After NICU discharge: Feeding and growth of low-income urban preterm infants through the first year

Abstract: BACKGROUND: Little is known about preterm infant feeding and growth in the outpatient setting, and there are no standardized post-hospital discharge feeding guidelines. This study aims to describe post-neonatal intensive care unit (NICU) discharge growth trajectories of very preterm (<32 weeks gestational age (GA)) and moderately preterm (32–34 0/7 weeks GA) infants managed by community providers and to determine the association between post-discharge feeding type and growth Z-scores and z-score changes through 12 months corrected age (CA). METHODS: This retrospective cohort study included very preterm infants (n = 104) and moderately preterm infants (n = 109) born 2010–2014 and followed in community clinics for low-income, urban families. Infant home feeding and anthropometry were abstracted from medical records. Repeated measures analysis of variance calculated adjusted growth z-scores and z-score differences between 4 and 12 months CA. Linear regression models estimated associations between 4 months CA feeding type and 12 months CA anthropometry. RESULTS: Moderately preterm infants on nutrient-enriched vs. standard term feeds at 4 months CA had significantly lower length z-scores at NICU discharge that persisted to 12 months CA (–0.04 (0.13) vs. 0.37 (0.21), respectively, P = .03), with comparable length z-score increase for both groups between 4 and 12 months CA. Very preterm infants’ 4 months CA feeding type predicted 12 month CA body mass index z-scores (β=–0.66 (–1.28, –0.04)). CONCLUSION: Community providers may manage preterm infant post-NICU discharge feeding in the context of growth. Further research is needed to explore modifiable drivers of infant feeding and socio-environmental factors that influence preterm infant growth trajectories.

*Corresponding Author: 

Cristina R. Fernández, MD MPH, Assistant Professor of Pediatrics, Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, Mailing Address: 622 West 168th Street, Vanderbilt Clinic, 4th floor, Room 417, New York, NY 10032, USA. Tel.: +1 212 342 1758; Fax: +1 212 305 8819; E-mail: