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Low energy intake during the first 4 weeks of life increases the risk for severe retinopathy of prematurity in extremely preterm infants
  1. Elisabeth Stoltz Sjöström1,
  2. Pia Lundgren2,
  3. Inger Öhlund1,
  4. Gerd Holmström3,
  5. Ann Hellström2,
  6. Magnus Domellöf1
  1. 1Department of Clinical Sciences, Paediatrics, Umeå University, Umeå, Sweden
  2. 2Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
  3. 3Department of Neuroscience, Ophthalmology, Uppsala University, Uppsala, Sweden
  1. Correspondence to Dr Magnus Domellöf, Department of Clinical Sciences, Paediatrics, Umeå University, Umeå 901 85, Sweden; magnus.domellof{at}


Objectives Poor weight gain during the first weeks of life in preterm infants is closely associated with the risk of developing the retinopathy of prematurity (ROP) and insufficient nutrition might be an important contributing factor. This study aimed to evaluate the effect of energy and macronutrient intakes during the first 4 weeks of life on the risk for severe ROP (stages 3–5).

Study design A population-based study including all Swedish extremely preterm infants born before 27 gestational weeks during a 3-year period. Each infant was classified according to the maximum stage of ROP in either eye as assessed prospectively until full retinal vascularisation. The detailed daily data of actual intakes of enteral and parenteral nutrition and growth data were obtained from hospital records.

Results Of the included 498 infants, 172 (34.5%) had severe ROP and 96 (19.3%) were treated. Energy and macronutrient intakes were less than recommended and the infants showed severe postnatal growth failure. Higher intakes of energy, fat and carbohydrates, but not protein, were significantly associated with a lower risk of severe ROP. Adjusting for morbidity, an increased energy intake of 10 kcal/kg/day was associated with a 24% decrease in severe ROP.

Conclusions We showed that low energy intake during the first 4 weeks of life was an independent risk factor for severe ROP. This implies that the provision of adequate energy from parenteral and enteral sources during the first 4 weeks of life may be an effective method for reducing the risk of severe ROP in extremely preterm infants.

  • growth failure
  • macronutrients
  • malnutrition
  • nutritional intakes
  • preterm infants

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