Optimized growth and reduced morbidity in preterm infants : focus on nutrition and saturation targets

Preterm birth alters the conditions during an important period of growth and organ maturation. Extremely preterm infants have a high risk of developing morbidity. Retinopathy of prematurity (ROP) and bronchopulmonary dysplasia (BPD) originate in a disturbed retinal and pulmonary development. Associations between nutrition and risk of ROP and BPD have been demonstrated in some previous studies. Practical guidelines published 2005 included recommendations of higher early macronutrient intakes after preterm birth, compared to previous guidelines. One well known risk factor for ROP is oxygen exposure. As a result of five coordinated randomized trials, European saturation target guidelines were revised 2013. The objective of this thesis is to study neonatal practices potentially associated with the risk of developing ROP and BPD. In addition, this thesis examines the adherence to implemented new recommendations of nutritional intakes and saturation targets. The overall aim is to increase the quality of care, in order to improve outcome in the high-risk population of extremely preterm infants. Paper I examined growth patterns in a large cohort of infants born in gestational age (GA) 23 0/7 to 30 6/7 weeks. Longitudinal data were used to investigate differences in growth patterns. The results demonstrated reduced postnatal weight gain in infants who developed ROP and BPD compared to infants without these diseases. The growth patterns differed depending on gestational age and postnatal age. Paper II used detailed nutritional data from infants born between 2004 and 2011 at GA