Nutritional practices and growth of preterm infants in two neonatal units in the UK and Malaysia: a prospective exploratory study

Abstract

Objective To explore differences in nutritional practices and growth outcomes among preterm infants in neonatal units in Malaysia and the UK. Design Prospective exploratory study of infants born at <34 weeks gestational age (GA). Setting Two neonatal units, one in Malaysia and one in the UK (May 2019 to March 2020). Methods Data collected from birth until discharge and compared between units. Results From 100 infants included, median GA (IQR) was 31 (30–33) and mean±SD birth weight was 1549±444\u2009g. There were more small-for-gestational age infants in Malaysian unit: 12/50 (24%) vs UK: 3/50 (6%), p=0.012\u2009and more morbidities. More Malaysian infants received breast milk (Malaysia: 49 (98%) vs UK: 38 (76%), p=0.001), fortified breast milk (Malaysia: 43 (86%) vs UK: 13 (26%), p<0.001) and exclusive breast milk at discharge (Malaysia: 26 (52%) vs UK: 16 (32%), p=0.043). There was higher parenteral nutrition use among Malaysian infants (40/50 (80%)) vs UK (19/50 (38%)) (p<0.001) with higher protein intake (mean±SD Malaysia: 3.0±0.5\u2009vs UK: 2.7±0.6\u2009g/kg/d, p=0.004) in weeks 1–4 and smaller cumulative protein deficits (mean±SD Malaysia: 11.4±6.1\u2009vs UK: 15.4±8.0\u2009g/kg, p=0.006). There were no significant differences in short-term growth between units and more than half of the infants in both units had ≥1.28 changes in weight-for-age Z-score at discharge (p=0.841). Conclusions An exploratory comparison of practices showed differences in patient characteristics and nutritional practices which impacted growth. Future studies with larger sample sizes and detailed analysis of maternal characteristics and infants’ outcomes are needed for improving care of preterm infants in all settings.