Original Article

Journal of Perinatology (2008) 28, 347–353; doi:10.1038/jp.2008.15; published online 13 March 2008

Improved growth and decreased morbidities in <1000 g neonates after early management changes

C A Geary1, R A Fonseca1, M A Caskey1 and M H Malloy1

1Department of Pediatrics, The University of Texas Medical Branch, Galveston, TX, USA

Correspondence: Dr CA Geary, Department of Pediatrics, University of Texas Medical Branch, 301 University Blvd, Route 0526, Galveston, TX 77555-0526, USA. E-mail: cageary@utmb.edu

Received 6 August 2007; Revised 9 January 2008; Accepted 4 February 2008; Published online 13 March 2008.

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Abstract

Objective:

 

To test the hypothesis that three changes in the early management of extremely low birth weight (ELBW) neonates would decrease the incidence of extra-uterine growth restriction (EUGR) by 25% . The three early management practice changes (EMPC) included surfactant at delivery followed by immediate extubation to nasal continuous positive airway pressure (CPAP), decreased oxygen exposure and early parenteral amino acids.

Study Design:

 

Historical cohort study of preterm infants less than or equal to1000 g birth weight (BW) born at the University of Texas Medical Branch between January 2001 and June 2002 (pre-EMPC, before changes, n=87) and July 2004 to December 2005 (post-EMPC, after changes, n=76). Outcomes measured included feeding and growth parameters, morbidities and interventions. Statistical analysis included chi2-analysis, Student's t-test, and analysis of variance.

Result:

 

Infants in the post-EMPC cohort regained BW more quickly, maintained appropriate size for weight at 36 weeks and had less morbidity associated with poor long-term outcome. Predictors of EUGR included BW <750 g and surgical necrotizing enterocolitis.

Conclusion:

 

The introduction of surfactant at delivery followed by immediate extubation to CPAP, decreased oxygen exposure and early parenteral amino acids in ELBW infants is possible, safe and associated with improvements in growth and morbidity.

Keywords:

extra-uterine growth restriction, neurodevelopmental delay, delivery room CPAP, surfactant, early amino acids, neonatal nutrition and growth

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