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Yersinia enterocolitica and...

PEDIATRICS Vol. 110 No. 6 December 2002, pp. 1125-1132

Intersite Differences in Weight Growth Velocity of Extremely Premature Infants

Irene E. Olsen, PhD, RD*,{ddagger},§, Douglas K. Richardson, MD, MBA{ddagger},#, Christopher H. Schmid, PhD||,**, Lynne M. Ausman, DSc, RD§,||,¶ and Johanna T. Dwyer, DSc, RD§,||,#,¶,{ddagger}{ddagger}

* Departments of Nutrition
{ddagger} Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
§ Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy
|| School of Medicine
Jean Mayer Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts
# Department of Maternal and Child Health, Harvard School of Public Health, Boston, Massachusetts
** Biostatistics Research Center, Division of Clinical Care Research
{ddagger}{ddagger} Frances Stern Nutrition Center, New England Medical Center, Boston, Massachusetts

--> Objective. To explain differences in weight growth velocity of extremely premature infants among 6 level III neonatal intensive care units (NICUs).

Methods. In 6 NICUs, we studied 564 infants, stratified by gestational age (GA), who were first admissions, survivors, <30 weeks’ GA at birth, and in the NICU at least 16 days. Case mix (eg, birth weight, GA, race, illness severity, prenatal steroids), exposure to medical practices/complications (eg, respiratory support, postnatal steroids, necrotizing enterocolitis, infection), and nutritional intake (kcal/kg/d and protein in g/kg/d) were collected and used to predict weight growth velocity between day 3 and day 28 (or discharge, if transferred early) in multiple linear regression models.

Results. Weight growth velocities varied significantly among the 6 NICUs. Adjustment for case mix and medical factors explained little of this variability, but additional control for calorie and especially protein intake accounted for much of the intersite variability. For the average infant, adjusted growth velocity ranged from 10.4 to 14.3 g/kg/d among the sites studied. The final predictive model, including case mix and medical and nutritional factors, explained 53% of the overall variance in growth velocity. Prolonged (>=15 days) exposure to postnatal steroids and greater severity of illness both decreased growth velocity. The model predicted that adding 1 g/kg/d protein to the mean intake for our sample would increase growth by 4.1 g/kg/d.

Conclusions. Variation in nutrition explained much of the difference in growth among the NICUs studied. Mean intake of calories and protein failed to meet recommended levels, and the average growth in only 1 NICU approximated intrauterine growth standards. Increasing nutritional intake into the recommended ranges, in particular of protein, may increase growth of extremely premature infants up to or above intrauterine rates.

Key Words: premature infants • growth • transfer bias • case mix • nutrition • protein • steroids • SNAP

Abbreviations: NICU, neonatal intensive care unit • NEC, necrotizing enterocolitis • GA, gestational age • VLBW, very low birth weight • SNAP, Score for Neonatal Acute Physiology • CI, confidence interval

Received for publication Oct 4, 2001; Accepted Jun 18, 2002.




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