title: Early Postnatal Growth in a Subset of Convalescing Extremely-Low-Birth-Weight Neonates: Approximating the "Index Fetus" Ex Utero.
abstract: OBJECTIVE
  The aim of the study was to evaluate whether a subset of noncritically ill, convalescing extremely-low-birth-weight neonates who were managed using a standardized nutritional protocol could achieve the growth rate of the index fetus. We hypothesized that an aggressive nutritional protocol applied to noncritically ill, convalescing premature neonates could achieve the growth rate of the index fetus.
  
  
  METHODS
  This was a retrospective review of a subset of 21 premature neonates defined by 4 criteria: inborn or transferred-in within 24 hours of birth, gestational age < 30 weeks and birth weight ≤1000 g, hospitalized >35 postnatal days, and discharged between 34 and 42 weeks postconceptual age. Optimal growth at discharge was defined as weight and head circumference >10th percentile compared with comparable gestational age fetal parameters.
  
  
  RESULTS
  Protein intake of ≥1.4 g · kg · day and energy ≥30 kcal · kg · day were provided as of the first postnatal day. Proteins ≥3 g · kg · day and >80 kcal · kg · day were established ≥10th postnatal day. Birth weight was regained by postnatal day 10 ± 5 day (mean + standard deviation). Nutrition was predominantly enteral (ie, >50% of all calories) after the 11th postnatal day. At discharge, 71% (15/21) by weight and 76% (16/21) by head circumference were >10th percentile. After 30 weeks postconceptual age, the cohort exceeded the weight gain rate (g/wk) of a 10th-percentile fetus.
  
  
  CONCLUSIONS
  In a selected subset of noncritically ill, convalescing extremely-low-birth-weight neonates, after a brief period of unavoidable postnatal weight loss and body water adjustment, adequate nutrition from birth can enable a more homeostatic pattern of growth that approximates growth of the index fetus.
authors: *Division of Neonatology, Good Samaritan Hospital Medical Center, West Islip †Division of Newborn Medicine, Department of Pediatrics, Kings County Hospital Center, Brooklyn ‡Regional Neonatal Center, Division of Newborn Medicine, Department of Pediatrics, New York Medical College, Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla.
authors: Mana
authors: M
authors: Dejhalla
authors: Nadine
authors: N
authors: Lahage
authors: Boriana
authors: B
authors: Parvez
authors: Heather L
authors: HL
authors: Brumberg
authors: Edmund F
authors: EF
authors: La Gamma
mesh_terms: D001724:Birth Weight; D004044:Dietary Proteins / Q000008:administration & dosage; D002149:Energy Intake; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D047109:Fetal Development; D005865:Gestational Age; D006801:Humans; D052577:Infant, Extremely Low Birth Weight / Q000254:growth & development*; D007231:Infant, Newborn; D007234:Infant, Premature / Q000254:growth & development*; D008297:Male; D012189:Retrospective Studies; D015430:Weight Gain / Q000502:physiology*
chemical_list: D004044:Dietary Proteins