-
A total of 1, 463 late preterm infants were enrolled in this study, with a median (IQR) GA of 35.6 (34.9, 36.1) weeks. The percentage of small for gestational age (SGA) was 11.6% for all late preterm infants. When stratified by GA, 17% of infants born at 36 weeks' GA were born SGA. Of the enrolled late preterm infants, 3.7% developed RDS. More infants born at 34 weeks' GA were diagnosed with RDS (6.5% of infants born at 34 weeks' GA versus 2.8% of infants born at 35 weeks' GA versus 2.7% of infants born at 36 weeks' GA, P = 0.004). The incidence of hypoglycemia was 13.1%, and 2.3% of late preterm infants were diagnosed with hyperglycemia (4.3% of infants born at 34 weeks' GA versus 2.1% of infants born at 35 weeks' GA versus 1.1% of infants born at 36 weeks' GA, P = 0.023). A total of 45.0% of infants were diagnosed with hyperbilirubinemia and 14.1% with anemia. Twenty-two percent of infants were diagnosed with neonatal infection and exposed to antibiotics, of which 1.8% had blood-culture-proven sepsis, and there was no significant difference between GA groups. There was an inverse correlation between the length of hospital stay and GA. Infants born at 34 weeks' GA stayed in hospital for 10 (8, 13) days, while the hospital stay length of infants born at 36 weeks' GA was shortened to 7 (6, 9) days. Other study characteristics of our late preterm infant cohort are shown in Table 1.
Table 1. Demographic Data of Late Preterm Infants
Characteristics All Infants 34 Weeks 35 Weeks 36 Weeks P Value N (%) 1, 463 (100%) 369 (25.2%) 566 (38.7%) 528 (36.1%) GA (weeks) 35.6 (34.9, 36.1) 34.4 (34.1, 34.7) 35.4 (35.1, 35.7) 36.3 (36.1, 36.6) < 0.001 Male infants, n (%) 789 (53.9%) 207 (56.1%) 303 (53.5%) 279 (52.8%) 0.061 C-section, n (%) 962 (65.8%) 262 (71.0%) 351 (62.0%) 349 (66.1%) 0.047 Asphyxia, n (%) 21 (1.4%) 10 (2.7%) 7 (1.2%) 4 (0.8%) 0.047 W at birth (g) 2, 440 (2, 200, 2, 710) 2, 250 (2, 020, 2, 440) 2, 485 (2, 259, 2, 740) 2, 545 (2, 300, 2, 800) < 0.001 L at birth (cm) 47.0 (45.0, 48.0) 46.0 (44.0, 47.0) 47.0 (45.0, 48.0) 47.0 (46.0, 49.0) < 0.001 HC at birth (cm) 32.0 (31.5, 33.0) 32.0 (30.5, 33.0) 32.5 (32.0, 33.0) 32.5 (32.0, 33.0) < 0.001 SGA, n (%) 170 (11.6%) 28 (7.6%) 52 (9.2%) 90 (17.0%) < 0.001 RDS, n (%) 54 (3.7%) 24 (6.5%) 16 (2.8%) 14 (2.7%) 0.004 Hypoglycemia, n (%) 192 (13.1%) 52 (14.1%) 67 (11.8%) 73 (13.8%) 0.519 Hyperglycemia, n (%) 34 (2.3%) 16 (4.3%) 12 (2.1%) 6 (1.1%) 0.023 Hyperbilirubinemia, n (%) 658 (45.0%) 175 (47.4%) 241 (42.6%) 242 (45.8%) 0.319 Anemia, n (%) 207 (14.1%) 67 (18.2%) 77 (13.6%) 63 (11.9%) 0.091 Infection, n (%) 321 (21.9%) 82 (22.2%) 123 (21.7%) 116 (22.0%) 0.987 Blood-culture-proven sepsis, n (%) 27 (1.8%) 8 (2.2%) 79 (1.2%) 12 (2.3%) 0.386 W at discharge (g) 2, 480 (2, 280, 2, 750) 2, 340 (2, 138, 2, 540) 2, 530 (2, 319, 2, 790) 2, 560 (2, 335, 2, 860) < 0.001 L at discharge (cm) 47.0 (46.0, 49.0) 46.5 (45.0, 48.0) 48.0 (46.0, 49.0) 48.0 (46.0, 49.0) < 0.001 HC at discharge (cm) 33.0 (32.0, 33.5) 32.0 (31.0, 33.0) 33.0 (32.0, 33.8) 33.0 (3.0, 34.0) < 0.001 Length of stay (d) 8 (7, 11) 10 (8, 13) 8 (7, 10) 7 (6, 9) < 0.001 Note. Data are shown as x±s or percentage (median and P25, P75); GA: gestational age; W: weight; L: length; HC: head circumference; SGA: small for gestational age; RDS: respiratory distress syndrome. -
The percentage of exclusive breastfeeding was 4.5% for the entire cohort at the initiation of enteral feeding and increased to 14.4% when the infants were discharged. Most late preterm infants, approximately 46.1%, were fed with preterm infant formula (80 kcal/100 mL or 81 kcal/100 mL) during hospitalization. Post-discharge formula (73 kcal/100 mL or 74 kcal/100 mL) was used for 17.0% of late preterm infants, and 8.7% infants accepted full-term formula (67 kcal/100 mL or 68 kcal/100 mL). Mixed feeding was given for 22.9% infants, who received any kind of formula and human milk. There were 12 cases of missing data concerning enteral feeding, which accounted for 0.8%. Infants born at 35 weeks' GA received more post-discharge formula, and more infants born at 36 weeks' GA received full-term formula. Only 4.3% of infants born at 34 weeks' GA were fed exclusively with human milk after birth, 33.1% of them received mixed feeding, and the exclusive human milk feeding rate increased to 21.1% at discharge, which is higher than that in infants born at 35 weeks' and 36 weeks' GA (Table 2).
