5990 Effect of nutritional assessment, counselling and supplementation on growth catch-up of preterm infants after NICU discharge, a single center study

Objectives To assess the nutritional status of premature infants using clinical, anthropometric and laboratory parameters during the first 90 days of life after neonatal intensive care unit (NICU) discharge and to highlight the effect of caregiver counselling regarding feeding practices and supplements in regard to catch-up growth. Methods 48 preterm infants who were discharged from the NICU of Cairo University were enrolled; of them, 46 completed the 3-month follow-up and were divided into 3 groups: mainly breast-fed infants (more than 6 times daily), mainly formula-fed infants (more than 6 times daily) and equally-fed with anthropometric measurements, laboratory assessment and nutritional plan. Results Among the 3 groups, the breast-feeding group had the lowest incidence of reported feeding problems. As shown in tables 1, 2 and 3 according to the study results, the breast-feeding group showed the best catch-up growth regarding weight, length and head circumference between discharge and the first and last follow-up visits followed by the formula feeding group.1 The study showed that nutritional assessment and counselling played an important role in overcoming feeding difficulties and lactation support regarding breast feeding, which encouraged mothers to breast feed until 4 months without turning to formula feeding or reducing human milk. We even managed for 3 babies from our breast feeding group to lower their complementary formula feeding from 3 times per day to just one time and for 2 infants to stop formula completely without affecting growth parameters. This study found significantly improved zinc levels after daily zinc supplementation with improved napkin dermatitis and length catch-up. The improvement in zinc levels was best in the combined feeding group (mean 99.9 ± 21 μg/dL), followed by the formula-fed group (99 ± 19 μg/dL) and was the lowest in the breast-feeding group (89 ± 15 μg/dL), with an overall increase in serum zinc levels in all preterm infants regardless of the type of feeding.3 The study found that the combined feeding group showed slightly better improvements in haemoglobin levels than the other two groups of breast- and formula-fed infants, with means of 12.5 ± 0.6 gm/dl and 12.2 ± 0.5 gm/dl, respectively. Serum iron levels were better in the combined feeding group (147 ± 25 μg/dL), followed by the formula-fed group (143 ± 29 μg/dL), with lower values in the breast feeding group (130.4 ± 14 μg/dL), with general improvement of iron levels in all three groups of feeding from discharge until the last follow-up after 3 months.2 Conclusion The article concludes that close follow-up of preterm infants via regular anthropometric measure assessment; laboratory value evaluation, especially haematological indices; nutritional counselling sessions with infants' caregivers; and nutritional plan evaluation by properly calculating caloric requirements and protein requirements according to age as post-discharge nutritional programs are very important to ensure optimum catch-up growth for preterm infants after discharge from neonatal intensive care units with optimum feeding whether breast, formula, or mixed. References Teller IC, et al. Clin. Nutr. 2016;35:791–801. Berglund S, et al. Pediatrics 2010;126:e874-e883. Gianluca T, et al. Nutrients 2015;7:10427–10446; doi:10.3390/nu7125542.