Improving head growth in preterm infants - a randomised controlled trial. I: Neonatal outcomes

Abstract

Background: Infants born very preterm are at an increased risk of poor growth in the postnatal period. Poor brain growth in this critical period may result from inadequate nutrition, and has long-term effects on neurodevelopmental outcome.

Aims: To examine the feasibility of providing macronutrients at amounts above current recommendations (hyperalimentation) to improve nutrition and head growth in preterm infants.

Methods: 142 infants <29 weeks gestation were randomised to hyperalimented or standard parenteral and enteral nutrition. Growth was monitored from birth to 36 weeks postmenstrual age (PMA). The primary outcome measure was occipitofrontal circumference (OFC) at 36 weeks PMA.

Results:55 infants in the intervention group and 59 in the control group survived to 36 weeks PMA. 11(16%) in intervention and 13 (18%) in control group were small for gestational age (SGA). There was no statistically significant difference between the two groups in the primary outcome measure or other growth variables. Babies in the intervention group received significantly more energy and protein, but 80% were still in a cumulative protein/energy deficit at the end of four weeks. 20 (24%, p=0.008) of those in deficit at 4 weeks had an OFC of more than 2SD below the mean at 36 weeks PMA, as opposed to none of those not in deficit.

Conclusion: Cumulative energy/protein deficit is predictive of poor head growth, but the delivery of adequate intakes remains a challenge in the preterm.