Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Improved growth and decreased morbidities in <1000 g neonates after early management changes

Journal of Perinatology volume 28, pages 347–353 (2008)Cite this article

Abstract

Objective:

To test the hypothesis that three changes in the early management of extremely low birth weight (ELBW) neonates would decrease the incidence of extra-uterine growth restriction (EUGR) by 25%. The three early management practice changes (EMPC) included surfactant at delivery followed by immediate extubation to nasal continuous positive airway pressure (CPAP), decreased oxygen exposure and early parenteral amino acids.

Study Design:

Historical cohort study of preterm infants ⩽1000 g birth weight (BW) born at the University of Texas Medical Branch between January 2001 and June 2002 (pre-EMPC, before changes, n=87) and July 2004 to December 2005 (post-EMPC, after changes, n=76). Outcomes measured included feeding and growth parameters, morbidities and interventions. Statistical analysis included χ2-analysis, Student's t-test, and analysis of variance.

Result:

Infants in the post-EMPC cohort regained BW more quickly, maintained appropriate size for weight at 36 weeks and had less morbidity associated with poor long-term outcome. Predictors of EUGR included BW <750 g and surgical necrotizing enterocolitis.

Conclusion:

The introduction of surfactant at delivery followed by immediate extubation to CPAP, decreased oxygen exposure and early parenteral amino acids in ELBW infants is possible, safe and associated with improvements in growth and morbidity.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1

Similar content being viewed by others

References

  1. Kilbride HW, Wirtschafter DD, Powers RJ, Sheehan MB . Implementation of evidence-based potentially better practices to decrease nosocomial infections. Pediatrics 2003; 111: 519–533.

    Article  Google Scholar 

  2. Zabari M, Suresh G, Tomlinson M, Lavin JP, Larison K, Halamek L et al. Implementation and case-study results of potentially better practices for collaboration between obstetrics and neonatology to achieve improved perinatal outcomes. Pediatrics 2006; 118: 153–158.

    Article  Google Scholar 

  3. Ohlinger J, Kantak A, Lavin JP, Fofah O, Hagen E, Suresh G et al. Evaluation and development of potentially better practices for perinatal and neonatal communication and collaboration. Pediatrics 2006; 118: 147–152.

    Article  Google Scholar 

  4. Kaempf JW, Campbell B, Sklar RS, Arduza C, Gallegos R, Zabari M et al. Implementing potentially better practices to improve neonatal outcomes after reducing postnatal dexamethasone use in infants born between 501–1250 grams. Pediatrics 2003; 111: 534–541.

    Google Scholar 

  5. Kuzma-O’Reilly B, Duenas ML, Greecher C, Kimberlin L, Mujsce D, Miller D et al. Evaluation, development, and implementation of potentially better practices in neonatal intensive care nutrition. Pediatrics 2003; 111: 461–470.

    Article  Google Scholar 

  6. Battaglia FC, Lubchenco LO . A practical classification of newborn infants by weight and gestational age. J Pediatr 1967; 71: 159–163.

    Article  CAS  Google Scholar 

  7. Kirchner L, Weninger M, Unterasinger L, Birnbacher R, Hayde M, Krepler R et al. Is the use of early nasal CPAP associated with lower rates of chronic lung disease and retinopathy of prematurity? Nine years experience with the Vermont oxford neonatal network. J Perinat Med 2004; 33 (1): 60–66.

    Google Scholar 

  8. Deulofeut R, Critz A, Adams-Chapman I, Sola A . Avoiding hyperoxia in infants ⩽1250 g is associated with improved short- and long-term outcomes. J Perinatol 2006; 26: 700–705.

    Article  CAS  Google Scholar 

  9. The STOP-ROP Multicenter Study Group: Supplemental therapeutic oxygen for pre-threshold retinopathy of prematurity (STOP-ROP), a randomized, controlled trial. Pediatrics 2000; 105 (2): 295–310.

