[Risk factors for malnutrition at two years of corrected age in preterm infants under 32 weeks]. / Factores de riesgo de malnutrición a los dos años de edad corregida en prematuros menores de 32 semanas al nacer.

Post-discharge nutrition of preterm newborns must avoid excessive or insufficient weight gain and optimal length and head circumference growth. In Chile, premature infants less than 32 wee ks at birth receive fortified formulas during the first year, unless they are exclusively breastfed. OBJECTIVE: To describe growth and identify the risk of malnutrition at 24 months. PATIENTS AND METHOD: Retrospective cohort study that analyzes growth from birth to 2 years of corrected age in preterm patients < 32 weeks of gestational age. Z-score of weight, length, head circumference, and Body Mass Index (BMI) were analyzed. Factors related to Z BMI at 24 months were analyzed as follows: Eutrophic: Z BMI between -1 and +1; Overweight: Z BMI > +1; Underweight: Z BMI < -1. RESULTS: 996 preterm infants were included, 559 completed check-ups at 24 months. 64.5% were eutrophic, 18.4% overweight, and 17.1% underweight. Multivariate analysis showed that risk of overweight was associated with birth weight > 1460 g: OR 5.77 (2.11-15.77) and Z BMI > 1.6 at 6 months: OR 2.67 (1.91-3.74); underweight risk was associated with birth weight < 1000g: OR 3.1 (1.1-8.8) and Z BMI < -0.75 at 6 months: OR 8.2 (4.3-16.3). CONCLUSIONS: The greater risk of overweight and underweight can be anticipated in premature infants under 32 weeks with birth weight or Z BMI at 6 months of corrected age.

Benefits of supplemented preterm formulas on insulin sensitivity and body composition after discharge from the neonatal intensive care unit.

OBJECTIVE: To evaluate body composition and fasting insulin level in preterm infants receiving preterm formulas (higher protein plus docosahexaenoic acid) for longer periods compared with a recent historical cohort receiving these formulas for shorter periods. STUDY DESIGN: A total of 95 infants fed preterm formula for 6 months or longer (postdischarge formula group) and 87 infants fed preterm formula only during their hospital stay (hospital formula group) were included in this arm of the study. RESULTS: Bone mineral density, content, and lean mass were not different at 1 year and 2 years. However, in the postdischarge formula group, total fat mass (%) was lower by the second year (19.3% ± 5.3% vs 21.7% ± 4.2%; P < .01), trunk fat was lower by the first year (14.7% ± 5.0% vs 16.9% ± 4.9%; P < .005) and at the second year (14.1% ± 5.7% vs 17.2% ± 4.7%; P < .001), and fasting insulin was lower by the first year (13.2% ± 7.1% vs 17.2% ± 13.6% mIU/L; P = .06) and at the second year (13.6% ± 6.1% vs 26.4% ± 14.2%; P < .001). CONCLUSION: Preterm infants fed formulas enriched with docosahexaenoic acid may have a better subsequent metabolic profile.

Bronchopulmonary dysplasia: incidence, risk factors and resource utilization in a population of South American very low birth weight infants.

