The Study Of Risk Factors Of Optimal Nutrition For Critically Ill Neonates

Part ?:Optimal timing for introducing enteral nutrition in the neonatal intensive care unit (NICU).Objective To identify the optimal time for introducing enteral nutrition to critically-ill neonates.Method This prospective cohort study included all eligible critically-ill neonates who were admitted to a multidisciplinary tertiary neonatal intensive care unit (NICU) between 1st June and 30th November 2013. Nutrient intake and clinical outcomes during NICU stay were recorded. The effect of early (<24 hours after NICU admission) and delayed (?24 hours) enteral nutrition introduction on clinical outcomes was assessed.Results Energy deficit in critically-ill neonates was frequent:221 neonates(43.3%) intaked less than 60kcal/kg/d during the NICU stay. Growth retardation was common especially among the preterm:the frequency of neonates whose weight was below the 10th percentile increased significantly from 21.6% on admission to 67.6% at discharge. Compared to delayed enteral nutrition, early enteral nutrition associated with better median time to starting weight gain (0 vs.6 days, p<0.01), a lower chance of receiving parenteral nutrition (41.7% vs.95.9%, p<0.01), shorter NICU stays (195.5 vs.288 hours, p<0.01) and a lower chance of developing pulmonary infection (37.5% vs.56%, p<0.05). Lower calorie intakes exposed to the delayed ones(76.7kcal/kg/d vs.63.3kcal/kg/d, p<0.05).Conclusion Early enteral nutrition initiation (<24 hours) is recommended. Growth retardation and energy deficit were common among the critically-ill neonates.Part ?:Barriers to optimal nutrient support-A prospective cohort study in NICU.Objective To identify potential barriers to the adequacy of nutrient delivery in a tertiary neonate intensive care unit (NICU), and examine the effects of frequent and prolonged feed interruptions respectively.Method This prospective observational cohort study included 510 consecutive neonates aged 1-28 postnatal day who were admitted to NICU and received nutrient therapy at lest 1day from 1st June and 30th November 2013.Results With indexes of nutrient intake and clinical outcomes recorded, factors responsible for interruption to enteral and parenteral nutrition (EN and PN) were identified. The effect of EN interruption on clinical outcomes was assessed. Growth retardation was common especially among the preterm:the frequency of neonates whose weight was below the 10th percentile increased significantly from 21.6% on admission to 67.6% at discharge. A total of 509 episodes accounting for 6951 hours of EN deprivation occurred in 204 neonates(41.5%). The most common factors that challenged EN were gastrointestinal intolerance and intentional procedures. With higher energy deficits and PN administrations, longer duration of EN interruption (>12 h) was highly associated with longer stays in hospital and NICU, prolonged median time to weight gain, more hours on mechanical ventilation and a higher chance of developing pulmonary infection. Accumulated energy deficit exposed to the ones with prolonged duration of EN interruptions could not be compensated by subsequent nutrition.Conclusion This study highlights that the duration of EN interruption<12 h is recommended.