title: Nutritional bundle to improve growth outcomes among very low birth weight infants.
abstract: BACKGROUND
  Aggressive enteral, parenteral nutrition, milk fortification and Kangaroo care are some of the interventions aimed at decreased postnatal malnutrition in very low birth weight (VLBW) infants. A bundle approach incorporating all these interventions in predominantly breast-milk fed infants to reduce postnatal malnutrition is evaluated in this study.
  
  
  METHODS
  In this before and after study, growth outcomes were evaluated in 389 infants (before nutrition bundle (BNB) n = 171, after nutrition bundle (ANB) n = 218) at corrected term gestational age (38-40weeks). The nutrition bundle consisted of starting aminoacids within hours of birth, introduction of aminoacids @ 3 g/kg/d and lipids @3 g/kg/d on day 2 and fortification of human milk.
  
  
  RESULTS
  The incidence of malnutrition at term corrected age was similar in both the epochs (57% versus 53.7%, p = 0.35; adjusted OR 0.81, 95% CI: 0.52-1.27. The weight gain in g/kg/d was comparable between the two groups. At term corrected age, the infants in the ANB period were taller by an average of 2.8 cm (95% CI: 2.1 cm-3.4 cm) but had similar weight and head size in comparison to the infants in BNB period. On linear regression analysis, use of early aminoacids and total parenteral nutrition independently improved the weight at discharge by 43 g (95% CI; 9 to 77 g) and length at discharge by 1 cm (95% CI; 0.55 to 1.4 cm). Also the length and OFC at term corrected age were increased by 2.1 cms (95% CI; 1.4 to 2.8 cm) and 0.46 cms (95% CI; 0.1 to 0.8 cm), respectively.
  
  
  CONCLUSIONS
  In a cohort of VLBW infants on predominant breast-milk feeds, a nutritional bundle improved weight and length at discharge and the length at term gestational age. The incidence of malnutrition at term gestational age was not affected.
authors.affiliation: a Department of Neonatology , Fernandez Hospital , Hyderabad , India and.
authors.forename: Siraj
authors.initials: S
authors.lastname: Khanam
authors.forename: Jafar
authors.initials: J
authors.lastname: Khan
authors.forename: Deepak
authors.initials: D
authors.lastname: Sharma
authors.forename: Deepak
authors.initials: D
authors.lastname: Chawla
authors.forename: Srinivas
authors.initials: S
authors.lastname: Murki
mesh_terms: D003131:Combined Modality Therapy; D004750:Enteral Nutrition / Q000379:methods; D005527:Food, Fortified; D006801:Humans; D041943:Infant Formula / Q000008:administration & dosage* / Q000737:chemistry; D007227:Infant Nutritional Physiological Phenomena; D052577:Infant, Extremely Low Birth Weight / Q000254:growth & development; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight / Q000254:growth & development*; D060127:Kangaroo-Mother Care Method; D008895:Milk, Human; D009752:Nutritional Status; D010288:Parenteral Nutrition / Q000379:methods*; D010351:Patient Discharge / Q000706:statistics & numerical data; D015430:Weight Gain / Q000502:physiology
keywords: Bundle approach; VLBW infants; nutrition