Early aggressive nutrition at 22–23 weeks gestational age improves weight gain and does not worsen neurological prognosis

Abstract The effect of early aggressive nutrition (EAN) on extremely low birth weight (ELBW) infants is unknown. The purpose of this study was to investigate the effect of EAN on ELBW infants, especially premature neonates of 22–23 weeks gestational age (GA22–23-week). Twenty-eight preterm infants of less than 26 weeks were divided into two groups (GA22–23-week group, 10 infants; GA24–25-week group, 18 infants) and compared. Each preterm infant received more than 3.0 g/kg/day of amino acids in the first day after birth and 1.0 g/kg/day of lipid emulsion from the next day. The GA22–23-week group had significantly smaller head circumference (20.4 ± 1.0 cm vs. 22.2 ± 1.4 cm, P = 0.002) and body weight at birth (539 ± 68 g vs. 697 ± 155 g, P = 0.003), but there were no differences in early postnatal weight loss (10.4% ± 6.3% vs. 8.1% ± 6.3%, P = 0.37), and body weight at 37 weeks postmenstrual age (1906 ± 321 g vs. 2081 ± 379 g, P = 0.17). Blood urea nitrogen levels were higher in the GA22–23-week group (59.7 ± 16.6 mg/dl vs. 45.0 ± 10.8 mg/dl, P = 0.004), but there were no differences in direct-bilirubin, bile acids, and ammonia levels. After discharge, there was no significant difference in developmental quotient at 2 years of age (71.3 ± 15.1 vs. 78.1 ± 22.6, P = 0.20) between the two groups. Conclusion: We suggest that EAN reduces the rate of early postnatal weight loss in ELBW infants and contributes to weight gain until full term age.