Evaluation of the nutritional status at 40 weeks corrected gestational age in a cohort of very low birth weight infants

Objetivo: Avaliar a adequa????o do peso ao termo em uma coorte de rec??m-nascidos com peso de nascimento menor que 1.500 g e correlacion ??-la a vari??veis cl??nicas e nutricionais. M??todos: Estudo longitudinal onde rec??m-nascidos de muito baixo peso de oito hospitais (divididos em duas categorias: tipo I aporte nutricional agressivo; tipo II outras pr??ticas) foram acompanhados prospectivamente de novembro de 1999 a abril de 2000. O estado nutricional foi avaliado pelo escore z, sendo considerado como desnutri????o o escore z menor ou igual a -2, segundo a curva do Canadian Perinatal Surveillance System. Os dados foram analisados por meio de regress??o linear m??ltipla e regress??o log??stica. Este estudo foi aprovado pelo Comit?? de ??tica em Pesquisa. Resultados: 63% da popula????o estudada (126/200) foi classificada como desnutrida ao termo. O peso ao termo apresentou correla????o negativa com o tempo de interna????o, com a idade gestacional ao nascimento, com o tempo para a recupera????o do peso de nascimento e com o clinical risk index for babies (p < 0,05). Ter sido classificado como pequeno para a idade gestacional aumentou a chance de ser desnutrido ao termo em 12,19 vezes. Ter nascido nas unidades tipo I, ser do sexo masculino e ter atingido dieta enteral plena em at?? 10 dias de vida reduziu o risco de desnutri????o ao termo em 2,17, 0,4 e 1,97 vezes, respectivamente (p < 0,03). Conclus??es: A forma mais eficaz de prevenir a desnutri????o nos rec??m-nascidos prematuros ?? estimular pr??ticas perinatais, objetivando a preven????o da restri????o do crescimento intra-uterino, al??m de priorizar uma abordagem nutricional mais agressiva.Objective: To evaluate the nutritional status at term of a cohort of newborn babies with birth weights of less than 1,500 g and to correlate this with nutritional practices and clinical variables. Methods: Very low birth weight infants admitted to eight neonatal intensive care units from November 1999 to April 2000 were studied prospectively. The units were defined as Type I if they employed aggressive nutritional support techniques and Type II if other nutritional practices were used. Babies were defined as malnourished if their zscore for weight was less than or equal to 2 on the Canadian Perinatal Surveillance System growth curves. Data was analyzed using multivariate linear regression and logistic regression. The study was approved by the Committee for Ethics in Research. Results: Sixty-three percent (126/200) of the study population were classified as being malnourished at term. Weight at term (corrected gestational age) showed a direct correlation with birth weight, but an indirect correlation with the length of stay, gestational age at birth, time to regain birth weight and CRIB score (p < 0.05). Small for gestational age infants had a 12.19 times greater chance of being malnourished at term. Being born at a Type I unit reduced the risk of malnutrition at term by 2.17 times, male sex reduced this risk by 0.4 times and achieving total enteral nutrition by the 10th day of life reduced it by 1.97 times (p < 0.03). Conclusions: The most effective means of preventing babies being malnourished at term is by encouraging perinatal practices aimed at preventing restricted intrauterine growth, in addition to giving priority to aggressive nutritional management