Neonatal Morbidity Count Is Associated With a Reduced Likelihood of Achieving Recommendations for Protein, Lipid, and Energy in Very Low Birth Weight Infants: A Prospective Cohort Study

JPEN J Parenter Enteral Nutr. 2018 Mar;42(3):623-632. doi: 10.1177/0148607117710441. Epub 2017 Dec 19.


Background: Serious morbidity may elevate nutrient requirements and affect adherence to feeding guidelines for very low birth weight (VLBW) infants. An understanding of factors affecting nutrient intakes of VLBW infants will facilitate development of strategies to improve nutrient provision. Our aim was to examine the impact of neonatal morbidity count on achieving recommended nutrient intakes in VLBW infants.

Methods: VLBW infants enrolled in the Donor Milk for Improved Neurodevelopmental Outcomes trial (ISRCTN35317141, n = 363) were included. Serious morbidities and daily parenteral and enteral intakes were collected prospectively.

Results: Median intakes of infants with and without ≥1 morbidity met protein recommendations (3.5-4.5 g/kg/d) by week 2, although not maintained after week 4. Infants with ≥1 morbidity (vs without) were 2 weeks slower in achieving lipid (4.8-6.6 g/kg/d; week 4 vs 2) and energy (110-130 kcal/kg/d; week 5 vs 3) and 1 week slower in achieving carbohydrate recommendations (11.6-13.2 g/kg/d; week 4 vs 3). Adjusted hazard ratios of first achieving recommendations on any given day in infants with any 1 or 2 morbidities were 0.6 (95% confidence interval [CI], 0.5-0.9) and 0.6 (0.4-0.9), respectively, for protein; 0.5 (0.4-0.7) and 0.3 (0.2-0.5) for lipid; and 0.5 (0.4-0.7) and 0.3 (0.2-0.4) for energy.

Conclusion: Morbidity is associated with a decreased likelihood of achieving lipid and consequently energy recommendations. This and the decline in protein intakes after the early neonatal period require further investigation to ensure optimal nutrition in this vulnerable population.

Keywords: energy; lipid; macronutrient; morbidity; protein; sepsis; very low birth weight.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cohort Studies
  • Dietary Proteins / administration & dosage*
  • Double-Blind Method
  • Energy Intake / physiology*
  • Female
  • Humans
  • Infant Nutritional Physiological Phenomena
  • Infant, Newborn
  • Infant, Premature / growth & development
  • Infant, Premature, Diseases / epidemiology
  • Infant, Very Low Birth Weight / growth & development*
  • Intensive Care Units, Neonatal
  • Lipids / administration & dosage*
  • Male
  • Milk, Human
  • Morbidity
  • Nervous System / growth & development
  • Nutritional Requirements
  • Nutritional Support / methods*
  • Prospective Studies
  • Recommended Dietary Allowances


  • Dietary Proteins
  • Lipids