaluated using analysis of variance controlling for site , feeding , gender , and birth weight group . Interaction effects were also assessed . Secondary analyses included a repeated measures analysis and growth modeling . Results . One hundred twenty-five infants were r and omized ; 74 completed to 6 months ' CA and 53 to 12 months ' CA . PDF-fed infants weighed more than TF-fed infants at 1 and 2 months ' CA , gained more weight from study day 1 to 1 and 2 months ' CA , and were longer at 3 months ' CA . There were significant interactions between feeding and birth weight group — among infants with birth weights < 1250 g , those fed PDF weighed more at 6 months ' CA , were longer at 6 months ' CA , had larger head circumferences at term 1 , 3 , 6 , and 12 months ' CA , and gained more in head circumference from study day 1 to term and to 1 month CA . The repeated measures and growth modeling analyses confirmed the analysis of variance results . The PDF formula seemed to be of particular benefit for the growth of male infants . Infants fed the PDF consumed less formula and had higher protein intakes at several time points . Energy intakes , however , were not different . Conclusions . Growth was improved in preterm infants fed a nutrient-enriched postdischarge formula after hospital discharge to 12 months ' CA . Beneficial effects were most evident among infants with birth weights < 1250 g , particularly for head circumference measurements We conducted a double-blinded , r and omized trial in premature infants after hospital discharge to test the hypotheses that growth and biochemical responses in those fed a formula with a reduced protein content ( 1.3 gm/dl ) would be similar to those in infants fed a  st and ard infant formula ( protein 1.5 gm/dl ) . Twenty low birth weight infants were followed for 16 weeks from the time of hospital discharge . Growth ( weight , length , and head circumference ) and biochemical responses ( total protein , prealbumin , retinol-binding protein , and blood urea nitrogen values ) were similar in the two groups of infants . Plasma amino acids reflected the differences in protein intakes and were similar to previously reported values for premature infants fed human milk or formula . These results demonstrate similar growth and biochemical responses in preterm infants fed a st and ard infant formula  and a formula with a protein content closer to that of human milk The objective of this study was to determine whether the growth and bone mineral status of discharged preterm infants fed human milk  differed from those of infants fed one of three different formulas varying in calcium content ( 545 mg/L , 660 mg/L , or 1290 mg/L ) . A r and omized , blinded study was conducted for 16 weeks after discharge in 16 human milk-fed and 43 formula-fed infants . All formula-fed infants received one of the three study formulas from discharge to 8 weeks afterward , and the st and ard formula , which contained 545 mg/L calcium , from 8 to 16 weeks . The human milk-fed infants gained weight more slowly than the formula-fed infants . The human milk-fed infants also had lower gains in length and higher serum alkaline phosphatase values than the formula-fed infants . The infants who received the formula containing the highest calcium concentration ( 1290 mg/L ) had greater bone mineral density during the first 8 weeks of the study . We conclude that preterm infants recently discharged from the hospital may benefit from higher calcium intake than is provided by either human milk or st and ard term formula Summary . Background : Most preterm infants are still preterm and have a low birth weight when they are discharged from the hospital . An important issue is whether the long-term consequences of early growth restriction can be diminished by nutritional intervention in preterm infants after discharge from the hospital . Aim : To evaluate differences in growth and in weight gain composition of preterm infants fed st and ard term formula ( SF ) or enriched formula ( PDF ) after discharge from hospital during the first 2 months of life . Methods : Thirty-three healthy preterm infants , birth weight < 1750 g at gestational age < 35 weeks , were r and omised to SF or PDF at the time of discharge from hospital . Anthropometric variables were studied longitudinally and body composition was measured using dual energy x-ray absorptiometry ( DEXA ) twice , before hospital discharge and two months later . Weight gain composition was calculated as the difference between the two determinations . Results : Seventeen infants were fed SF and 16 PDF .  Anthropometric variables and whole body composition were similar at birth , at the start of the nutritional study ( mean age 45 days ) , and at the end of the study 2 months later . Over the whole study period , weight gain and weight gain composition were similar in the two groups . Sex did not appear to influence weight gain and weight gain composition . In infants with growth restriction at discharge there was a significant reduction of weight gain , fat mass gain , and bone mineral content deposition independently of the formula provided . Conclusions : There is no immediate effect on preterm infants of a nutrient enriched formula compared with a st and ard formula on growth , weight gain , or weight gain composition OBJECTIVES ( 1 ) To determine whether nutrient malabsorption or inadequate nutrient intake were involved in the cause of growth delay in patients with bronchopulmonary dysplasia , and ( 2 ) to determine whether a nutrient-enriched formula given to infants with bronchopulmonary dysplasia to 3 months corrected age improves the rate of growth with greater lean and bone mass accretion when compared with infants fed an isoenergetic st and ard infant formula . STUDY DESIGN A blinded , nutrition intervention trial of 60 preterm infants with bronchopulmonary dysplasia ( birth weight , 866 + /- 169 g , gestational age , 26 + /- 1.5 weeks ) r and omized to either nutrient-enriched formula or st and ard formula .  