Low energy intake during the first 4 weeks of life increases the risk for severe retinopathy of prematurity in extremely preterm infants

Arch Dis Child Fetal Neonatal Ed. 2016 Mar;101(2):F108-13. doi: 10.1136/archdischild-2014-306816. Epub 2015 Feb 12.


Objectives: Poor weight gain during the first weeks of life in preterm infants is closely associated with the risk of developing the retinopathy of prematurity (ROP) and insufficient nutrition might be an important contributing factor. This study aimed to evaluate the effect of energy and macronutrient intakes during the first 4 weeks of life on the risk for severe ROP (stages 3-5).

Study design: A population-based study including all Swedish extremely preterm infants born before 27 gestational weeks during a 3-year period. Each infant was classified according to the maximum stage of ROP in either eye as assessed prospectively until full retinal vascularisation. The detailed daily data of actual intakes of enteral and parenteral nutrition and growth data were obtained from hospital records.

Results: Of the included 498 infants, 172 (34.5%) had severe ROP and 96 (19.3%) were treated. Energy and macronutrient intakes were less than recommended and the infants showed severe postnatal growth failure. Higher intakes of energy, fat and carbohydrates, but not protein, were significantly associated with a lower risk of severe ROP. Adjusting for morbidity, an increased energy intake of 10 kcal/kg/day was associated with a 24% decrease in severe ROP.

Conclusions: We showed that low energy intake during the first 4 weeks of life was an independent risk factor for severe ROP. This implies that the provision of adequate energy from parenteral and enteral sources during the first 4 weeks of life may be an effective method for reducing the risk of severe ROP in extremely preterm infants.

Keywords: growth failure; macronutrients; malnutrition; nutritional intakes; preterm infants.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cohort Studies
  • Dietary Carbohydrates / administration & dosage
  • Dietary Fats / administration & dosage
  • Dietary Proteins / administration & dosage
  • Energy Intake / physiology*
  • Growth Disorders / etiology
  • Humans
  • Infant, Extremely Premature / physiology*
  • Infant, Newborn / growth & development
  • Multivariate Analysis
  • Nutritional Requirements
  • Retinopathy of Prematurity / physiopathology*
  • Risk Factors
  • Severity of Illness Index*


  • Dietary Carbohydrates
  • Dietary Fats
  • Dietary Proteins