Restricción de crecimiento postnatal y asociación con lactancia materna exclusiva en menores de 1500 gramos
Resumen Objetivo: Conocer la incidencia de restricción postnatal de crecimiento (RPC) en recién nacidos (RN) de muy bajo peso (peso al nacer <1500 g; RNMBP) de nuestra unidad, analizando el impacto del incremento de lactancia materna exclusiva (LME) y la introducción de leche donada (LD). Material y métodos: Estudio cuasi-experimental en RNMBP divididos en dos grupos respecto a una intervención para optimizar las prácticas de lactancia, incluyendo la disponibilidad de LD: grupo 1 (PRE-intervención; enero 2016-mayo 2018) y grupo 2 (POST-intervención; junio 2018-diciembre 2020). Se registran variables de somatometría al nacer, 28 días, 36 semana postmenstrual (sEPM) y alta, convirtiéndolas en z-score y percentil según estándares Intergrowth-21st. Se analiza la evolución de dichas variables y las posibles diferencias entre grupos. Resultados: Se incluyen 115 RNMBP con una mediana de edad gestacional de 29 semanas y peso 1235 g, 58 en grupo 1 y 57 en grupo 2. Encontramos diferencias significativas en las tasas de LME durante el ingreso entre ambos grupos (22.4 % vs. 61.4 %; p < 0.001) y al alta (39.7 % vs. 66.7 %; p = 0.004). Respecto a la RPC al alta, de forma global, un 31 % presentaba peso < p10 y 19 % perímetro cefálico < p10. Comparando ambos grupos, no hubo diferencias significativas en la RPC ni a las 36 sEPM (38.6 % vs. 33.9 %; p = 0.35) ni al alta (34.5 % vs. 28.1 %; p = 0.46).
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1. American Academy of Pediatrics Committee on Nutrition: Nutritional needs of low-birth-weight infants. Pediatrics. 1985;75(5):976-86.
2. Cacho NT, Parker LA, Neu J. Necrotizing enterocolitis and human milk feeding: A systematic review. Clin Perinatol [Internet]. 2017;44(1):49-67. Disponible en: http://dx.doi.org/10.1016/j.clp.2016.11.009
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4. Victora CG, Bahl R, Barros AJ, França GV, Horton S, Krasevec J. Lancet Breastfeeding Series Group. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet. 2016;30:475-90.
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9. Gidrewicz DA, Fenton TR. A systematic review and meta-analysis of the nutrient content of preterm and term breast milk. BMC Pediatr [Internet]. 2014;14(1):216. Disponible en: http://dx.doi.org/10.1186/1471-2431-14-216
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11. Arslanoglu S, Moro GE, Ziegler EE. The Wapm Working Group On Nutrition. Optimization of human milk fortification for preterm infants: new concepts and recommendations. J Perinat Med. 2010;38(3):233-8.
12. Arslanoglu S, Boquien C-Y, King C, Lamireau D, Tonetto P, Barnett D. Fortification of human milk for preterm infants: Update and recomendations of the European Milk Bank Association (EMBA) Working Group on human milk fortification. Front Pediatr. 2019;7.
13. Cooke RJ, Ainsworth SB, Fenton AC. Postnatal growth retardation: a universal problem in preterm infants. Arch Dis Child Fetal Neonatal Ed [Internet]. 2004;89(5):F428-30. Disponible en: http://dx.doi.org/10.1136/adc.2001.004044
14. Ehrenkranz RA, Das A, Wrage LA, Poindexter BB, Higgins RD, Stoll BJ. Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Early nutrition mediates the influence of severity of illness on extremely LBW infants. Pediatr Res. 2011;69:522-9.
15. Ávila-Álvarez A, Solar Boga A, Bermúdez-Hormigo C, Fuentes Carballal J. Restricción del crecimiento extrauterino en recién nacidos de menos de 1500 gramos de peso al nacer. Anales de Pediatría. 2018;89(6):325-32.