Table 2. The Nature of Enteral Feeding of Late Preterm Infants During Hospitalization
Nature All Infants
(N = 1, 463)34 Weeks
(n = 369)35 Weeks
(n = 566)36 Weeks
(n = 528)P Value Exclusive human milk feeding, n (%) 66 (4.5%) 16 (4.3%) 25 (4.4%) 25 (4.7%) 0.628 Preterm infant formula feeding, n (%) 674 (46.1%) 178 (48.2%) 258 (45.6%) 238 (45.1%) 0.473 Post-discharge formula feeding, n (%) 248 (17.0%) 41 (11.1%) 126 (22.3%) 81 (15.3%) < 0.001 Full-term formula feeding, n (%) 128 (8.7%) 8 (2.2%) 48 (8.5%) 72 (13.6%) < 0.001 Mixed feeding, n (%) 335 (22.9%) 122 (33.1%) 107 (18.9%) 106 (20.1%) < 0.001 Exclusively human milk feeing at discharge, n (%) 209 (14.4%) 77 (21.1%) 68 (12.1%) 64 (12.3%) < 0.001 The volume and energy levels of enteral nutrition at different time points are shown in Table 3. Infants born at 36 weeks' GA received a greater volume of enteral feeding on days 1 through 6 and more calories in the form of enteral feeding on days 1 through 5, but this trend was reversed on days 6 and 7 (Figures 1, 2). With the present nutritional support, only 28.4% of late preterm infants achieved full enteral feeding at discharge, and only 19.2% of late preterm infants achieved 120 kcal/(kg·d) by enteral feeding at discharge. More infants born at 34 weeks' GA achieved full enteral nutrition (41.7% of infants born at 34 weeks' GA versus 24.2% of infants born at 35 weeks' GA versus 23.7% of infants born at 36 weeks' GA, P < 0.001) and full enteral caloric intake (29.3% of infants born at 34 weeks' GA versus 16.6% of infants born at 35 weeks' GA versus 15.0% of infants born at 36 weeks' GA, P < 0.001) at discharge and received a greater volume [118.3 mL/(kg·d)] in infants born at 34 weeks' GA versus 103.0 mL/(kg·d) in infants born at 35 weeks' GA versus 105.9 mL/(kg·d) of infants born at 36 weeks' gestation, P < 0.001) and higher energy by enteral feeding [117.7 kcal/(kg·d)] in infants born at 34 weeks' GA versus 102.4 kcal/(kg·d) in infants born at 35 weeks' GA versus 100.4 kcal/(kg·d) in infants born at 36 weeks' GA, P < 0.001) at discharge. At discharge, 40.5% of infants had not regained their birth weight. Infants born at 36 weeks' GA regained their birth weight sooner, but more of them did not regain their birth weight at discharge (47.9% of infants born at 36 weeks' GA versus 38.7% of infants born at 35 weeks' GA versus 32.5% of infants born at 34 weeks' GA, P < 0.001). The mean rate of body weight gain in late preterm infants was 9.6 (5.9, 13.9) g/(kg·d). There was a trend toward a higher rate of body weight gain in infants born at 34 weeks' GA but no significant difference between different GA groups (Table 4).
