Optimizing Early Nutrition Management of Extremely and/or Very Preterm Infants

Compared with full-term infants, preterm infants, especially extremely and/or very preterm infants, have fewer nutritional reserves and higher nutritional demands. If their nutritional intake is insufficient, they are more likely to suffer from nutritional deficiencies, which can affect the development of important organs during critical periods. According to a study by the Chinese neonatal network (CHNN) in 2019, the overall incidence of postnatal growth restriction (PGR) among extremely and very preterm infants in 57 NICUs in China was 19.9%. A large number of studies have confirmed that early postnatal nutritional insufficiency or growth retardation is significantly associated with adverse outcomes such as long-term growth disorders, insufficient bone mineralization, and neurodevelopmental disorders. At the same time, some chronic diseases are also related to early nutritional imbalance. Therefore, optimizing the nutritional support strategies for extremely and/or very preterm infants during the early postnatal period has a crucial impact on improving their short-term and long-term outcomes. The current study is based on the best clinical practice evidence, integrating both parenteral nutrition and enteral nutrition. A quality improvement bundle is developed on nutrition supplementary, including individualized and precise human milk feeding, early enteral zinc supplementation, and routine parenteral carnitine supplementation. These interventions aim to improve the clinical outcomes of extremely and/or very preterm infants, including their growth and development, organ function, and neurodevelopmental outcomes.

• Z-score of weight [Срок оценки: At discharge, approximately corrected gestational age of 36 to 42 weeks.]
• Z-score of length [Срок оценки: At discharge, approximately corrected gestational age of 36 to 42 weeks.]
• Z-score of head circumference [Срок оценки: At discharge, approximately corrected gestational age of 36 to 42 weeks.]
• The incidence of extrauterine growth retardation (EUGR) [Срок оценки: At discharge, approximately corrected gestational age of 36 to 42 weeks.]
• The incidence of bronchopulmonary dysplasia (BPD) [Срок оценки: At corrected gestational age 36 weeks.]
• The incidence of necrotizing enterocolitis (NEC) [Срок оценки: At discharge, approximately corrected gestational age of 36 to 42 weeks.]
• Time to achieve full enteral feeding [Срок оценки: At discharge, a corrected gestational age of approximately 36-42 weeks.]
• Neurodevelopmental outcomes [Срок оценки: At 12 months corrected age]
• Serum albumin level [Срок оценки: One week, one month, two months, three months after birth]
• The content of zinc in peripheral blood [Срок оценки: One week, one month, two months, three months after birth.]
• The content of carnitine in peripheral blood [Срок оценки: One week, one month, two months, three months after birth.]
• Intestinal metabolic status [Срок оценки: Every week after birth until discharge, approximately corrected gestational age of 36 to 42 weeks.]