16. Villar J, Giuliani F, Barros F, Roggero P, Coronado Zarco IA, Rego MAS et al. Monitoring the postnatal growth of preterm infants: A paradigm change. Pediatrics [Internet]. 2018;141(2). Disponible en: http://dx.doi.org/10.1542/peds.2017-2467
17. González-García L, García-López E, Fernández-Colomer B, Mantecón-Fernández L, Lareu-Vidal S, Suárez-Rodríguez M et al. Extrauterine growth restriction in very low birth weight infants: Concordance between Fenton 2013 and INTERGROWTH-21st growth charts. Front Pediatr [Internet]. 2021;9:690788. Disponible en: http://dx.doi.org/10.3389/fped.2021.690788
18. Izquierdo Renau M, Aldecoa-Bilbao V, Balcells Esponera C, Del Rey Hurtado de Mendoza B, Iriondo Sanz M, Iglesias-Platas I. Applying methods for postnatal growth assessment in the clinical setting: Evaluation in a longitudinal cohort of very preterm infants. Nutrients [Internet]. 2019;11(11):2772. Disponible en: http://dx.doi.org/10.3390/nu11112772
19. Ehrenkranz RA, Dusick AM, Vohr BR, Wright LL, Wrage LA, Poole WK. Growth in the neonatal intensive care unit influences neurodevelopmental and growth outcomes of extremely low birth weight infants. Pediatrics [Internet]. 2006;117(4):1253-61. Disponible en: http://dx.doi.org/10.1542/peds.2005-1368
20. Ong KK, Kennedy K, Castañeda-Gutiérrez E, Forsyth S, Godfrey KM, Koletzko B et al. Postnatal growth in preterm infants and later health outcomes: a systematic review. Acta Paediatr [Internet]. 2015;104(10):974-86. Disponible en: http://dx.doi.org/10.1111/apa.13128
21. Stevens TP, Shields E, Campbell D, Combs A, Horgan M, La Gamma EF et al. Statewide initiative to reduce postnatal growth restriction among infants <31 weeks of gestation. J Pediatr [Internet]. 2018;197:82-89.e2. Disponible en: http://dx.doi.org/10.1016/j.jpeds.2018.01.074
22. Shlomai O, Reichman N, Lerner-Geva B, Boyko L, Bar-Oz V. Population-based study shows improved postnatal growth in preterm very-low-birthweight infants between 1995 and 2010. Acta Paediatr. 2014;103:498-503.
23. Andrews ET, Ashton JJ, Pearson F, Beattie RM, Johnson MJ. Early postnatal growth failure in preterm infants is not inevitable. Arch Dis Child Fetal Neonatal Ed [Internet]. 2019;104(3):F235-41. Disponible en: http://dx.doi.org/10.1136/archdischild-2018-315082
24. Meier PP, Johnson TJ, Patel AL, Rossman B. Evidence-based methods that promote human milk feeding of preterm infants: An expert review. Clin Perinatol [Internet]. 2017;44(1):1-22. Disponible en: http://dx.doi.org/10.1016/j.clp.2016.11.005
25. Lee HC, Kurtin PS, Wight NE, Chance K, Cucinotta-Fobes T, Hanson-Timpson TA et al. A quality improvement project to increase breast milk use in very low birth weight infants. Pediatrics [Internet]. 2012;130(6):e1679-87. Disponible en: http://dx.doi.org/10.1542/peds.2012-0547
26. Parker MG, Patel AL. Using quality improvement to increase human milk use for preterm infants. Semin Perinatol [Internet]. 2017;41(3):175-86. Disponible en: http://dx.doi.org/10.1053/j.semperi.2017.03.007
27. Villar J, Giuliani F, Fenton TR, Ohuma EO, Ismail LC, Kennedy SH. Consortium I-s. INTERGROWTH-21st very preterm size at birth reference charts. Lancet. 2016;387:844-5.
28. Jobe AH, Bancalari E. NICHD/NIH Workshop summary: bronchopulmonary dysplasia. Am J Respir Crit Care Med. 2001;163:1723-9.
29. Sáenz de Pipaón M, Martínez-Biarge M, Dorronsoro I, Salas S, Madero R, Martos GÁ et al. Growth in preterm infants until 36 weeks’ postmenstrual age is close to target recommendations. Neonatology [Internet]. 2014;106(1):30-6. Disponible en: http://dx.doi.org/10.1159/000358479
30. García-Muñoz Rodrigo F, Figueras Aloy J, Saavedra Santana P, García-Alix A. Crecimiento posnatal hasta el alta hospitalaria en recién nacidos extremadamente prematuros españoles. An Pediatr (Barc) [Internet]. 2017;87(6):301-10. Disponible en: http://dx.doi.org/10.1016/j.anpedi.2016.10.011
31. Rochow N, Raja P, Liu K, Fenton T, Landau-Crangle E, Göttler S et al. Physiological adjustment to postnatal growth trajectories in healthy preterm infants. Pediatr Res [Internet]. 2016;79(6):870-9. Disponible en: http://dx.doi.org/10.1038/pr.2016.15
32. Vidal K, Aloyb F, Pujolc N, Platasa I, Serrano M, Pérez C, Martín-Ancel F. Restricción posnatal del crecimiento en recién nacidos españoles de muy bajo peso con edad gestacional menor o igual a 32 semanas. Anales de Pediatría. 2018;68(3):206-12.