Growth , body composition , and nutrient retention were compared between groups by Student 's t tests and analysis of covariance . RESULTS Infants fed the enriched formula had significantly greater nitrogen and mineral retention at 38 weeks ' postmenstrual age , and only the infants fed enriched formula had zinc retention similar to the intrauterine accretion . At 3 months corrected age infants fed enriched formula attained greater length ( P < .05 ) , greater radial bone mineral content ( P < .01 ) , and greater lean mass ( P < .01 ) . The male infants in the enriched formula group had greater whole body bone mineral content than did male infants in the st and ard formula group ( P = .02 ) . CONCLUSIONS Greater linear growth and lean and bone mass in the enriched formula group suggests that infants with bronchopulmonary dysplasia attain faster " catch-up " growth when fed higher intakes of protein , calcium , phosphorus , and zinc than provided in st and ard proprietary formulas BACKGROUND Nutrient intakes meeting recommended dietary intakes ( RDIs ) take time to establish and once established are rarely maintained throughout hospital stay in preterm infants . A nutrient deficit , therefore , accrues . RDI are based on needs for maintenance and growth , with no provision to replace this deficit . We , therefore , hypothesized that postnatal malnutrition and growth retardation were inevitable in infants fed current RDI . METHODOLOGY Dietary intakes were prospect ively collected , by a single observer ( N.P. ) , on a daily basis in a group of preterm infants ( n = 105 ; birth weight < /=1750 g ; gestational age < /=34 weeks ) admitted to neonatal intensive care unit over a 6-month period . Actual was subtracted from recommended energy ( 120 kcal/kg/day ) and protein ( 3 g/kg/day ) intakes and nutritional deficits calculated . Infants were weighed on admission and throughout hospital stay . The data were analyzed using a combination of repeated measures analysis of variance and stepwise regression analysis . RESULTS Nutrient intakes meeting current RDIs were rarely achieved during early life . By the end of the first week , cumulative energy and protein deficits were 406 + /- 92 and 335 + /- 86 kcal/kg and 14 + /- 3 and 12 + /- 4 g/kg in infants < /=30 and those at > /=31 weeks . By the end of the fifth week , cumulative energy and protein deficits were 813 + /- 542 and 382 + /- 263 kcal/kg and 23 + /- 12 and 13 + /- 15 g/kg and the z scores were -1.14 + /-.6 and -.82 + /-.5 for infants at < /=30 and > /=31 weeks . Stepwise regression analysis indicated that variation in dietary intake accounted for 45 % of the variation in changes in z score . CONCLUSIONS Preterm infants inevitably accumulate a significant nutrient deficit in the first few weeks of life that will not be replaced when current RDIs are fed . This deficit can be directly related to subsequent postnatal growth retardation.postnatal growth retardation , preterm infants BACKGROUND The purpose of the present study was to determine the effect of feeding nutrient-enriched preterm formula to preterm infants until 6 months ' corrected age ( CA ) on growth and development in the first 18 months of life . METHODS Very low-birthweight preterm infants were fed preterm formula until term ( 40 weeks CA ) . Infants were then assigned to one of three groups and were fed term formula until 6 months ' CA ( group 1 , n= 29 ) ; preterm formula to 3 months ' CA and then term formula to 6 months ' CA ( group 2 , n= 30 ) ; or preterm formula until 6 months ' CA ( group 3 , n= 31 ) . Anthropometry was performed at term , 3 , 6 , 9 , 12 , 15 , and at s18 months ' CA . Mental and psychomotor development were assessed using the Bayley Scales of Infant Development II at 18 months ' CA . RESULTS Although body weight , length , head circumference and z score for CA at term in group 3 were significantly lower than those of groups 1 and 2 , growth rates of these parameters were significantly higher in group 3 up to 18 months CA ' , as compared to groups 1 and 2 . The mental developmental index and psychomotor developmental index of the Bayley test were not significantly different between the three groups . CONCLUSIONS Very low-birthweight preterm infants fed nutrient-enriched preterm formula until 6 months ' CA demonstrated significantly improved growth rates for bodyweight , length and head circumference , and comparable mental and psychomotor development throughout the first 18 months of life
BACKGROUND Preterm infants are often growth-restricted at hospital discharge .
Feeding nutrient-enriched formula rather than st and ard formula to infants after hospital discharge might facilitate ' catch-up ' growth and might improve development .
OBJECTIVES To compare the effects of nutrient-enriched formula versus st and ard formula on growth and development of preterm infants after hospital discharge .