Abstract
To evaluate whether differences in early nutritional support provided to extremely premature infants mediate the effect of critical illness on later outcomes, we examined whether nutritional support provided to “more critically ill” infants differs from that provided to “less critically ill” infants during the initial weeks of life, and if, after controlling for critical illness, that difference is associated with growth and rates of adverse outcomes. One thousand three hundred sixty-six participants in the NICHD Neonatal Research Network parenteral glutamine supplementation randomized controlled trial who were alive on day of life 7 were stratified by whether they received mechanical ventilation for the first 7 d of life. Compared with more critically ill infants, less critically ill infants received significantly more total nutritional support during each of the first 3 wk of life, had significantly faster growth velocities, less moderate/severe bronchopulmonary dysplasia, less late-onset sepsis, less death, shorter hospital stays, and better neurodevelopmental outcomes at 18–22 mo corrected age. Rates of necrotizing enterocolitis were similar. Adjusted analyses using general linear and logistic regression modeling and a formal mediation framework demonstrated that the influence of critical illness on the risk of adverse outcomes was mediated by total daily energy intake during the first week of life.
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Abbreviations
- AGA:
-
appropriate-for-GA
- BPD:
-
bronchopulmonary dysplasia
- DOL:
-
day of life
- ELBW:
-
extremely LBW
- GLM:
-
general linear model
- MDI:
-
mental developmental index
- MV:
-
mechanical ventilation
- NDI:
-
neurodevelopmental impairment
- NEC:
-
necrotizing enterocolitis
- NRN:
-
Neonatal Research Network
- PDI:
-
psychomotor developmental index
- PMA:
-
postmenstrual age
- SGA:
-
small-for-GA
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Acknowledgements
A list of investigators, who participated in the NICHD NRNs Glutamine Trial is available online as supplemental digital content for this article (http://links.lww.com/PDR/A70). We are indebted to our medical and nursing colleagues and the infants and their parents who agreed to take part in this study. Data collected at participating sites of the NICHD NRN were transmitted to RTI International, the data coordinating center for the network, which stored, managed, and analyzed the data for this study.
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Supported by the National Institutes of Health and the Eunice Kennedy Shriver National Institute of Child Health and Human Development by grant support provided to the cooperating centers of the Neonatal Research Network (NRN).
Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.pedresearch.org).
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Ehrenkranz, R., Das, A., Wrage, L. et al. Early Nutrition Mediates the Influence of Severity of Illness on Extremely LBW Infants. Pediatr Res 69, 522–529 (2011). https://doi.org/10.1203/PDR.0b013e318217f4f1
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DOI: https://doi.org/10.1203/PDR.0b013e318217f4f1
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