33. Embleton NE, Pang N, Cooke RJ. Postnatal malnutrition and growth retardation: an inevitable consequence of current recommendations in preterm infants? Pediatrics. 2001;107(2):270-3.
34. Clark RH, Thomas P, Peabody J. Extrauterine growth restriction remains a serious problem in prematurely born neonates. Pediatrics [Internet]. 2003;111(5 Pt 1):986-90. Disponible en: http://dx.doi.org/10.1542/peds.111.5.986
35. Hanigainathan S, Abiramalatha T. Early fortification of human milk versus late fortification to promote growth in preterm infants. Cochrane Database of Systematic Reviews. 2020;7:1057-68.
36. Maas C, Wiechers C, Bernhard W, Poets CF, Franz AR. Early feeding of fortified breast milk and in-hospital-growth in very premature infants: a retrospective cohort analysis. BMC Pediatr [Internet]. 2013;13(1):178. Disponible en: http://dx.doi.org/10.1186/1471-2431-13-178
37. Vázquez DC, García SS, Renau MI. Iglesias-Platas, I. Aviability of donor milk for very preterm infants decreased the risk of necrotizing enterocolitis without adversely impacting growth or rates of breastfeeding. Nutrients. 2019;11(8).
38. Boquien C-Y. Human milk: An ideal food for nutrition of preterm newborn. Front Pediatr [Internet]. 2018;6:295. Disponible en: http://dx.doi.org/10.3389/fped.2018.00295
2. Cacho NT, Parker LA, Neu J. Necrotizing enterocolitis and human milk feeding: A systematic review. Clin Perinatol [Internet]. 2017;44(1):49-67. Disponible en: http://dx.doi.org/10.1016/j.clp.2016.11.009
3. Patel AL, Johnson TJ, Engstrom JL, Fogg LF, Jegier BJ, Bigger HR et al. Impact of early human milk on sepsis and health-care costs in very low birth weight infants. J Perinatol [Internet]. 2013;33(7):514-9. Disponible en: http://dx.doi.org/10.1038/jp.2013.2
4. Victora CG, Bahl R, Barros AJ, França GV, Horton S, Krasevec J. Lancet Breastfeeding Series Group. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet. 2016;30:475-90.
5. Global breastfeeding investment case. The Investment Case for Breastfeeding: Nurturing the Health and Wealth of Nations. UNICEF, WHO; 2017.
6. The Baby-friendly Hospital Initiative for small, sick and preterm newborns. Geneva: World Health Organization and the United Nations Children’s Fund (UNICEF); 2020.
7. Moro GE, Arslanoglu S, Bertino E, Corvaglia L, Montirosso R, Picaud J-C et al. XII. Human milk in feeding premature infants: Consensus statement: Consensus statement. J Pediatr Gastroenterol Nutr [Internet]. 2015;61 Suppl 1(1):S16-9. Disponible en: http://dx.doi.org/10.1097/01.mpg.0000471460.08792.4d
8. Agostoni C, Buonocore G, Carnielli VP, Curtis D, Darmaun M, Decsi D. ESPGHAN Committee on Nutrition. Enteral nutrient supply for preterm infants: commentary from the European Society of Paediatric Gastroenterology, Hepatology and Nutrition Committee on Nutrition. J Pediatr Gastroenterol Nutr. 2010;50(1):85-91.
9. Gidrewicz DA, Fenton TR. A systematic review and meta-analysis of the nutrient content of preterm and term breast milk. BMC Pediatr [Internet]. 2014;14(1):216. Disponible en: http://dx.doi.org/10.1186/1471-2431-14-216
10. Ballard O, Morrow AL. Human milk composition: nutrients and bioactive factors. Pediatr Clin North Am [Internet]. 2013;60(1):49-74. Disponible en: http://dx.doi.org/10.1016/j.pcl.2012.10.002
11. Arslanoglu S, Moro GE, Ziegler EE. The Wapm Working Group On Nutrition. Optimization of human milk fortification for preterm infants: new concepts and recommendations. J Perinat Med. 2010;38(3):233-8.