Table 3. Data on Enteral Feeding Practices of Late Preterm Infants During Hospitalization
Feeding Practices All Infants
(N = 1, 463)34 Weeks
(n = 369)35 Weeks
(n = 566)36 Weeks
(n = 528)P Value Initial time of enteral feeding (d) 1.0 (1.0, 1.0) 1.0 (1.0, 1.0) 1.0 (1.0, 1.0) 1.0 (1.0, 1.0) 0.760 Volume of EN on D1 [mL/(kg·d)] 14.1 (6.5, 26.5) 12.9 (5.3, 21.6) 13.3 (7.0, 21.4) 16.3 (6.4, 32.1) < 0.001 Energy of EN on D1 [mL/(kg·d)] 10.7 (4.9, 19.9) 10.0 (4.1, 17.2) 9.9 (5.5, 16.2) 12.3 (4.9, 23.9) < 0.001 Volume of EN on D2 [mL/(kg·d)] 32.0 (17.1, 48.5) 29.7 (16.7, 43.2) 30.7 (16.0, 46.5) 35.7 (19.3, 53.3) < 0.001 Energy of EN on D2 [mL/(kg·d)] 24.4 (13.0, 36.0) 21.8 (12.3, 34.0) 23.2 (12.3, 35.2) 27.3 (14.9, 39.9) < 0.001 Volume of EN on D3 [mL/(kg·d)] 46.8 (29.3, 67.8) 43.4 (26.8, 63.4) 45.7 (27.9, 65.9) 51.2 (32.9, 75.8) < 0.001 Energy of EN on D3 [mL/(kg·d)] 35.8 (22.3, 51.3) 33.5 (20.9, 49.3) 35.1 (21.6, 49.0) 39.5 (24.4, 56.1) < 0.001 Volume of EN on D4 [mL/(kg·d)] 64.0 (42.1, 87.7) 60.0 (37.8, 84.4) 63.2 (42.7, 86.0) 67.9 (45.7, 91.4) < 0.001 Energy of EN on D4 [mL/(kg·d)] 48.3 (32.4, 66.9) 46.1 (29.3, 64.7) 48.3 (33.3, 64.9) 51.2 (34.3, 70.2) 0.002 Volume of EN on D5 [mL/(kg·d)] 82.1 (55.6, 105.4) 75.3 (52.1, 103.7) 79.5 (55.1, 100.5) 87.0 (59.0, 112.0) 0.002 Energy of EN on D5 [mL/(kg·d)] 61.1 (42.4, 80.0) 57.2 (39.9, 78.3) 59.8 (41.7, 76.4) 66.5 (43.9, 84.2) 0.011 Volume of EN on D6 [mL/(kg·d)] 95.6 (68.4, 123.4) 93.5 (67.9, 122.5) 91.3 (66.7, 119.4) 103.0 (71.4, 112.0) 0.037 Energy of EN on D6 [mL/(kg·d)] 72.0 (51.6, 92.9) 71.5 (51.9, 92.4) 69.6 (50.5, 89.8) 77.2 (52.4, 97.9) 0.083 Volume of EN on D7 [mL/(kg·d)] 108.0 (78.1, 133.3) 108.8 (77.5, 134.0) 103.8 (79.8, 131.1) 110.7 (78.0, 136.4) 0.532 Energy of EN on D7 [mL/(kg·d)] 81.5 (60.0, 101.9) 80.9 (61.3, 103.4) 80.8 (60.2, 100.2) 83.0 (58.7, 102.8) 0.804 Volume of EN at discharge [mL/(kg·d)] 108.7 (81.1, 133.0) 118.3 (94.0, 139.9) 103.0 (76.7, 130.2) 105.9 (77.7, 131.2) < 0.001 Energy of EN at discharge [mL/(kg·d)] 105.0 (84.3, 133.2) 117.7 (97.8, 151.7) 102.4 (82.5, 129.4) 100.4 (79.1, 126.6) < 0.001 Achieving 150 (mL/kg·d) at discharge n (%) 416 (28.4%) 154 (41.7%) 137 (24.2%) 125 (23.7%) < 0.001 The time achieving 150 [mL/(kg·d)] (d) 8 (7, 10) 9 (7, 11) 8 (6, 10) 7 (6, 10) 0.198 Achieving 120 (kcal/kg·d) at discharge n (%) 281 (19.2%) 108 (29.3%) 94 (16.6%) 79 (15.0%) < 0.001 The time achieving 120 [mL/(kg·d)] (d) 8 (7, 11) 9 (7, 12) 8 (7, 10) 7 (6, 9) < 0.001 Note. EN: Enteral nutrition. Table 4. Data on Body Weight Change
Items All Infants
(N = 1, 463)34 Weeks
(n = 369)35 Weeks
(n = 566)36 Weeks
(n = 528)P Value W at birth (g) 2, 440 (2, 200, 2, 710) 2, 250 (2, 020, 2, 440) 2, 485 (2, 259, 2, 740) 2, 545 (2, 300, 2, 800) < 0.001 Time with lowest W (d) 3 (3, 4) 3 (3, 4) 3 (3, 4) 2 (3, 4) 0.442 Time regained the BW (d) 6 (4, 7) 6 (5, 8) 6 (4, 7) 5 (4, 6) < 0.001 Infants who did not regain their BW at discharge, n (%) 592 (40.5%) 120 (32.5%) 219 (38.7%) 253 (47.9%) < 0.001 Length of stay of infants who did not regain their BW (d) 7 (6, 9) 8 (7, 10) 7 (5, 9) 6 (5, 8) < 0.001 W at discharge in g (IQR) 2, 480 (2, 280, 2, 750) 2, 340 (2, 138, 2, 540) 2, 530 (2, 319, 2, 790) 2, 560 (2, 335, 2, 860) < 0.001 Growth velocity [mL/(kg·d)] 9.6 (5.9, 13.9) 10.7 (7.1, 14.4) 9.1 (5.5, 13.6) 9.3 (5.5, 14.1) 0.818 Note. W: Weight; BW: Birth weight.
