Associação entre práticas de alimentação e ganho de peso intra-hospitalar em recém-nascidos prematuros de muito baixo peso de nascimento.

Abstract

This paper evaluated [1] factors associated to weight gain restriction at discharge and [2] the association between feeding practices and weight gain during hospitalization in very low birth weight infants (501 to 1.499) at Hospital Geral de Bonsucesso (Rio de Janeiro). Data were collected from hospital charts including all births between June 2002 and June 2004. Two hundred forty-seven alive-births were included and 203 of them were discharged from hospital. Birth characteristics, illness and feeding practices were registered. A lower birth weight, small for gestational age (third percentile), a higher CRIB score and sepsis were factor associated to weight gain restriction at discharge. Among those appropriate at birth (158), sixty-nine (43.7%) children were below the third percentile at discharge. Those cases of weight gain restriction were associated to sepsis, metabolic bone disease and higher number of blood transfusions, although the model poorly explained them (14%). These illness (or exposures) may be markers of a worse weight performance during hospitalization. As morbidities poorly explain weight gain restriction at discharge, particularly the inhospital cases. We analyzed the association between feeding practices and inhospital weight gain. By using mixed effects longitudinal regression we observed that the number of days to start enteral feedings, to achieve full enteral feeding, to start parenteral nutrition and days on th parenteral nutrition were associated to the initial weight variation (until the 17day). The number of days to begin parenteral nutrition did not influence weight variation after the 17day of life. This study results suggest 1) that a lower birth weight, small for gestational age, a higher CRIB score and sepsis are associated to weight gain restriction at discharge; 2) among those appropriate at birth, the occurrence of sepsis, metabolic bone disease and higher number of blood transfusion area associated to a worse inhospital weight performance; 3) that feeding practices, decided at the first days of life influence weight gain along the hospitalization and by reviewing those practices we might improve inhospital weight performance of preterm very low birth weight infants.