Factors associated with energy intake at 28 days in preterm infants: a prospective cohort study.
6 affiliations
- 1Clinical School Johor Bahru, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia , No. 8, Masjid Sultan Abu Bakar, Johor Bahru, Johor, 80100, Malaysia. [email protected].
- 2Clinical School Johor Bahru, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia , No. 8, Masjid Sultan Abu Bakar, Johor Bahru, Johor, 80100, Malaysia.
- 3JCSMHS, Monash University Malaysia, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia.
- 4Department of Paediatrics, Hospital Sultanah Aminah, Johor Bahru, Malaysia.
- 5Microbiome Research Group, Research Centre for Life Science and Healthcare, Nottingham Ningbo China Beacons of Excellence Research and Innovation Institute, University of Nottingham Ningbo China, Ningbo, China.
- 6Pathogen Resistome Virulome and Diagnostic Research Group, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway , Selangor, Malaysia.
Abstract
Early energy intake is critical for growth in preterm infants, but evidence on factors affecting energy delivery in middle-income settings is limited. This study identified factors associated with energy intake at 28 days in preterm infants. Infants with birthweight ≤ 1500 g and gestational age < 33 weeks surviving to 28 days were enrolled. Serial energy and protein intake, growth and morbidities were assessed. Multiple linear and mixed-effects regression evaluated energy intake at 28 days and longitudinally, respectively. Among 168 infants, mean birthweight was 1113.5 (SD 241.9) g and gestational age 29.3 (SD 2.1) weeks. Bronchopulmonary dysplasia (BPD) occurred in 31.9% and necrotising enterocolitis (NEC) in 4.8%. Full enteral feeding and energy intake of 100 kcal/kg/day were achieved at 16.8 (SD 9.3) and 17.2 (SD 7.4) days, respectively. Energy and protein intake from parenteral and enteral nutrition remained below recommended targets during the first 14 days, while the protein-energy ratio remained inadequate through day 28. Mean growth velocity to 28 days was 5.1 (SD 3.6) g/kg/day, with a median weight z-score change of - 1.48 (IQR - 1.78 to - 1.27). After adjustment, energy intake at 28 days was lower in infants with BPD (mean difference - 11.7 kcal/kg/day, 95% CI - 23.1 to - 0.4) and NEC (- 33.3 kcal/kg/day, 95% CI - 57.3 to - 9.3).Conclusion
Preterm infants experienced suboptimal early energy and protein intake and growth. BPD and NEC were independently associated with lower energy intake at 28 days, highlighting ongoing nutritional challenges, particularly in preterm infants with major morbidities.What is known
• Optimal early postnatal growth remains challenging to attain in sick preterm infants. • Recommended energy and protein targets may remain unmet despite structured nutrition protocols.What is new
• Lower energy intake at 28 days was independently associated with NEC and subsequent development of BPD. • Suboptimal parenteral and enteral nutrient delivery, particularly during the first 14 days, occurred alongside subsequent growth faltering.
Related
- Three distinct trajectories of early oral feeding ability in preterm infants and their associated clinical factors
- Perinatal and Early Respiratory Factors Associated with Invasive Mechanical Ventilation in Very Preterm Infants: A Retrospective Cohort Study from Kazakhstan
- Development of a machine learning-based predictive model for feeding intolerance risk in preterm infants : A prospective cohort study
- Self-weaning versus dose-adjusted caffeine regimens in preterm infants discharged home: a prospective cohort study
- Outcomes associated with surgical ligation versus medical treatment for patent ductus arteriosus in extremely preterm infants
BibTeX
@article{lee2026factors,
title = {{Factors associated with energy intake at 28 days in preterm infants: a prospective cohort study.}},
author = {Jimmy Kok-Foo Lee and Shed-Peng Khor and Jeevitha Mariapun and Aliffah Zakaria and Huey-Ling Chow and Nisah Abdullah and Mohd Nizam Mat Bah and Jodi Woan-Fei Law and Learn-Han Lee and Amutha Ramadas and Vengadesh Letchumanan},
journal = {European journal of pediatrics},
year = {2026},
month = oct,
doi = {10.1007/s00431-026-07529-7},
url = {https://europepmc.org/article/MED/42920039},
note = {CC BY},
}
RIS
TY - JOUR
TI - Factors associated with energy intake at 28 days in preterm infants: a prospective cohort study.
AU - Jimmy Kok-Foo Lee
AU - Shed-Peng Khor
AU - Jeevitha Mariapun
AU - Aliffah Zakaria
AU - Huey-Ling Chow
AU - Nisah Abdullah
AU - Mohd Nizam Mat Bah
AU - Jodi Woan-Fei Law
AU - Learn-Han Lee
AU - Amutha Ramadas
AU - Vengadesh Letchumanan
PY - 2026
DA - 2026/10/23
JO - European journal of pediatrics
DO - 10.1007/s00431-026-07529-7
UR - https://europepmc.org/article/MED/42920039
AB - Early energy intake is critical for growth in preterm infants, but evidence on factors affecting energy delivery in middle-income settings is limited. This study identified factors associated with energy intake at 28 days in preterm infants. Infants with birthweight ≤ 1500 g and gestational age < 33 weeks surviving to 28 days were enrolled. Serial energy and protein intake, growth and morbidities were assessed. Multiple linear and mixed-effects regression evaluated energy intake at 28 days and longitudinally, respectively. Among 168 infants, mean birthweight was 1113.5 (SD 241.9) g and gestational age 29.3 (SD 2.1) weeks. Bronchopulmonary dysplasia (BPD) occurred in 31.9% and necrotising enterocolitis (NEC) in 4.8%. Full enteral feeding and energy intake of 100 kcal/kg/day were achieved at 16.8 (SD 9.3) and 17.2 (SD 7.4) days, respectively. Energy and protein intake from parenteral and enteral nutrition remained below recommended targets during the first 14 days, while the protein-energy ratio remained inadequate through day 28. Mean growth velocity to 28 days was 5.1 (SD 3.6) g/kg/day, with a median weight z-score change of - 1.48 (IQR - 1.78 to - 1.27). After adjustment, energy intake at 28 days was lower in infants with BPD (mean difference - 11.7 kcal/kg/day, 95% CI - 23.1 to - 0.4) and NEC (- 33.3 kcal/kg/day, 95% CI - 57.3 to - 9.3).Conclusion Preterm infants experienced suboptimal early energy and protein intake and growth. BPD and NEC were independently associated with lower energy intake at 28 days, highlighting ongoing nutritional challenges, particularly in preterm infants with major morbidities.What is known • Optimal early postnatal growth remains challenging to attain in sick preterm infants. • Recommended energy and protein targets may remain unmet despite structured nutrition protocols.What is new • Lower energy intake at 28 days was independently associated with NEC and subsequent development of BPD. • Suboptimal parenteral and enteral nutrient delivery, particularly during the first 14 days, occurred alongside subsequent growth faltering.
SN - 0340-6199
SN - 1432-1076
ER -