Abstract
Background: Nutrition has become a priority in the intensive care of VLBW infants. The WGV during the neonatal period, expressed in g/kg/day, is considered a determinant of the long term nutritional status of this infants.
Objectives: 1) Assess the perinatal and postnatal factors (clinical and nutritional) explaining differences in WGV between centers. 2) Identify possible risk factors associated to poor WGV from comparing centers with the lowest and highest weight gain (benchmarking).
Design: This a retrospective cohort analyisis of infants registered in the NEOCOSUR database (16 NICUs), born from January 2001 to December 2004, alive and with weight data at 28 days of life. Infant with major malformations were excluded. We developed multiple regression model to include centers (Model 1) + case mix (gestaciónal age (GE), sex, use of prenatal steroids, SGA, APGAR<6 at 5′)(Model 2), + clinical practice and complications (use of postnatal steroids, mechanical ventilation, BPD at 28 days, NEC, late onset sepsis) (Model 3) + and nutritional practices (use of TPN, age at enteral nutrition100 cc/kg/day) (Model 4). To accomplish the second objective, centers′mean WGV was adjusted with multiple regression model and then ranked in lower and higher quartiles.
Results: Of the 3.974 VLBW infants we analyzed 2.419. We found a great variability in the WGV between centers, with the final predictive model (model 4) explaining only 31% of the overall variance. The centers final predicted WGV varies from 5,6 to 14,7 g/kg/day. Comparison of centers in the lower and higher quartile showed the lower group being older and heavier at birth with higher proprotion of SGA infants and less need for ventilatory support at birth. Nevertheless they present greater incidence of delayed sepsis and NEC and lower use of TPN.
Conclusions: The analysis showed a significant variability in WGV between centers, with model explaining just 31% of the overall predictive value. The comparison between centers suggests that control of LOS and NeC associated to greater use of TPN, would have a favorable effect in the WGV in centers with poor nutritional performance.
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Llanos, A., Mena, P. & Gómez, A. Differeneces in Weight Gain Velocity (WGV) in Very Low Birth Weight Infants (VLBW) Between Centers in the Neocosur Network: TL026. Pediatr Res 60, 637 (2006). https://doi.org/10.1203/00006450-200611000-00033
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DOI: https://doi.org/10.1203/00006450-200611000-00033