Abstract
IntroductionWhether parenteral nutrition benefits growth of very low birth weight (VLBW) preterm infants in the setting of rapid enteral feeding advancement is unclear. Our aim was to examine this issue using data from Japan, where enteral feeding typically advances at a rapid rate.MethodsWe studied 4005 hospitalized VLBW, very preterm (23–32 weeks' gestation) infants who reached full enteral feeding (100 ml/kg/day) by day 14, from 75 institutions in the Neonatal Research Network Japan (2003–2007). Main outcomes were weight gain, head growth, and extra-uterine growth restriction (EUGR, measurement <10th percentile for postmenstrual age) at discharge.Results40% of infants received parenteral nutrition. Adjusting for maternal, infant, and institutional characteristics, infants who received parenteral nutrition had greater weight gain [0.09 standard deviation (SD), 95% CI: 0.02, 0.16] and head growth (0.16 SD, 95% CI: 0.05, 0.28); lower odds of EUGR by head circumference (OR 0.66, 95% CI: 0.49, 0.88). No statistically significant difference was seen in the proportion of infants with EUGR at discharge. SGA infants and infants who took more than a week until full feeding had larger estimates.DiscussionEven in infants who are able to establish enteral nutrition within 2 weeks, deprivation of parenteral nutrition in the first weeks of life could lead to under nutrition, but infants who reached full feeding within one week benefit least. It is important to predict which infants are likely or not likely to advance on enteral feedings within a week and balance enteral and parenteral nutrition for these infants.
Highlights
Whether parenteral nutrition benefits growth of very low birth weight (VLBW) preterm infants in the setting of rapid enteral feeding advancement is unclear
As growth can be affected by different obstetric and pediatric characteristics as well as the wellbeing of the infant, we considered as covariates the following: maternal age, parity, gestational diabetes (GDM), pregnancy induced hypertension (PIH), use of antenatal steroid, multiplicity, route of delivery, gestational length, sex, standard deviation (SD) scores of weight and head circumference at birth, Apgar score at 5 minutes, use of mechanical ventilation, diagnosis and stage of intra-ventricular hemorrhage (IVH), diagnosis of bronchopulmonary dysplasia (BPD), periventricular hemorrhage (PVL), and days taken to reach full enteral feeding
We observed that among VLBW preterm (24–32 weeks’ gestation) infants who reached full enteral feedings within 2 week of birth, those infants provided with parenteral nutrition demonstrated greater weight gain and head growth, and a lower prevalence of extra-uterine growth restriction (EUGR) by weight, as compared with those who did not receive parenteral nutrition
Summary
Whether parenteral nutrition benefits growth of very low birth weight (VLBW) preterm infants in the setting of rapid enteral feeding advancement is unclear. Providing parenteral nutrition has risks, such as infection, thrombosis, and other complications associated with central venous access [7], and cholestasis [8], and costs more than feeding enterally. It is important to clarify the extent to which infants who reach full enteral nutrition at a rapid rate benefit from parenteral nutrition. This information would inform guidelines about the routine vs selective parental nutrition use for VLBW preterm infants, those infants expected to achieve full enteral feeding at a rapid rate
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