Nutrient Intake and Growth of Infants Enrolled in the Donor Milk for Improved Neurodevelopmental Outcomes (GTA‐DoMINO) Trial: Comparison to Clinical Targets
Bibliographic record
Abstract
Background Very low birth weight (VLBW) infants often grow slower than targets, increasing their risk of adverse long‐term outcomes. Subgroups within VLBW infants, such as infants born < 26 weeks gestation, require disproportionately more resources and have higher risks of morbidities and slower growth, than bigger more mature infants. Current research is lacking on growth and nutrient intakes of small immature VLBW infants and those with morbidities. Objectives To describe and assess relationships between growth and nutrient intakes of VLBW infants against commonly used clinical metrics. Methods Daily estimated macronutrient intakes, expressed breast milk (EBM) volumes, and weekly weights were collected prospectively from birth until 36 weeks corrected age for 302 infants that remained in the study for ≥ 28 days. Average growth using growth velocity (GV) and changes in z‐score, energy and nutrient intakes (mean ± SD), and median (1 st , 3 rd quartile) EBM volume were assessed for VLBW infants, infants born < and ≥ 1000g, < and ≥ 26 weeks gestation, and infants with and without morbidities (patent ductus arteriosus, necrotizing enterocolitis, retinopathy of prematurity, brain injury or chronic lung disease) using univariate analysis and Wilcoxon rank sum test. Relationships between intakes and growth were assessed using analysis of variance. Results GV and weight z‐score change were 13.8 ± 2.4 g/kg/d and −0.91 ± 0.64, respectively. Total energy (105 ± 12 kcal/kg/d) and protein (3.4 g ± 0.3 g/kg/d) intakes were below recommended targets, while carbohydrate (12 ± 1.1 g/kg/d) and lipid (5.1 ± 0.8 g/kg/d) intakes met recommendations. Total protein to energy ratio was 3.3 ± 0.3 g/100 kcal. EBM volume was 96 (78, 100) % of total enteral volume received. Smaller, more immature infants, and those with morbidities had lower nutrient intakes and slower growth than larger, more mature infants and those without morbidity. Weight z‐score change was −1.01 ± 0.68 and −0.73 ± 0.52 for infants with and without morbidity, respectively (p< 0.001) and −1.14 ± 0.76 and −0.83 ± 0.57 for infants born < and ≥ 26 weeks gestation, respectively (p<0.001). GV (g/kg/d) was similar between infants with morbidities (13.8 ± 2.3) and those without (13.7 ± 2.4) and for infants born < 26 weeks (13.8 ± 2.4) and those born ≥ 26 weeks (13.8 ± 2.4). When total energy or protein intakes exceeded 100 kcal/kg/d and 3.5 g/kg/d, respectively, growth was improved (p<0.05); however protein to energy ratio was not related to growth. Conclusion Growth of VLBW infants continues to fall below targets. Special attention to daily nutrient intakes in the clinical setting may have a major impact on growth. Using weight z‐score change may be more useful clinically compared to GV. Support or Funding Information Funded by CIHR (MOP#102638) and by The Breastfeeding Centre of Excellence, Sunnybrook Health Sciences Centre.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".