    Article  Google Scholar 

  10. Hay WW . Early postnatal nutritional requirements of the very preterm infant based on a presentation at the NICHD-AAP workshop on research in neonatology. J Perinatol 2006; 26: 13–18.

    Article  Google Scholar 

  11. Thureen PJ, Anderson AH, Baron KA, Melara DL, Hay WW, Fennessey PV . Protein balance in the first week of life in ventilated neonates receiving parenteral nutrition. Am J Clin Nutr 1998; 68: 1128–1135.

    Article  CAS  Google Scholar 

  12. Akram Khan M, Kuzma-O’Reilly B, Brodsky NL, Bhandari V . Site-specific characteristics of infants developing bronchopulmonary dysplasia. J Perinatol 2006; 26 (7): 428–435.

    Article  CAS  Google Scholar 

  13. Biniwale MA, Ehrenkranz RA . The role of nutrition in the prevention and management of bronchopulmonary dysplasia. Semin Perinatol 2006; 30 (4): 200–208.

    Article  Google Scholar 

  14. Frank L, Sosenko IR . Undernutrition as a major contributing factor in the pathogenesis of bronchopulmonary dysplasia. Am Rev Respir Dis 1988; 138 (3): 725–729.

    Article  CAS  Google Scholar 

  15. Thureen P, Melara D, Fennessey P, Hay W . Effect of low versus high intravenous amino acid intake on very low birth weight infants in the early neonatal period. Pediatr Res 2003; 53 (1): 24–32.

    Article  CAS  Google Scholar 

  16. Thureen PJ, Hay WW . Intravenous nutrition and postnatal growth of the micropremie. Clin Perinatol 2000; 27: 197–219.

    Article  CAS  Google Scholar 

  17. Ehrenkranz RA, Younes N, Lemons JA, Fanaroff AA, Donovan EF, Wright LL et al. Longitudinal growth of hospitalized very low birth weight infants. Pediatrics 1999; 104: 280–289.

    Article  CAS  Google Scholar 

  18. Latal-Hajnal B, Von Siebenthal K, Kovari H, Bucher HU, Largo RH . Postnatal growth in VLBW infants: significant association with neurodevelopmental outcome. J Pediatr 2003; 143: 163–170.

    Article  Google Scholar 

  19. Peralta-Carcelen M, Jackson DS, Goran MI, Royal SA, Mayo MS, Nelson KG . Growth of adolescents who were born at extremely low birth weight without major disability. J Pediatr 2000; 136: 633–640.

    Article  CAS  Google Scholar 

  20. Wood NS, Costeloe K, Gibson AT, Hennessy EM, Marlow N, Wilkinson AR . The EPICure study: growth and associated problems in children born at 25 weeks of gestational age or less. Arch Dis Child Fetal Neonatal Ed 2003; 88: 492–500.

    Article  Google Scholar 

  21. Ehrenkranz RA, Walsh MC, Vohr VR, Jobe AH, Wright LL, Fanaroff AA et al. Validation of the national institute of health consensus definition of bronchopulmonary dysplasia. Pediatrics 2005; 116: 1353–1360.

    Article  Google Scholar 

  22. Hintz SR, Kendrick DE, Stoll BJ, Vohr BR, Fanaroff AA, Donovan EF et al. Neurodevelopmental and growth outcomes of extremely low birth weight infants after necrotizing enterocolitis. Pediatrics 2005; 115: 696–703.

    Article  Google Scholar 

  23. Walsh MC, Kliegman RM, Hack M . Severity of necrotizing enterocolitis: influence on outcome at 2 years of age. Pediatrics 1989; 84: 808–814.

    CAS  PubMed  Google Scholar 

  24. Jackson JK, Biondo DJ, Jones JM, Moor PJ, Simon SD, Hall RT et al. Can an alternative umbilical arterial catheter solution and flush regimen decrease iatrogenic hemolysis while enhancing nutrition? A double-blind, randomized, clinical trial comparing an isotonic amino acid with a hypotonic salt infusion. Pediatrics 2004; 114: 377–383.

