Background. Premature infants are at risk for many complications. Among these, growth failure and intermittent hypoxia (IH) can independently impact the outcomes of other comorbidities. Recent data suggest that IH may directly affect postnatal growth. Our study aims to evaluate the impact of IH on growth velocity in preterm infants. Methods. This prospective cohort study utilized inpatient oximetry, nutrition, and growth data to evaluate the relationship between IH and growth velocity. Enrolled infants were dichotomized by high- versus low-exposure to IH. This relationship was explored in both unadjusted analyses and generalized linear models with repeated measures. Results. The study population included 19 preterm infants, with average birth gestational age of 29 weeks, each contributing one or more measures of weekly data. Infants in the high-exposure cohort had lower birth weight, higher rates of bronchopulmonary dysplasia, and longer duration of respiratory support and caffeine treatment. The unadjusted analysis revealed a marginally significant trend towards higher IH rates during weeks of slower growth. The logistic regression with repeated measures analysis also supported increased odds of slower growth associated with higher IH rates, but this relationship was also only marginally significant. Conclusion. Our study suggests a relationship between exposure to IH and slower growth velocity in preterm infants. The prospectively collected data allowed for accurate measures of IH, growth, and nutrition, but the small sample size likely contributed to the lack of significance of our results.

No description available.

Background Modern neonatal care has improved the survival rate of extremely preterm infants. These infants are at high risk of malnutrition and growth failure during 3-4 months of hospital care. The objectives of this study was to investigate nutritional intakes during hospitalization and explore associations between nutritional intakes, postnatal growth and retinopathy of prematurity (ROP). Perioperative nutrition in infants undergoing surgery for patent ductus arteriosus (PDA) was also investigated. Methods This is a population-based study of Swedish extremely preterm infants (<27 weeks) born during 2004-2007 (n=602). Detailed data on nutritional supply and anthropometric measurements during hospitalization were retrospectively retrieved from hospital records. Comprehensive data on cohort characteristics, neonatal morbidity and infant mortality were obtained from the Extremely Preterm Infants in Sweden Study (EXPRESS). Results During the first 70 days of life, intakes of energy, protein and several micronutrients, with the exception of iron and some vitamins, were less than estimated requirements, and infants showed severe postnatal growth failure. Energy and protein intake predicted growth in all anthropometric outcomes even when adjusting for severity of illness, and fat intake was positively associated with head growth. Low folate intake was positively correlated with poor weight and length gain while high iron intake, mainly explained by blood transfusions, was negatively associated with poor length gain. Furthermore, a low energy intake was associated with severe ROP (stage 3-5). An increased energy intake of 10 kcal/kg/d was associated with 24% decrease in severe ROP (p=0.01). During the first month, 99% of the infants were exclusively fed human milk. Infants who underwent surgery for PDA (n=140) were malnourished, with energy and macronutrient intakes below minimum estimated requirements before, during and after surgery. Conclusions The severe postnatal growth failure observed in Swedish extremely preterm infants may be prevented by improved intakes of energy, protein, fat and folate and a reduction of the number of blood transfusions. Human milk is the main enteral food source and analyses of human milk macronutrient contents facilitates individualized fortification. Provision of adequate energy intakes during the first four weeks of life may be an effective way to reduce the risk of severe ROP. Perioperative nutrition in infants undergoing PDA surgery needs to be improved. The study results have important implications for nutritional regimens, postnatal growth and health outcome in this new generation of survivors.