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Enhanced Feeding and Diminished Postnatal Growth Failure in Very-Low-Birth-Weight Infants

Moltu, Sissel J.*; Blakstad, Elin W.; Strømmen, Kenneth*; Almaas, Astrid N.; Nakstad, Britt; Rønnestad, Arild; Brække, Kristin§; Veierød, Marit B.||; Drevon, Christian A.*; Iversen, Per O.*; Westerberg, Ane C.

Journal of Pediatric Gastroenterology & Nutrition: March 2014 - Volume 58 - Issue 3 - p 344–351
doi: 10.1097/MPG.0000000000000220
Original Articles: Hepatology and Nutrition

Objective: The aim of the present study was to determine whether an increased supply of energy, protein, essential fatty acids, and vitamin A reduces postnatal growth failure in very-low-birth-weight infants.

Methods: Fifty infants with birth weight <1500 g were randomized to an intervention (n = 24) or a control (n = 26) feeding protocol within 24 hours after birth. Forty-four infants were included in the final analysis. This study was discontinued because of an increased occurrence of septicemia in the intervention group.

Results: The intervention group had a lower mean birth weight (P = 0.03) and a higher proportion of infants small-for-gestational age (P = 0.04) than the control group. Other baseline characteristics were similar. The median (interquartile range) energy and protein supplies during the first 4 weeks of life were higher in the intervention group: 139 (128–145) versus 126 (121–128) kcal · kg−1 · day−1 (P < 0.001) and 4.0 (3.9–4.2) versus 3.2 (3.1–3.3) g · kg−1 · day−1 (P < 0.001). The infants in the intervention group regained birth weight faster (P = 0.001) and maintained their z scores for weight and head circumference from birth to 36 weeks’ postmenstrual age (both P < 0.001). The median (interquartile range) growth velocity was 17.4 (16.3–18.6) g · kg−1 · day−1 in the intervention group and 13.8 (13.2–15.5) g · kg−1 · day−1 in the control group (P < 0.001). In line with the improved growth in the intervention group, the proportion of growth-restricted infants was 11 of 23 both at birth and at 36 weeks’ postmenstrual age, whereas this proportion increased among the controls from 4 of 21 to 13 of 21 (P = 0.04).

Conclusions: Enhanced supply of energy, protein, essential fatty acids, and vitamin A caused postnatal growth along the birth percentiles for both weight and head circumference.

*Department of Nutrition, University of Oslo

Oslo University Hospital HF, Rikshospitalet

Akershus University Hospital and Faculty Division AHUS, Institute for Clinical Medicine

§Oslo University Hospital HF, Ullevål

||Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo

Atlantis Medical University College, Oslo, Norway.

Address correspondence and reprint requests to Sissel J. Moltu, MD (e-mail:

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website ( registration no.: NCT01103219.

Funding was obtained from the Research Council of Norway, the Norwegian Foundation for Health and Rehabilitation, the South-Eastern Norway Regional Health Authority, the Johan Throne Holst Foundation for Nutrition Research, and the Freia Medisinske Fond.

The authors report no conflicts of interest.

This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License, where it is permissible to download and share the work, provided it is properly cited. The work cannot be changed in any way or used commercially.

Received October 1, 2012

Accepted October 17, 2013

© 2014 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,