Growth and energy and protein intake of preterm newborns in the first year of gestation-corrected age
Keywords:
Premature infants, Growth, Nutritional evaluation, DietAbstract
CONTEXT: There are few longitudinal studies that analyze the growth and nutritional status parameters of children born prematurely. OBJECTIVE: To evaluate the growth and dietary intake of preterm newborns in the first year of gestation-corrected age. DESIGN: Prospective clinical study. SETTING: Tertiary care hospital. PATIENTS: 19 children (7 male) who were born prematurely, with birth weight between 1000g and 2000g, which was adequate for the gestational age. PROCEDURES: At 3, 6, 9 and 12 months of gestation-corrected age, children were evaluated in relation to weight, height and cephalic perimeter, using the National Center for Health Statistics as the standard reference, and the Rozalez-Lopez and Frisancho standards for brachial perimeter and triceps and subscapular skinfolds. The calculated dietary intake was compared to the Recommended Dietary Allowances. MAIN MEASUREMENTS: The Z score was calculated for the weight/age, height/age and weight/height relationships, and the percentiles of the perimeters and skinfolds were considered. Dietary intake records were made using the 24-hour Dietary Recall and the Food Frequency Intake Questionnaire methods. The Virtual Nutri software was used to calculate energy and protein intake. RESULTS: The weight/age, height/age and weight/ height relationships and the brachial perimeter and triceps skinfold were statistically greater in the first semester in relation to the second. The cephalic perimeter remained above the 50th percentile for the ages studied and there was no difference in the subscapular skinfold between the first and second semesters, remaining below the 50th percentile. The calorie and protein intake, although statistically lower in the first than in the second semester, always remained above the recommended. CONCLUSIONS: The pace of growth is greater in the first semester than in the second, not reaching the standard expected for full-term newborns, with the exception of the cephalic perimeter, which remains adequate. Calorie/protein intake shows an inverse relationship with growth speed, remaining above the recommended for full-term newborns, although with difficulty in depositing subcutaneous fat, in spite of the high caloric intake.
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Ministério da Saúde. Datasus; 2001. [cited on August 16, 2001]. Available at URL: http://www.seade.gov.br.
Guyer B, MacDorman MF, Martin JA, et al. Annual summary of vital statistics 1997, Pediatrics 1998;102(6):1333-49.
Ericson A, Eriksson M, Källén B, et al. Socioeconomic vari- ables and pregnancy outcome. Birthweight in singletons. Acta Paediatr Scand 1989;360 (Suppl):48-55.
Samueloff A, Schimmel MS, Eidelman AI. Grand multiparity. Is it a perinatal risk? Clin Perinatol 1998;25(3):529-38.
Guo SS, Roche AF, Chumlea WC, et al. Growth in weight, recumbent length, and head circumference for preterm low birthweight infants during the first three years of life using ges- tation-adjusted ages. Early Hum Dev 1997;47(3):305-25.
Shaffer SG, Quirimo CL, Anderson JV, et al. Postnatal weight changes in low birth weight infants. Pediatrics 1987;79(5):702-5.
Altigani M, Murphy JF, Newcombe RG, et al. Catch-up growth in preterm infants. Acta Paediatr Scand 1989;357(Suppl):3-19.
Karlberg J, Gelander L, Albertsson-Wiklnad K. Distinctions between short and long-term human growth studies. Acta Paediatr 1993;82(8):631-4.
Goulart AL, Barros MCM, Azevedo MF, et al. Crescimento e desenvolvimento do recém-nascido pré-termo. Acta paul enfermagem 1996;9(n.esp):82-8.
Babson SG. Growth of low birth weight infants. J Pediatr 1970;77(1):11-8.
Kimura RE, Warshaw JB. Intrauterine development of gastrointestinal tract function. In: Lebenthal E, ed. Textbook of gastroenterology and nutrition in infancy. New York: Raven Press; 1981.p.39-46.
Hay WW. Nutritional requirements of extremely low birthweight infants. Acta Paediatr 1994;402(Suppl):94-9.
Lucas A, Fewtrel MS, Morley R, et al. Randomized outcome trial of human milk fortification and development outcome in preterm infants. Am J Clin Nutr 1996;64(2):142-51.
National Research Council (US). Recommended dietary allow- ances. 10th ed. Washington (DC): National Academic Press; 1989.
Sparks JW, Cetin I. Intrauterine growth. In: Hay WW, ed. Neonatal nutrition and metabolism. St Louis: Mosby; 1995.p.3-41.
Dubowitz LM, Dubowitz V, Goldberg C. Clinical assessment of gestational age in the newborn infant. J Pediatr 1970;77(1):1-10.