12. Arslanoglu S, Boquien C-Y, King C, Lamireau D, Tonetto P, Barnett D. Fortification of human milk for preterm infants: Update and recomendations of the European Milk Bank Association (EMBA) Working Group on human milk fortification. Front Pediatr. 2019;7.
13. Cooke RJ, Ainsworth SB, Fenton AC. Postnatal growth retardation: a universal problem in preterm infants. Arch Dis Child Fetal Neonatal Ed [Internet]. 2004;89(5):F428-30. Disponible en: http://dx.doi.org/10.1136/adc.2001.004044
14. Ehrenkranz RA, Das A, Wrage LA, Poindexter BB, Higgins RD, Stoll BJ. Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Early nutrition mediates the influence of severity of illness on extremely LBW infants. Pediatr Res. 2011;69:522-9.
15. Ávila-Álvarez A, Solar Boga A, Bermúdez-Hormigo C, Fuentes Carballal J. Restricción del crecimiento extrauterino en recién nacidos de menos de 1500 gramos de peso al nacer. Anales de Pediatría. 2018;89(6):325-32.
16. Villar J, Giuliani F, Barros F, Roggero P, Coronado Zarco IA, Rego MAS et al. Monitoring the postnatal growth of preterm infants: A paradigm change. Pediatrics [Internet]. 2018;141(2). Disponible en: http://dx.doi.org/10.1542/peds.2017-2467
17. González-García L, García-López E, Fernández-Colomer B, Mantecón-Fernández L, Lareu-Vidal S, Suárez-Rodríguez M et al. Extrauterine growth restriction in very low birth weight infants: Concordance between Fenton 2013 and INTERGROWTH-21st growth charts. Front Pediatr [Internet]. 2021;9:690788. Disponible en: http://dx.doi.org/10.3389/fped.2021.690788
18. Izquierdo Renau M, Aldecoa-Bilbao V, Balcells Esponera C, Del Rey Hurtado de Mendoza B, Iriondo Sanz M, Iglesias-Platas I. Applying methods for postnatal growth assessment in the clinical setting: Evaluation in a longitudinal cohort of very preterm infants. Nutrients [Internet]. 2019;11(11):2772. Disponible en: http://dx.doi.org/10.3390/nu11112772
19. Ehrenkranz RA, Dusick AM, Vohr BR, Wright LL, Wrage LA, Poole WK. Growth in the neonatal intensive care unit influences neurodevelopmental and growth outcomes of extremely low birth weight infants. Pediatrics [Internet]. 2006;117(4):1253-61. Disponible en: http://dx.doi.org/10.1542/peds.2005-1368
20. Ong KK, Kennedy K, Castañeda-Gutiérrez E, Forsyth S, Godfrey KM, Koletzko B et al. Postnatal growth in preterm infants and later health outcomes: a systematic review. Acta Paediatr [Internet]. 2015;104(10):974-86. Disponible en: http://dx.doi.org/10.1111/apa.13128
21. Stevens TP, Shields E, Campbell D, Combs A, Horgan M, La Gamma EF et al. Statewide initiative to reduce postnatal growth restriction among infants <31 weeks of gestation. J Pediatr [Internet]. 2018;197:82-89.e2. Disponible en: http://dx.doi.org/10.1016/j.jpeds.2018.01.074
22. Shlomai O, Reichman N, Lerner-Geva B, Boyko L, Bar-Oz V. Population-based study shows improved postnatal growth in preterm very-low-birthweight infants between 1995 and 2010. Acta Paediatr. 2014;103:498-503.
