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Identifier 000447752
Title Θρεπτική υποστήριξη προώρων που νοσηλεύονται σε Πανεπιστημιακή Μονάδα Εντατικής Νοσηλείας Νεογνών : επιπτώσεις του ισοζυγίου ενεργειακής – πρωτεϊνικής πρόσληψης σε δείκτες ανάπτυξης και έκβασης
Alternative Title Nutritional support for premature infants hospitalized in an Academic Neonatal Intensive Care Unit
Author Λυγερού, Ιωάννα
Thesis advisor Μπριασούλης, Γεώργιος
Reviewer Ηλία, Σταυρούλα
Χατζηδάκη, Ελευθερία
Abstract Introduction: Preterm birth is a nutritional emergency, and the nutritional support of preterm infants constitutes a major challenge in the Neonatal Intensive Care Units and a broad field of discussion in the literature. Preterm neonates need adequate energy for thermoregulation, growth, and dealing with acute illness. Simultaneously, physiological immaturity and limited nutrient storage expose preterm neonates to the risk of malnutrition soon after birth. Nutritional support should aim towards a satisfactory growth rate, comparable to intrauterine growth. Poor postnatal growth negatively affects the neurodevelopmental outcome of preterms, making them susceptible to short periods of undernourishment. Aim: In this study, we have aimed to document the nutritional support of preterm neonates admitted to the NICU and to calculate the energy and protein balance, to explore their impact on growth and outcome. Furthermore, our study intends to examine the adherence of the currently used protocols with the most recently published guidelines. Material and Methods The study was conducted in the University Hospital of Heraklion NICU. Data were collected retrospectively from medical records of patients admitted between December 2020 – May 2021. A data collection form was used containing demographic and clinical information as well as details about nutritional care. Neonates were classified based on gestational age and birth weight. Percentiles and z-scores were assigned using standard curves. Exclusion criteria from the study were the presence of syndromes or congenital defects that rule out enteral nutrition and severe perinatal asphyxia. Results: We included 90 neonates in the study, 53 (58.9%) of whom were boys. Late preterms 34-36+6 GA comprised the majority of our population (49, 54.4%). Most neonates belonged to the birthweight group 1500-2500gr (58.9%). 16.7% of neonates were classified as SGA most of them being <32 weeks GA. Lower clinical severity MSNS scores were found with declining gestational age (p=0.001). Respiratory distress was the most common cause of admission apart from prematurity. Six neonates required invasive mechanical ventilation, with higher frequency being in the <32 weeks GA group. The rest of the neonates requiring respiratory support (40/46), were treated with nasal CPAP. The most commonly encountered complication was intraventricular hemorrhage (n=9, 10%). Length of stay differed significantly between GA groups and was independently associated with the age of birth (Beta -0.89, p=0.047). Time to initiate enteral feeding and duration of parenteral feeding were significantly increased with lower GA (p=0.001). Furthermore, full enteral feeding was achieved later in the very preterm (7.4 days) and extremely preterm (13 days) groups (p=0.001). The type of enteral nutrition did not differ between groups and was mostly comprised of mixed enteral feeds (formula and breast milk). No cases of NEC were recorded. Biochemical complications of parenteral nutrition were recorded mainly in preterms of smaller GA. The daily cumulative enteral and parenteral caloric intake increased significantly from 87 Kcal/kg/d on the 3rd day to 121 Kcal/kg/d on days 7 and 14, providing a positive energy balance in all neonates >28 weeks GA. The daily cumulative protein intake increased significantly from 2.3 g/kg/d on the 3rd day to 2.8 g/kg/d on days 7 and 14 (p<0.001). The protein balance remained negative on day 7 for all preterm groups >28 weeks GA, while on day 14 it remained negative only in the late preterm subgroup. The day of maximum weight loss and days to regain birth weight were not significantly different between age groups. Upon NICU discharge, preterms born at 28-34 GA had accomplished positive z-score change for weight, length, and head circumference. Late preterms demonstrated negative z-score changes for weight and HC. Conclusions: Initiation and rapid advancement of enteral feeds in preterm neonates is feasible and safe. Late preterms, even though they constitute the largest preterm subgroup, face special challenges. In our study, late preterms were the only group that maintained a negative protein balance on day 14 and had lower weight z-scores on discharge. Achieving a positive energy balance is feasible, as is the rapid regain of birthweight. The latter is described in the literature to be a benchmark for the optimization of nutrition and growth.
Language Greek
Subject Nutrition
Prematurity
Standard curves
Θρέψη
Ισοζύγιο
Προωρότητα
Πρωτεϊνη
Issue date 2022-03-30
Collection   School/Department--School of Medicine--Department of Medicine--Post-graduate theses
  Type of Work--Post-graduate theses
Permanent Link https://elocus.lib.uoc.gr//dlib/7/3/4/metadata-dlib-1651054744-836201-16612.tkl Bookmark and Share
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