Capurro H, Konichezky S, Fonseca D, et al. A simplified method for diagnosis of gestational age in the newborn infant. J Pediatr 1978;93(1):120-2.
Ballard JL, Khoury JC, Wedik K, et al. New Ballard Score, ex- panded to include extremely premature infants. J Pediatr 1991;119(3):417-23.
Dunn PM. The search for perinatal definitions and standards. Acta Paediatr Scand 1985;319(Suppl):7-16.
Jelliffe DB. The assessment of the nutritional status of the com- munity. Geneva: WHO; 1966.p.291 [Monograph Series, 53].
Hamil PV, Drizd TA, Johnson CL, et al. Physical growth: Na- tional Center for Health Statistics percentiles. Am J Clin Nutr 1979;32(3):607-29.
Dean AG, Dean JA, Coulombier D, et al. Epi-Info: a word processing, database, and statistics program for epidemiology on microcomputers. [computer program]. Version 6. Atlanta (Georgia): Centers for Disease Control and Prevention; 1994.
Rosales-López A, Martínez-Meza A, Sánchez-Aguilar G, et al. Crecimiento físico diferencial durante el primer años de vida. III. Composición corporal. Bol Med Hosp Infant Mex 1992;49(12):823-31.
Frisancho AR. New norms of upper limb fat and muscle areas for assessment of nutritional status. Am J Clin Nutr 1981;34(11):2540-45.
Beaton GH, Milner J, Mc Guire, et al. Source of variance in 24-hour dietary recall data: implications for nutrition study de- sign and interpretation. Carbohydrate sources, vitamins, and minerals. Am J Clin Nutr 1983;37(6):986-95.
Basiotis PP, Welsh SO, Cromin FJ, et al. Number of days of food intake records required to estimate individual and group nutrient intakes with defined confidence. J Nutr 1987;117(9):1638-41.
Philippi ST, Szarfac SC, Laterza CR. Virtual Nutri: sistema de análise nutricional. [computer program]. Version 1.0. São Paulo (SP):; 1996.
Euclides MP. Nutrição do lactente [thesis]. Viçosa: Federal Uni- versity of Viçosa; 1997.
Siegel S, Castellan Jr NJ. Nonparametric statistics. New York:McGraw-Hill; 1988.
Hollander M, Wolff DA. Nonparametric statistical methods. New York: John Wiley & Sons; 1973.
Bryson SR, Theriot L, Ryan NJ, et al. Primary follow-up care in a multidisciplinary setting enhances catch-up growth of very- low-birth-weight infants. J Am Diet Assoc 1997;97(4):386-90.
Brandt I. Growth dynamics of low-birth-weight infants. Acta Paediatr Scand 1985;319(Suppl):38-47.
de Bruin NC, Degenhart HJ, Gàl S, et al. Energy utilization and growth in breast-fed and formula-fed infants measured pro- spectively during the first year of life. Am J Clin Nutr 1998;67(5):885-96.
Cooke RJ, Griffin IJ, McCormick K, et al. Feeding preterm in- fants after hospital discharge: effect of dietary manipulation on nutrient intake and growth. Pediatr Res 1998;43(3):355-60.
Ernst JA, Bull MJ, Rickard KA, et al. Growth outcome and feeding practices of the very low birth weight infant (less than 1500 grams) within the first year of life. J Pediatr 1990;117(Suppl):156-66.
Hendricks KM. Nutritional assessment: anthropometrics and growth. In: Hendricks KM, Duggan C, Walker WA, eds. Manual of pediatric nutrition. 3rd ed. London: BC Decker; 2000.p.9-51.
Kennedy TS, Oakland MJ, Shaw RD. Growth patterns and nutritional factors associated with increased head circumference at 18 months in normally developing, low-birth weight infants. J Am Diet Assoc 1999;99(12):1522-6 .
Georgieff MK, Mills MM, Zempel CE, et al. Catch-up growth, muscle and fat accretion, and body proportionality of infants one year after newborn intensive care. J Pediatr 1989;114(2):288-92 .
Sauve RS, Geggie JH. Growth and dietary status of preterm and term infants during the first two years of life. Can J Public Health 1991;82(2):95-100.
Pereira GR, Georgieff MK. Nutritional assessment. In: Cunningham FG, MacDonald PC, Gant NF, et al. Willians’ obstetrics. 20th ed. Texas: Appleton & Lange; 1997.p.383-94.
Michaelsen KF. Nutrition and growth during infancy: The Co- penhagen Cohort Study. Acta Paediatr 1997;420(Suppl):1-36.
Bell EF. Diet and body composition of preterm infants. Acta Paediatr 1994;405(Suppl):25-8.