Early energy and protein intakes and associations with growth, BPD, and ROP in extremely preterm infants

Extremely preterm infants face substantial neonatal morbidity. Nutrition is important to promote optimal growth and organ development in order to reduce late neonatal complications. The aim of this study was to examine the associations of early nutritional intakes on growth and risks of bronchopulmonary dysplasia (BPD) and retinopathy of prematurity (ROP) in a high-risk population. This population-based cohort study includes infants born before 27 0/7 weeks of gestational age without severe malformations and surviving ≥10 days. Intake of energy and protein on postnatal days 4–6 and association with weight standard deviation score (WSDS) from birth to day 7, as well as intakes of energy and protein on postnatal days 4–6 and 7 to 27, respectively, and association with composite outcome of death and BPD and separate outcomes of BPD and ROP were examined, and adjusted for potential confounders. The cohort comprised 296 infants with a median gestational age of 25 3/7 weeks. Expressed as daily intakes, every additional 10 kcal/kg/d of energy during days 4–6 was associated with 0.08 higher WSDS on day 7 (95% CI 0.06–0.11; p 10 days of mechanical ventilation, a combined higher intake of energy and protein was associated with a reduced risk of BPD. Early provision of energy and protein may reduce postnatal weight loss and risk of morbidity in extremely preterm infants. •Higher energy intake the first month is associated with lower risk of BPD and ROP.•Need of mechanical ventilation modifies the association of intake and ROP.•High energy and protein intakes are associated with BPD despite critical illness.•Higher energy and protein intake the first week reduce initial growth restriction.