Nutrient Intake and Growth of Infants Enrolled in the Donor Milk for Improved Neurodevelopmental Outcomes (GTA‐DoMINO) Trial: Comparison to Clinical Targets
Authors: Bishara Rosine , Ng Dawn , Asbury Michelle , Ng Eugene , Unger Sharon , Gibbins Sharyn , O'Connor Deborah L 
Published: November 2023

Background

Very low birth weight (VLBW) infants often grow slower than targets, increasing their risk of adverse long‐term outcomes. Subgroups within VLBW infants, such as infants born < 26 weeks gestation, require disproportionately more resources and have higher risks of morbidities and slower growth, than bigger more mature infants. Current research is lacking on growth and nutrient intakes of small immature VLBW infants and those with morbidities.

Objectives

To describe and assess relationships between growth and nutrient intakes of VLBW infants against commonly used clinical metrics.

Methods

Daily estimated macronutrient intakes, expressed breast milk (EBM) volumes, and weekly weights were collected prospectively from birth until 36 weeks corrected age for 302 infants that remained in the study for ≥ 28 days. Average growth using growth velocity (GV) and changes in z‐score, energy and nutrient intakes (mean ± SD), and median (1st, 3rd quartile) EBM volume were assessed for VLBW infants, infants born < and ≥ 1000g, < and ≥ 26 weeks gestation, and infants with and without morbidities (patent ductus arteriosus, necrotizing enterocolitis, retinopathy of prematurity, brain injury or chronic lung disease) using univariate analysis and Wilcoxon rank sum test. Relationships between intakes and growth were assessed using analysis of variance.

Results

GV and weight z‐score change were 13.8 ± 2.4 g/kg/d and −0.91 ± 0.64, respectively. Total energy (105 ± 12 kcal/kg/d) and protein (3.4 g ± 0.3 g/kg/d) intakes were below recommended targets, while carbohydrate (12 ± 1.1 g/kg/d) and lipid (5.1 ± 0.8 g/kg/d) intakes met recommendations. Total protein to energy ratio was 3.3 ± 0.3 g/100 kcal. EBM volume was 96 (78, 100) % of total enteral volume received. Smaller, more immature infants, and those with morbidities had lower nutrient intakes and slower growth than larger, more mature infants and those without morbidity. Weight z‐score change was −1.01 ± 0.68 and −0.73 ± 0.52 for infants with and without morbidity, respectively (p< 0.001) and −1.14 ± 0.76 and −0.83 ± 0.57 for infants born < and ≥ 26 weeks gestation, respectively (p<0.001). GV (g/kg/d) was similar between infants with morbidities (13.8 ± 2.3) and those without (13.7 ± 2.4) and for infants born < 26 weeks (13.8 ± 2.4) and those born ≥ 26 weeks (13.8 ± 2.4). When total energy or protein intakes exceeded 100 kcal/kg/d and 3.5 g/kg/d, respectively, growth was improved (p<0.05); however protein to energy ratio was not related to growth.

Conclusion

Growth of VLBW infants continues to fall below targets. Special attention to daily nutrient intakes in the clinical setting may have a major impact on growth. Using weight z‐score change may be more useful clinically compared to GV.

Support or Funding Information

Funded by CIHR (MOP#102638) and by The Breastfeeding Centre of Excellence, Sunnybrook Health Sciences Centre.