CURRENT ASPECTS OF NUTRITIONAL SUPPORT FOR VERY LOW AND EXTREMELY LOW BIRTH WEIGHT INFANTS IN THE NEONATAL PERIOD

Objective. To evaluate the efficiency of a procedure for the early forced dotation of essential nutrients versus the traditional tactics in very low and extremely low birth weight (VLBW and ELBW) infants. Subjects and methods. According to the time of dietary protein intake and the rates of its dose increment, all the infants were divided into 2 groups. Group 1 with forced protein donation comprised 52 premature neonates who began receiving protein not later than on the second day of life; moreover, protein donation was increased up to >3 g/kg/day on day 5 of life. Group 2 with traditional protein donation included 36 premature newborn babies who were given protein < 3 g/kg/day on day 5 of life. The amount of the dotated plastic substrate was estimated by adding the parenterally and enterally administered protein (amino acids). The results of clinical and laboratory studies were assessed until the babies were less than 37 weeks post-conceptual age or until they were discharged from hospital if it occurred earlier. Results. Within the first week of life, the daily total protein intake in Group 1 babies averaged 2.48 g/kg/day, which was 47.17% higher than that in Group 2 infants who had received a protein level of 1.17g/kg/day; within the second week of life, the mean protein intake was 3.96 versus 3.12g/kg/day, which was 21.2 % greater than that in Group 1. No differences were found in the administered protein doses during the succeeding weeks of life. The energy supply from carbohydrate and fat components was similar in the compared groups. In Groups 1 and 2, the maximum postnatal weight loss was noted on 4±1.6 and 6±2 days of life, respectively (p < 0.05). Positive weight changes or start of weight gain was seen on 5.37 and 7.14 days of life in Groups 1 and 2, respectively. There was less weight loss in Group 1 than in Group 2 (8.24 versus 9.18%). The postnatal weight loss of > 15% of the baseline birth weight, which was abnormal in premature babies, was observed in 3 and 10 infants from Groups 1 and 2, respectively (6% versus 28%;p < 0.05). In Groups 1 and 2, weight was restored to the baseline birth values on 11±4.5 and 14±4.2 days, respectively (p < 0.05). The rate of daily weight gain after weight restoration was 18.37 and 17.13 g/kg/day in Groups 1 and 2, respectively. Conclusion. In the VLBW and ELBW groups, early forced parenteral protein administration improved the time course of changes in the levels of restoration of primary loss of weight and its further gain in the neonatal period, which can promote better nursing results, a shorter hospital stay, and lower treatment cost.

neonatal infant, parenteral feeding, nutritional support, premature infant, very low and extremely low birth weight, amino acids, fats