doi: 10.3967/bes2018.066
Multi-center Study of Enteral Feeding Practices in Hospitalized Late Preterm Infants in China
-
Abstract:
Objective To investigate the current enteral feeding practices in hospitalized late preterm infants in the Beijing area of China. Methods A multi-center, cross-sectional study was conducted. Infants born after 34 weeks and before 37 weeks of gestation were enrolled from 25 hospitals in the Beijing area of China from October 2015 to October 2017. Data on enteral feeding practices were collected and analyzed. Results A total of 1, 463 late preterm infants were enrolled, with a mean gestational age (GA) of 35.6(34.9, 36.1) weeks. The percentage of exclusive breastfeeding was 4.5% at the initiation of enteral feeding but increased to 14.4% at discharge. When human milk was not available, most infants (46.1%) were fed with preterm infant formula. The rate of exclusive human milk feeding in infants born at 34 weeks gestation was higher than at discharge (21.1% of infants born at 34 weeks' GA versus 12.1% of infants born at 35 weeks' GA versus 12.3% of infants born at 36 weeks' GA, P < 0.001). Only 28.4% of late preterm infants achieved full enteral feeding at discharge, and only 19.2% achieved 120 kcal/(kg·d) by enteral feeding at discharge. Importantly, 40.5% of infants did not regain the birth weight at discharge. Conclusion Enteral feeding support of late preterm infants has not been standardized to achieve optimal growth. Moreover, the human milk feeding rate was low, and many late preterm infants did not achieve the goal of enteral feeding and failed to regain birth weight at the time of discharge. More aggressive enteral feedings protocols are needed to promote human milk feeding and optimize growth for late preterm infants. -
Key words:
- Late preterm infants /
- Enteral feeding /
- Human milk feeding
-
Table 1. Demographic Data of Late Preterm Infants
Characteristics All Infants 34 Weeks 35 Weeks 36 Weeks P Value N (%) 1, 463 (100%) 369 (25.2%) 566 (38.7%) 528 (36.1%) GA (weeks) 35.6 (34.9, 36.1) 34.4 (34.1, 34.7) 35.4 (35.1, 35.7) 36.3 (36.1, 36.6) < 0.001 Male infants, n (%) 789 (53.9%) 207 (56.1%) 303 (53.5%) 279 (52.8%) 0.061 C-section, n (%) 962 (65.8%) 262 (71.0%) 351 (62.0%) 349 (66.1%) 0.047 Asphyxia, n (%) 21 (1.4%) 10 (2.7%) 7 (1.2%) 4 (0.8%) 0.047 W at birth (g) 2, 440 (2, 200, 2, 710) 2, 250 (2, 020, 2, 440) 2, 485 (2, 259, 2, 740) 2, 545 (2, 300, 2, 800) < 0.001 L at birth (cm) 47.0 (45.0, 48.0) 46.0 (44.0, 47.0) 47.0 (45.0, 48.0) 47.0 (46.0, 49.0) < 0.001 HC at birth (cm) 32.0 (31.5, 33.0) 32.0 (30.5, 33.0) 32.5 (32.0, 33.0) 32.5 (32.0, 33.0) < 0.001 SGA, n (%) 170 (11.6%) 28 (7.6%) 52 (9.2%) 90 (17.0%) < 0.001 RDS, n (%) 54 (3.7%) 24 (6.5%) 16 (2.8%) 14 (2.7%) 0.004 Hypoglycemia, n (%) 192 (13.1%) 52 (14.1%) 67 (11.8%) 73 (13.8%) 0.519 Hyperglycemia, n (%) 34 (2.3%) 16 (4.3%) 12 (2.1%) 6 (1.1%) 0.023 Hyperbilirubinemia, n (%) 658 (45.0%) 175 (47.4%) 241 (42.6%) 242 (45.8%) 0.319 Anemia, n (%) 207 (14.1%) 67 (18.2%) 77 (13.6%) 63 (11.9%) 0.091 Infection, n (%) 321 (21.9%) 82 (22.2%) 123 (21.7%) 116 (22.0%) 0.987 