OBJECTIVE: To determine the incidence of bronchopulmonary dysplasia, its risk factors and resource utilization in a large South American population of very low birth weight infants. METHODS: Prospectively collected data in infants weighing 500 to 1,500 g born at 16 NEOCOSUR Network centers from 10/2000 through 12/2003. Multivariate relative risk and 95% confidence intervals were estimated by Poisson regression with robust error variance to find factors that affected the risk of bronchopulmonary dysplasia. RESULTS: 1,825 very low birth weight infants survivors were analyzed. Mean birth weight and gestational age were 1085+/-279 g and 29+/-3 weeks respectively. Bronchopulmonary dysplasia incidence averaged 24.4% and survival without bronchopulmonary dysplasia augmented with increasing gestational age. A higher birth weight and gestational age and a female gender all decreased the risk for bronchopulmonary dysplasia. Factors that independently increased that risk were surfactant requirement, mechanical ventilation, airleak, patent ductus arteriosus, late onset sepsis and necrotizing enterocolitis. Bronchopulmonary dysplasia infants had more days of hospitalization (91+/-27 vs. 51+/-19), of mechanical ventilation (19+/-20 vs. 4+/-7) and oxygen therapy (72+/-30 vs. 8+/-14) in comparison with non BPD infants. CONCLUSIONS: Bronchopulmonary dysplasia incidence was 24.4% in a large South American population and is related to greater resource utilization. Risk factors for bronchopulmonary dysplasia in this study were: surfactant requirement, mechanical ventilation, airleak, patent ductus arteriosus, late onset sepsis and necrotizing enterocolitis. These studies may provide useful information in the design of effective preventive perinatal strategies.

Bronchopulmonary dysplasia: incidence, risk factors and resource utilization in a population of South-American very low birth weight infants

OBJECTIVE: To determine the incidence of bronchopulmonary dysplasia, its risk factors and resource utilization in a large South American population of very low birth weight infants. METHODS: Data were prospectively collected from infants weighing 500 to 1,500 g born at 16 NEOCOSUR Network centers from 10/2000 through 12/2003. Multivariate relative risk and 95% confidence intervals were estimated by Poisson regression with robust error variance to find factors that affected the risk of bronchopulmonary dysplasia. RESULTS: 1,825 very low birth weight infant survivors were analyzed. Mean birth weight and gestational age were 1085+279 g and 29+3 weeks respectively. Bronchopulmonary dysplasia incidence averaged 24.4% and survival without bronchopulmonary dysplasia augmented with increasing gestational age. Higher birth weight and gestational age and a female gender all decreased the risk for bronchopulmonary dysplasia. Factors that independently increased that risk were surfactant requirement, mechanical ventilation, air leak, patent ductus arteriosus, late onset sepsis and necrotizing enterocolitis. Bronchopulmonary dysplasia infants had more days of hospitalization (91±27 vs. 51±19), on mechanical ventilation (19±20 vs. 4±7) and oxygen therapy (72±30 vs. 8±14) in comparison with non BPD infants. CONCLUSIONS: Bronchopulmonary dysplasia incidence was 24.4% in a large South American population and is related to greater resource utilization. Risk factors for bronchopulmonary dysplasia in this study were: surfactant requirement, mechanical ventilation, air leak, patent ductus arteriosus, late onset sepsis and necrotizing enterocolitis. These studies may provide information useful to the design of effective preventive perinatal strategies.

A new score for predicting neonatal very low birth weight mortality risk in the NEOCOSUR South American Network.

OBJECTIVE: To develop and validate a model for very low birth weight (VLBW) neonatal mortality prediction, based on commonly available data at birth, in 16 neonatal intensive care units (NICUs) from five South American countries. STUDY DESIGN: Prospectively collected biodemographic data from the Neonatal del Cono Sur (NEOCOSUR) Network between October 2000 and May 2003 in infants with birth weight 500 to 1500 g were employed. A testing sample and crossvalidation techniques were used to validate a statistical model for risk of in-hospital mortality. The new risk score was compared with two existing scores by using area under the receiver operating characteristic curve (AUC). RESULTS: The new NEOCOSUR score was highly predictive for in-hospital mortality (AUC=0.85) and performed better than the Clinical Risk Index for Babies (CRIB) and the NICHD risk models when used in the NEOCOSUR Network. The new score is also well calibrated - it had good predictive capability for in-hospital mortality at all levels of risk (HL test=11.9, p=0.85). The new score also performed well when used to predict in hospital neurological and respiratory complications. CONCLUSIONS: A new and relatively simple VLBW mortality risk score had a good prediction performance in a South American network population. This is an important tool for comparison purposes among NICUs. This score may prove to be a better model for application in developing countries.