    Article  Google Scholar 

  25. Geary C, Caskey M, Fonseca R, Malloy M . Decreased incidence of bronchopulmonary dysplasia after early management changes, including surfactant and nasal continuous positive airway pressure treatment at delivery, lowered oxygen saturation goals, and early amino acids administration: an historical cohort study. Pediatrics 2008; 121: 89–96.

    Article  Google Scholar 

  26. Kotsopoulos K, Benadiba-Torch A, Cuddy A, Shah PS . Safety and efficacy of early amino acids in preterm &lt;28 weeks gestation: prospective observational comparison. J Perinatol 2006; 26: 749–754.

    Article  CAS  Google Scholar 

  27. Wilson DC, Cairns P, Halliday HL, Reid M, McClure G, Dodge JA . Randomized controlled trial of an aggressive nutritional regimen in sick very low birth weight infants. Arch Dis Child 1997; 77: 4–11.

    Article  Google Scholar 

  28. Pauls J, Bauer K, Versmold H . Postnatal body weight curves for infants below 1000 g birth weight receiving early enteral and parenteral nutrition. Eur J Pediatr 1998; 157: 416–421.

    Article  CAS  Google Scholar 

  29. Poindexter BB, Langer JC, Dusick AM, Ehrenkranz RA . Early provision of parenteral amino acids in extremely low birth weight infants: relation to growth and neurodevelopmental outcome. J Pediatr 2006; 148: 300–305.

    Article  CAS  Google Scholar 

  30. Heird WC . Determination of nutritional requirements in preterm infants, with special reference to ‘catch up’ growth. Semin Neonatol 2001; 6: 365–375.

    Article  CAS  Google Scholar 

  31. Hack M, Breslau N, Weismann B, Aram D, Klein N, Borawski E . Effect of VLBW and subnormal head size on cognitive abilities at school age. N Engl J Med 1991; 325: 231–237.

    Article  CAS  Google Scholar 

  32. Short EJ, Klein NK, Lewis BA, Fulton S, Eisengart S, Kercsmar C et al. Cognitive and academic consequences of bronchopulmonary dysplasia and very low birth weight: 8-year-old outcomes. Pediatrics 2003; 112: 359–366.

    Article  Google Scholar 

  33. Vohr B, Wright L, Dusick A, Perritt R, Poole K, Tyson J et al. Center differences and outcomes of extremely low birth weight infants. Pediatrics 2004; 113: 781–789.

    Article  Google Scholar 

  34. O’Shea MT, Goldstein DJ, DeRegnier RA, Sheaffer CI, Roberts DD, Dillard RG . Outcome at 4–5 years of age in children recovered from neonatal chronic lung disease. Dev Med Child Neurol 1996; 38: 830–839.

    PubMed  Google Scholar 

  35. Van Goudoever JB, Wattimena JDL, Carnielli VP, Sulkers EJ, Degenhart HJ, Sauer PJ . Effect of dexamethasone on protein metabolism in infants with bronchopulmonary dysplasia. J Pediatr 1994; 124: 112–118.

    Article  CAS  Google Scholar 

  36. Gregoire MC, Lefebvre F, Glorieux J . Health and developmental outcomes at 18 month in very preterm infants with bronchopulmonary dysplasia. Pediatrics 1998; 101: 856–860.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatrics, The University of Texas Medical Branch, Galveston, TX, USA

    C A Geary, R A Fonseca, M A Caskey & M H Malloy

Authors
  1. C A Geary
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R A Fonseca
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M A Caskey
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M H Malloy
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C A Geary.

Additional information

The authors have no real or perceived conflict of interest to declare in regards to the contents of this manuscript. There is no source of funding to report for this research.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Geary, C., Fonseca, R., Caskey, M. et al. Improved growth and decreased morbidities in <1000 g neonates after early management changes. J Perinatol 28, 347–353 (2008). https://doi.org/10.1038/jp.2008.15

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jp.2008.15

Keywords

This article is cited by

Search

Advanced search

Quick links