Blood-culture-proven sepsis, n (%) 27 (1.8%) 8 (2.2%) 79 (1.2%) 12 (2.3%) 0.386 W at discharge (g) 2, 480 (2, 280, 2, 750) 2, 340 (2, 138, 2, 540) 2, 530 (2, 319, 2, 790) 2, 560 (2, 335, 2, 860) < 0.001 L at discharge (cm) 47.0 (46.0, 49.0) 46.5 (45.0, 48.0) 48.0 (46.0, 49.0) 48.0 (46.0, 49.0) < 0.001 HC at discharge (cm) 33.0 (32.0, 33.5) 32.0 (31.0, 33.0) 33.0 (32.0, 33.8) 33.0 (3.0, 34.0) < 0.001 Length of stay (d) 8 (7, 11) 10 (8, 13) 8 (7, 10) 7 (6, 9) < 0.001 Note. Data are shown as x±s or percentage (median and P25, P75); GA: gestational age; W: weight; L: length; HC: head circumference; SGA: small for gestational age; RDS: respiratory distress syndrome. Table 2. The Nature of Enteral Feeding of Late Preterm Infants During Hospitalization
Nature All Infants
(N = 1, 463)34 Weeks
(n = 369)35 Weeks
(n = 566)36 Weeks
(n = 528)P Value Exclusive human milk feeding, n (%) 66 (4.5%) 16 (4.3%) 25 (4.4%) 25 (4.7%) 0.628 Preterm infant formula feeding, n (%) 674 (46.1%) 178 (48.2%) 258 (45.6%) 238 (45.1%) 0.473 Post-discharge formula feeding, n (%) 248 (17.0%) 41 (11.1%) 126 (22.3%) 81 (15.3%) < 0.001 Full-term formula feeding, n (%) 128 (8.7%) 8 (2.2%) 48 (8.5%) 72 (13.6%) < 0.001 Mixed feeding, n (%) 335 (22.9%) 122 (33.1%) 107 (18.9%) 106 (20.1%) < 0.001 Exclusively human milk feeing at discharge, n (%) 209 (14.4%) 77 (21.1%) 68 (12.1%) 64 (12.3%) < 0.001 Table 3. Data on Enteral Feeding Practices of Late Preterm Infants During Hospitalization
Feeding Practices All Infants
(N = 1, 463)34 Weeks
(n = 369)35 Weeks
(n = 566)36 Weeks
(n = 528)P Value Initial time of enteral feeding (d) 1.0 (1.0, 1.0) 1.0 (1.0, 1.0) 1.0 (1.0, 1.0) 1.0 (1.0, 1.0) 0.760 Volume of EN on D1 [mL/(kg·d)] 14.1 (6.5, 26.5) 12.9 (5.3, 21.6) 13.3 (7.0, 21.4) 16.3 (6.4, 32.1) < 0.001 Energy of EN on D1 [mL/(kg·d)] 10.7 (4.9, 19.9) 10.0 (4.1, 17.2) 9.9 (5.5, 16.2) 12.3 (4.9, 23.9) < 0.001 Volume of EN on D2 [mL/(kg·d)] 32.0 (17.1, 48.5) 29.7 (16.7, 43.2) 30.7 (16.0, 46.5) 35.7 (19.3, 53.3) < 0.001 Energy of EN on D2 [mL/(kg·d)] 24.4 (13.0, 36.0) 21.8 (12.3, 34.0) 23.2 (12.3, 35.2) 27.3 (14.9, 39.9) < 0.001 Volume of EN on D3 [mL/(kg·d)] 46.8 (29.3, 67.8) 43.4 (26.8, 63.4) 45.7 (27.9, 65.9) 51.2 (32.9, 75.8) < 0.001 Energy of EN on D3 [mL/(kg·d)] 35.8 (22.3, 51.3) 33.5 (20.9, 49.3) 35.1 (21.6, 49.0) 39.5 (24.4, 56.1) < 0.001 Volume of EN on D4 [mL/(kg·d)] 64.0 (42.1, 87.7) 60.0 (37.8, 84.4) 63.2 (42.7, 86.0) 67.9 (45.7, 91.4) < 0.001 Energy of EN on D4 [mL/(kg·d)] 48.3 (32.4, 66.9) 46.1 (29.3, 64.7) 48.3 (33.3, 64.9) 51.2 (34.3, 70.2) 0.002 Volume of EN on D5 [mL/(kg·d)] 82.1 (55.6, 105.4) 75.3 (52.1, 103.7) 79.5 (55.1, 100.5) 87.0 (59.0, 112.0) 0.002 Energy of EN on D5 [mL/(kg·d)] 61.1 (42.4, 80.0) 57.2 (39.9, 78.3) 59.8 (41.7, 76.4) 66.5 (43.9, 84.2) 0.011 Volume of EN on D6 [mL/(kg·d)] 95.6 (68.4, 123.4) 93.5 (67.9, 122.5) 91.3 (66.7, 119.4) 103.0 (71.4, 112.0) 0.037 Energy of EN on D6 [mL/(kg·d)] 72.0 (51.6, 92.9) 71.5 (51.9, 92.4) 69.6 (50.5, 89.8) 77.2 (52.4, 97.9) 0.083 Volume of EN on D7 [mL/(kg·d)] 108.0 (78.1, 133.3) 108.8 (77.5, 134.0) 103.8 (79.8, 131.1) 110.7 (78.0, 136.4) 0.532 Energy of EN