Changes in Nutritional Management and Outcome of Very-Low-Birth-Weight Infants

• We compared the in-hospital and postdischarge growth of 47 preterm very-low-birth-weight infants born in 1982 with that of 29 born in 1986. Infants in the two groups were of comparable gestational age, size, and illness at birth. During hospitalization, the 1986 infants began parenteral and enteral nutrition earlier, had fewer days when they received less than 252 kJ/kg, were treated earlier for patent ductus arteriosus (6.1 ±4.5 days vs 14.5±7.7 days), and had a lower prevalence of severe medical complications. By hospital discharge, these infants had significantly higher mean growth percentiles and fewer of them had weights and occipitofrontal circumferences below the fifth percentile. Follow-up at 4 and 12 months corrected age showed that these infants continued to have significantly higher growth percentiles, and fewer of them had weights below the fifth percentile (49% vs 24%) or major neurologic abnormalities. Infants whose weights were below the fifth percentile had significantly poorer 12-month developmental outcomes. We speculate that more aggressive early neonatal nutritional management, changes in cardiopulmonary management, and lower incidences of chronic disease promote earlier onset of and more rapid rates of postnatal growth, which extend through the first year of follow-up.