Effect of adherence to nutrition guidelines and use of fortification of feeds on the growth of late preterm neonates

by Isabella DeStefano, Adanna Ibeku, Krystal Hunter, Melissa Micallef, Alla Kushnir

“Late preterm” or “LPT” neonates are generally defined as infants born between 34 0/7 and 36 6/7 weeks gestation and constitute approximately 74% of all preterm births. While much effort has been put into evaluating the nutritional needs of early preterm or low birthweight infants, there is a shortage of research on the nutritional needs of LPT infants. This work examined how adherence to current nutrition guidelines and how the use of fortification of feeds affected the growth of LPT neonates in the first year of life. A retrospective chart review was conducted of 898 neonates born between 34 0/7 and 36 6/7 weeks gestation, as identified from electronic medical records. The study site where the data was obtained was an urban hospital in New Jersey. Head circumference, weight, and length at birth, documented as measurements, percent, and z-scores, at discharge, at two months, at six months, and at twelve months post birth, were collected and evaluated. Data regarding the neonate’s feeding regimen, caloric fortification, and type of nutrition at the point of discharge were assessed. Data were analyzed using independent t-tests and Mann-Whittney U tests to assess the relationship between adherence and growth parameters. Of these participants, 50.1% were male, the mean gestational age was 34.91 (±1.19), and the mean birth weight was 2317 (±489) grams. Infants with lower birth weight (BW) were more likely to receive fortification (BW p < 0.001, BW percentile p < 0.001). Participants who followed fortification guidelines had lower birth weight, discharge weight, and weight percentile (p < 0.001), as well as lower z-scores for BW, length, and head circumference (HC) at birth and at discharge. At six and twelve months, weight, weight percentile, length, length percentile, head circumference, and head circumference percentiles were not statistically significant. The results show that adherence to nutritional guidelines recommending fortified feeding is associated with growth within the first year of life of LPT infants. By two, six, and twelve months, there were no differences in z scores in participants with fortification.