on D7 [mL/(kg·d)] 81.5 (60.0, 101.9) 80.9 (61.3, 103.4) 80.8 (60.2, 100.2) 83.0 (58.7, 102.8) 0.804 Volume of EN at discharge [mL/(kg·d)] 108.7 (81.1, 133.0) 118.3 (94.0, 139.9) 103.0 (76.7, 130.2) 105.9 (77.7, 131.2) < 0.001 Energy of EN at discharge [mL/(kg·d)] 105.0 (84.3, 133.2) 117.7 (97.8, 151.7) 102.4 (82.5, 129.4) 100.4 (79.1, 126.6) < 0.001 Achieving 150 (mL/kg·d) at discharge n (%) 416 (28.4%) 154 (41.7%) 137 (24.2%) 125 (23.7%) < 0.001 The time achieving 150 [mL/(kg·d)] (d) 8 (7, 10) 9 (7, 11) 8 (6, 10) 7 (6, 10) 0.198 Achieving 120 (kcal/kg·d) at discharge n (%) 281 (19.2%) 108 (29.3%) 94 (16.6%) 79 (15.0%) < 0.001 The time achieving 120 [mL/(kg·d)] (d) 8 (7, 11) 9 (7, 12) 8 (7, 10) 7 (6, 9) < 0.001 Note. EN: Enteral nutrition. Table 4. Data on Body Weight Change
Items All Infants
(N = 1, 463)34 Weeks
(n = 369)35 Weeks
(n = 566)36 Weeks
(n = 528)P Value W at birth (g) 2, 440 (2, 200, 2, 710) 2, 250 (2, 020, 2, 440) 2, 485 (2, 259, 2, 740) 2, 545 (2, 300, 2, 800) < 0.001 Time with lowest W (d) 3 (3, 4) 3 (3, 4) 3 (3, 4) 2 (3, 4) 0.442 Time regained the BW (d) 6 (4, 7) 6 (5, 8) 6 (4, 7) 5 (4, 6) < 0.001 Infants who did not regain their BW at discharge, n (%) 592 (40.5%) 120 (32.5%) 219 (38.7%) 253 (47.9%) < 0.001 Length of stay of infants who did not regain their BW (d) 7 (6, 9) 8 (7, 10) 7 (5, 9) 6 (5, 8) < 0.001 W at discharge in g (IQR) 2, 480 (2, 280, 2, 750) 2, 340 (2, 138, 2, 540) 2, 530 (2, 319, 2, 790) 2, 560 (2, 335, 2, 860) < 0.001 Growth velocity [mL/(kg·d)] 9.6 (5.9, 13.9) 10.7 (7.1, 14.4) 9.1 (5.5, 13.6) 9.3 (5.5, 14.1) 0.818 Note. W: Weight; BW: Birth weight. -
[1] Fleming PF, Arora P, Mitting R, et al. A national survey of admission practices for late preterm infants in England. BMC Pediatr, 2014; 14, 150. doi: 10.1186/1471-2431-14-14 [2] Ma X, Huang C, Lou S, et al. The clinical outcomes of late preterm infants:a multi-center survey of Zhejiang, China. J Perinat Med, 2009; 37, 695-9. http://www.cabdirect.org/abstracts/20093354192.html [3] Reichman NE, Teitler JO, Moullin S, et al. Late-preterm birth and neonatal morbidities:population-level and within-family estimates. Ann Epidemiol, 2015; 25, 126-32. http://www.ncbi.nlm.nih.gov/pubmed/25481078 [4] Zou L, Wang X, Ruan Y, et al. Preterm birth and neonatal mortality in China in 2011. Int J Gynaecol Obstet, 2014; 127, 243-7. doi: 10.1016/j.ijgo.2014.06.018 [5] Engle WA, Tomashek KM, Wallman C, et al. "Late-preterm" infants:a population at risk. Pediatrics, 2007; 120, 1390-401. doi: 10.1542/peds.2007-2952 [6] Petrini JR, Dias T, McCormick MC, et al. Increased risk of adverse neurological development for late preterm infants. J Pediatr, 2009; 154, 169-76. doi: 10.1016/j.jpeds.2008.08.020 [7] Talge NM, Holzman C, Wang J, et al. Late-preterm birth and its association with cognitive and socioemotional outcomes at 6 years of age. Pediatrics, 2010; 126, 1124-31. doi: 10.1542/peds.2010-1536 [8] Chan E, Leong P, Malouf R, et al. Long-term cognitive and school outcomes of late-preterm and early-term births:a systematic review. Child Care Health Dev, 2016; 42, 297-312. doi: 10.1111/cch.12320 [9] Tsai