Sydorenko I. Optimization of nutritional support in very low birth weight infants

The thesis is devoted to the important issue of Pediatrics optimization of nutritional support in very low birth weight infants (VLBW) to reduce the frequency of extrauterine growth retardation. Was involved 145 premature babies with a weight 1000-1500 g and 25-34 weeks gestational age from the Perinatal Center of Kyiv. The results obtained in the study showed the importance of parenteral nutrition for postnatal physical development. The increase of weight in the growth chart during the first two weeks of life largely determined the increase of weight at the discharge (r= 0.78, p<0.01). Intensive parenteral nutrition contributed to less weight loss, more rapid recovery of weight and better weight gain during the first month of life (in the main group- 319 [254- 393] g/kg, against- 149 [99-199] g/kg in the comparison group (p<0,01)). It was found that higher initial doses of amino acids contributed to a higher head circumference at the age of 1 month (r= 0,3, p<0,01). There was no relationship between the level of urea and the dose of amino acids during parenteral nutrition, which indicates that up to 4 g/kg/day of protein during parenteral nutrition in VLBW infants did not affect the level of urea. This allows using of high protein doses (≥2 g/kg/day) from the first hours of life. Lipid emulsions (LE) are an important component of parenteral nutrition during the transition to enteral feeding. Infusion of the 0,5-3 g/kg/day LE did not cause thrombocytopenia (χ2=2.343, p>0.05). The inverse correlation was revealed between the level of triglycerides and weight of the VLBW infants, which suggests that the possibility of assimilation of LE increases in VLBW infants with the weight increase. There was no significant effect on the reduction of the frequency of retinopathy of prematurity, bronchopulmonary dysplasia and early anaemia of prematurity in infants received combined LE compared to infants who received soybean oil LE. The analysis of the rate of increasing in enteral nutrition was performed. It was found that 65% of VLBW infants were tolerated well the progressive rate of increase in enteral nutrition, which allowed stopping their parenteral nutrition up to 14 days of life and only 35% of VLBW infants needed a longer parenteral nutrition. Complicated respiratory pathology, requiring longer respiratory support, reduces the average rate of increase in enteral feeding. The early onset of breastfeeding is associated with better tolerance for enteral feeding. The use of fortified breast milk resulted in a better increase of weight. It is the best method for enteral nutrition of VLBW infants before discharge from the hospital. The use of nasogastric tube improves the level of breastfeeding in VLBW infants at the time of discharge. In 12 months more than 90% of VLBW infants, regardless of the type of feeding after discharge (breastfeeding or artificial), are able to achieve normal signs in WHO growth chart. In 12 infants (35.3%) psychomotor development corresponded to the age of 12 months. Infants with extrauterine growth retardation and bronchopulmonary dysplasia require more careful monitoring compared to other VLBW infants. This emphasizes the importance of proper follow up. Keywords: parenteral nutrition, increase in the rate of enteral nutrition, improvement of breastfeeding, very low birth weight.