GROWTH OF VERY PREMATURE-INFANTS FED INTRAVENOUS HYPERALIMENTATION AND CALCIUM-SUPPLEMENTED FORMULA

Objective. To describe growth during initial hospitalization for very small premature infants fed intravenous hyperalimentation, then calciu m supplemented 1460 mg/L (36.5 mmol/L) 81 kcal preterm formula. Popula tion. A total of 109 survivors whose <1000 g birth weight was appropri ate for gestational age. Mean gestational age was 25.8 weeks. Results. Graphs were constructed for weight, length, and head circumference by week of age. Mean and +/- 2 SD lines were depicted, with mean intraut erine growth lines for comparison. Separate graphs showed mean weight, length, and head circumference growth by 100 g birth weight cohorts. Mean Z scores based on normal intrauterine growth curves were calculat ed. Weight Z scores were -.35 at birth, -1.79 at 14 days, and -1.87 at 56 days. Length Z scores were -.32 at birth, -1.29 at 14 days, and -2 .24 at 56 days. Head circumference Z scores were 0.01 at birth, -1.26 at 14 days, and -1.06 at 56 days. (Z score [measured parameter - intra uterine mean for gestation]/intrauterine SD for gestation). Repeated-m easures multivariate ANOVAs showed the following significant Z score c hanges. There were decreases in Z scores for weight, length, and head circumference between birth and 14 days and an additional decrease for length between 14 and 56 days. Head circumference Z scores increased from day 14 to day 56, but remained smaller at day 56 than at day 0. I nitially, head circumference Z scores were better than weight or lengt h (possibly because of late head measurement timing). At day 14, the Z scores for weight were lower than those for length and head circumfer ence. At day 56, the head circumference Z scores were higher than thos e for length or weight. Conclusion. Compared with intrauterine standar ds, weight, length, and head circumference were all worse at day 56 th an at birth, although there was relative head-sparing and weight growt h paralleled intrauterine growth after 14 days. Length worsened from d ay 14 to day 56 in spite of the use of calcium and phosphorus-enriched formula.