ML, Lien R, Chiang MC, et al. Prevalence and morbidity of late preterm infants:current status in a medical center of Northern Taiwan. Pediatr Neonatol, 2012; 53, 171-7. doi: 10.1016/j.pedneo.2012.04.003 [10] Xiaomei Shao, Hongmao Ye, Xiaoshan Qiu. Practice of neonatology, 4th edition. Beijing:People's Health Press, 2011; 340-713. (In Chinese) [11] Bhutani VK, Johnson L, Sivieri EM. Predictive ability of a predischarge hour-specific serum bilirubin for subsequent significant hyperbilirubinemia in healthy term and near-term newborns. Pediatrics, 1999; 103, 6-14. doi: 10.1542/peds.103.1.6 [12] Okumura A, Kidokoro H, Shoji H, et al. Kernicterus in preterm infants. Pediatrics, 2009; 123, e1052-8. doi: 10.1542/peds.2008-2791 [13] Patel AL, Engstrom JL, Meier PP, et al. Calculating Postnatal Growth Velocity in Very Low Birth Weight (VLBW) Premature Infants. J Perinatol, 2009; 29, 618-22. doi: 10.1038/jp.2009.55 [14] Patel AL, Engstrom JL, Meier PP, et al. Accuracy of methods for calculating postnatal growth Velocity for extremely low birth weight infants. Pediatrics, 2005; 116, 1466-73. doi: 10.1542/peds.2004-1699 [15] Celik IH, Demirel G, Canpolat FE, et al. A common problem for neonatal intensive care units:late preterm infants, a prospective study with term controls in a large perinatal center. J Matern Fetal Neonatal Med, 2013; 26, 459-2. doi: 10.3109/14767058.2012.735994 [16] Lu L, Qu Y, Tang J, et al. Risk factors associated with late preterm births in the underdeveloped region of China:A cohort study and systematic review. Taiwan J Obstet Gynecol, 2015; 54, 647-53. doi: 10.1016/j.tjog.2014.05.011 [17] Shah P, Kaciroti N, Richards B, et al. Developmental Outcomes of Late Preterm Infants From Infancy to Kindergarten. Pediatrics, 2016; 138. http://europepmc.org/abstract/MED/27456513 [18] Bulut C, Gürsoy T, Ovalı F. Short-Term Outcomes and Mortality of Late Preterm Infants. Balkan Med J, 2016; 33, 198-203. doi: 10.5152/balkanmedj. [19] Sarici SU, Serdar MA, Korkmaz A, et al. Incidence, course, and prediction of hyperbilirubinemia in near-term and term newborns. Pediatrics, 2004; 113, 775-80. doi: 10.1542/peds.113.4.775 [20] Giannì ML, Roggero P, Piemontese P, et al. Is nutritional support needed in late preterm infants? BMC Pediatr, 2015; 15, 194. doi: 10.1186/s12887-015-0511-8 [21] Baron IS, Weiss BA, Baker R, et al. Subtle adverse effects of late preterm birth:a cautionary note. Neuropsychology, 2014; 28, 11-8. doi: 10.1037/neu0000018 [22] Boyle EM, Johnson S, Manktelow B, et al. Neonatal outcomes and delivery of care for infants born late preterm or moderately preterm:a prospective population-based study. Arch Dis Child Fetal Neonatal Ed, 2015; 100, 479-85. doi: 10.1136/archdischild-2014-307347 [23] Ziegler E. Meeting the nutritional needs of the low-birth-weight infant. Ann Nutr Metab, 2011; 58(suppl 1), 8-18. http://europepmc.org/abstract/med/21701163 [24] Lapillonne A, O'Connor D, Wang D, et al. Nutritional recommendation for the late-preterm infant and the preterm infant after hospital discharge. J of Pediatrics, 2013; 162, s90-100. doi: 10.1016/j.jpeds.2012.11.058 [25] Kwok TC, Dorling J, Ojha S. Multicentre prospective observational study of feeding practices in 30-33 weeks preterm infants. BMJ Paediatrics Open, 2017; 1, e000040. doi: 10.1136/bmjpo-2017-000040 [26] Maas C, Franz AR, von Krogh S, et al. Growth and morbidity of extremely preterm infants after early full enteral nutrition. Arch Dis Child Fetal Neonatal Ed, 2018; 103, F79-81. doi: 10.1136/archdischild-2017-312917 [27] Westin V, Klevebro S, Domellof M, et al. Improved nutrition for extremely preterm infants-A population based observational study. Clin Nutr ESPEN, 2018; 23, 245-51. doi: 10.1016/j.clnesp.2017.09.004 [28] Klingenberg C, Muraas FK, Isaksen CE, et al. Growth and neurodevelopment in very preterm infants receiving a high enteral volume-feeding regimen-a population-based cohort study. J Matern Fetal Neonatal Med, 2017; 17, 1-9. doi: 10.1080/14767058.2017.1414796 [29] Wiedmeier JE, Joss-Moore LA, Lane RH, et al. Early postnatal nutrition and programming of the preterm neonate. Nutr Rev, 2011; 69, 76-82. doi: 10.1111/nure.2011.69.issue-2 [30] Shulman RJ, Ou CN, Smith EO. Evaluation of potential factors predicting attainment of full gavage feedings in preterm infants. Neonatology, 2011; 99, 38-44. doi: 10.1159/000302020 [31] Santos IS, Matijasevich A, Domingues MR, et al. Late preterm birth is a risk factor for growth faltering in early childhood:a cohort study. BMC Pediatr, 2009; 9, 71. doi: 10.1186/1471-2431-9-71 [32] Goyal NK, Fiks AG, Lorch SA. Persistence of underweight status among late preterm infants. Arch Pediatr Adolesc Med, 2012; 166, 424-30. doi: 10.1001/archpediatrics.2011.1496 [33] Gill JV, Boyle EM. Outcomes of infants born near term. Arch Dis Child, 2017; 102, 194-8. doi: 10.1136/archdischild-2015-309584 [34] Kair LR, Colaizy TT. Breastfeeding continuation among late preterm infants:barriers, facilitators, and any association with NICU admission? Hosp Pediatr, 2016; 6, 261-8. doi: 10.1542/hpeds.2015-0172 [35] Taylor HG. Outcomes of late preterm birth:who is at risk and for what? Am J Obstet Gynecol, 2012; 206, 181-2. doi: 10.1016/j.ajog.2012.01.023 [36] Ayton J, Hansen E, Quinn S, et al. Factors associated with initiation and exclusive breastfeeding at hospital discharge:late preterm compared to 37 week gestation mother and infant cohort. Int Breastfeed J, 2012; 7, 16. doi: 10.1186/1746-4358-7-16 [37] Academy of Breastfeeding Medicine. ABM clinical protocol #10:breastfeeding the late preterm infant (34(0/7) to 36(6/7) weeks gestation) (first revision June 2011). Breastfeed Med, 2011; 6, 151-6. doi: 10.1089/bfm.2011.9990 [38] Whyte R. Safe discharge of the late preterm infant. Paediatr Child Health, 2010; 15, 655-66. doi: 10.1093/pch/15.10.655 [39] Rayfield S, Oakley L, Quigley MA. Association between breast-feeding support and breastfeeding rates in the UK:a comparison of late preterm and term infants. BMJ Open, 2015; 5, e009144. doi: 10.1136/bmjopen-2015-009144 [40] Jackson BN, Kelly BN, McCann CM, et al. Predictors of the time to attain full oral feeding in late preterm infants. Acta Paediatr, 2016; 105, e1-6. doi: 10.1111/apa.13227