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Wittwer A, Hascoët JM. Impact of introducing a standardized nutrition protocol on very premature infants' growth and morbidity. PLoS One. 2020;15(5):e0232659. Published 2020 May 21. doi:10.1371/journal.pone.0232659

Background: Inappropriate nutritional intake in premature infants may be responsible for postnatal growth restriction (PGR) and adverse long-term outcomes.

Objective: We evaluated the impact of an updated nutrition protocol on very premature infants’ longitudinal growth and morbidity, and secondly the compliance to this new protocol.

Design: All infants born between 26-32 weeks gestation (GA) were studied retrospectively during two 6-month periods before (group 1) and after (group 2) the introduction of an optimized nutrition protocol, in a longitudinal comparative analysis.

Results: 158 infants were included; 72 before and 86 after the introduction of the protocol (Group 1: (mean±SD) birthweight (BW) 1154±276 g, GA 29.0±1.4 weeks; Group 2: BW 1215±332 g, GA 28.9±1.7 weeks). We observed growth improvement in Group 2 more pronounced in males (weight z-score) at D42 (-1.688±0.758 vs. -1.370±0.762, p = 0.045), D49 (-1.696±0.776 vs. -1.370±0.718, p = 0.051), D56 (-1.748±0.855 vs. -1.392±0.737, p = 0.072), D63 (-1.885±0.832 vs. -1.336±0.779 p = 0.016), and D70 (-2.001±0.747 vs. -1.228±0.765 p = 0.004). There was no difference in females or in morbidities between the groups. We observed low compliance to the protocol in both groups: similar energy intake but higher lipid intake in Group 1 and higher protein intake in Group 2.

Conclusion: The quality of nutritional care with a strictly-defined protocol may significantly improve weight gain for very preterm infants. As compliance remained low, an educational reinforcement is needed to prevent PGR

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