Arch Dis Child Fetal Neonatal Ed 1997;77:F4-F11 ( July )

Randomised controlled trial of an aggressive nutritional regimen in sick very low birthweight infants

David C Wilson, Pamela Cairns, Henry L Halliday, Mark Reid, Garth McClure, John A Dodge

Royal Maternity Hospital, Belfast and Department of Child Health, The Queen's University of Belfast, Northern Ireland

Correspondence to: Dr D C Wilson Division of Gastroenterology and Nutrition, Department of Paediatrics, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8.

Accepted 3 March 1997

AIMSTo improve energy intake in sick very low birthweight (VLBW) infants; to decrease growth problems, lessen pulmonary morbidity, shorten hospital stay, and avoid possible feeding related morbidity. Morbidity in VLBW infants thought to be associated with parenteral and enteral feeding includes bronchopulmonary dysplasia, necrotising enterocolitis, septicaemia, cholestasis and osteopenia of prematurity.
METHODSA prospective randomised controlled trial (RCT) comparing two types of nutritional intervention was performed involving 125 sick VLBW infants in the setting of a regional neonatal intensive care unit. Babies were randomly allocated to either an aggressive nutritional regimen (group A) or a control group (group B). Babies in group B received a conservative nutritional regimen while group A received a package of more aggressive parenteral and enteral nutrition. Statistical analysis was done using Student's t test, the Mann-Whitney U test, the ² test and logistic regression.
RESULTSThere was an excess of sicker babies in group A, as measured by initial disease severity (P <0.01), but mean total energy intakes were significantly higher (P <0.001) in group A at days 3 to 42 while receiving total or partial parenteral nutrition. Survival and the incidences of bronchopulmonary dysplasia, septicaemia, cholestasis, osteopenia and necrotising enterocolitis were similar in both groups. Growth in early life and at discharge from hospital was significantly better in babies in group A. There were no decreases in pulmonary morbidity or hospital stay.
CONCLUSIONNutritional intake in sick VLBW infants can be improved without increasing the risk of adverse clinical or metabolic sequelae. Improved nutritional intake resulted in better growth, both in the early neonatal period and at hospital discharge, but did not decrease pulmonary morbidity or shorten hospital stay.

Keywords: very low birthweight infant; nutrition; bronchopulmonary dysplasia; necrotising enterocolitis

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© 1997 by Archives of Disease in Childhood
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