23. Andrews ET, Ashton JJ, Pearson F, Beattie RM, Johnson MJ. Early postnatal growth failure in preterm infants is not inevitable. Arch Dis Child Fetal Neonatal Ed [Internet]. 2019;104(3):F235-41. Disponible en: http://dx.doi.org/10.1136/archdischild-2018-315082
24. Meier PP, Johnson TJ, Patel AL, Rossman B. Evidence-based methods that promote human milk feeding of preterm infants: An expert review. Clin Perinatol [Internet]. 2017;44(1):1-22. Disponible en: http://dx.doi.org/10.1016/j.clp.2016.11.005
25. Lee HC, Kurtin PS, Wight NE, Chance K, Cucinotta-Fobes T, Hanson-Timpson TA et al. A quality improvement project to increase breast milk use in very low birth weight infants. Pediatrics [Internet]. 2012;130(6):e1679-87. Disponible en: http://dx.doi.org/10.1542/peds.2012-0547
26. Parker MG, Patel AL. Using quality improvement to increase human milk use for preterm infants. Semin Perinatol [Internet]. 2017;41(3):175-86. Disponible en: http://dx.doi.org/10.1053/j.semperi.2017.03.007
27. Villar J, Giuliani F, Fenton TR, Ohuma EO, Ismail LC, Kennedy SH. Consortium I-s. INTERGROWTH-21st very preterm size at birth reference charts. Lancet. 2016;387:844-5.
28. Jobe AH, Bancalari E. NICHD/NIH Workshop summary: bronchopulmonary dysplasia. Am J Respir Crit Care Med. 2001;163:1723-9.
29. Sáenz de Pipaón M, Martínez-Biarge M, Dorronsoro I, Salas S, Madero R, Martos GÁ et al. Growth in preterm infants until 36 weeks’ postmenstrual age is close to target recommendations. Neonatology [Internet]. 2014;106(1):30-6. Disponible en: http://dx.doi.org/10.1159/000358479
30. García-Muñoz Rodrigo F, Figueras Aloy J, Saavedra Santana P, García-Alix A. Crecimiento posnatal hasta el alta hospitalaria en recién nacidos extremadamente prematuros españoles. An Pediatr (Barc) [Internet]. 2017;87(6):301-10. Disponible en: http://dx.doi.org/10.1016/j.anpedi.2016.10.011
31. Rochow N, Raja P, Liu K, Fenton T, Landau-Crangle E, Göttler S et al. Physiological adjustment to postnatal growth trajectories in healthy preterm infants. Pediatr Res [Internet]. 2016;79(6):870-9. Disponible en: http://dx.doi.org/10.1038/pr.2016.15
32. Vidal K, Aloyb F, Pujolc N, Platasa I, Serrano M, Pérez C, Martín-Ancel F. Restricción posnatal del crecimiento en recién nacidos españoles de muy bajo peso con edad gestacional menor o igual a 32 semanas. Anales de Pediatría. 2018;68(3):206-12.
33. Embleton NE, Pang N, Cooke RJ. Postnatal malnutrition and growth retardation: an inevitable consequence of current recommendations in preterm infants? Pediatrics. 2001;107(2):270-3.
34. Clark RH, Thomas P, Peabody J. Extrauterine growth restriction remains a serious problem in prematurely born neonates. Pediatrics [Internet]. 2003;111(5 Pt 1):986-90. Disponible en: http://dx.doi.org/10.1542/peds.111.5.986
35. Hanigainathan S, Abiramalatha T. Early fortification of human milk versus late fortification to promote growth in preterm infants. Cochrane Database of Systematic Reviews. 2020;7:1057-68.
36. Maas C, Wiechers C, Bernhard W, Poets CF, Franz AR. Early feeding of fortified breast milk and in-hospital-growth in very premature infants: a retrospective cohort analysis. BMC Pediatr [Internet]. 2013;13(1):178. Disponible en: http://dx.doi.org/10.1186/1471-2431-13-178
37. Vázquez DC, García SS, Renau MI. Iglesias-Platas, I. Aviability of donor milk for very preterm infants decreased the risk of necrotizing enterocolitis without adversely impacting growth or rates of breastfeeding. Nutrients. 2019;11(8).
38. Boquien C-Y. Human milk: An ideal food for nutrition of preterm newborn. Front Pediatr [Internet]. 2018;6:295. Disponible en: http://dx.doi.org/10.3389/fped.2018.00295
Bolea Muguruza, G., de Frutos Martínez, C., García Miralles, L. C., Tamayo Martínez, M. T., & Martín Corral, J. (2023). Restricción de crecimiento postnatal y asociación con lactancia materna exclusiva en menores de 1500 gramos. Revista De Lactancia Materna, 1(1), e30743. https://doi.org/10.14201/rlm.30743
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