Early Enteral Feeding Improves Tolerance of Parenteral Nutrition in Preterm Newborns.

Giovanni Boscarino,Elisa Onestà,Maria Di Chiara,Salvatore Oliva,Marco Bianchi,Francesco Cresi,Giorgia Deli,Gianluca Terrin,Maria Giulia Conti,Paola Repole,Francesca Faccioli

doi:10.3390/nu13113886

Giovanni Boscarino, Elisa Onestà + Show 9 more

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https://doi.org/10.3390/nu13113886

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Abstract

(1) Background: The tolerance of preterm newborns for the high nutritional intakes given by parenteral nutrition (PN) is still debated because of the risk of metabolic complications. Despite enteral nutrition (EN) being the preferred route of nutrition, an exclusive enteral feeding is not always possible, as in preterm newborns, the gut is immature and less tolerant of EN. We aimed to study the impact of a minimal enteral feeding (MEF) on the possible early metabolic complications of PN in a cohort of preterms with gestational age at birth GA ≤ 29 + 6/7 weeks of postmenstrual age. (2) Methods: We divided the study sample in two cohorts: 1) Late-Feeding (cohort 1), newborns who received MEF starting from the 8th day of age, and (2) Early-Feeding (cohort 2), newborns who received MEF, consisting of the administration of at least 4–5 mL/kg/day by the enteral route, in the first 7 days of age. The primary outcome of the study was the rate of at least one metabolic complication, including hyperglycemia, hypertriglyceridemia, or metabolic acidosis. (3) Results: We enrolled 80 newborns (Late-Feeding cohort 51 vs. Early-Feeding cohort 29). The rate of all metabolic complications was statistically higher in the Late-Feeding cohort compared to the Early-Feeding cohort. Binary logistic regression analysis showed that late administration of MEF negatively influenced the rate of all metabolic complications. (4) Conclusions: Early minimal administration of EN is associated with less frequent PN-related metabolic side effects and a higher rate of survival in critically ill newborns.

Highlights

Current guidelines for preterm neonates recommend high nutritional intakes in order to limit extrauterine growth restriction (EUGR) and the possible long-term consequences of malnutrition [1,2]
In adults and children observed in an intensive care unit (ICU), a nutritional approach based on a high macronutrient intake significantly affects morbidity and mortality [10,11,12]
We considered eligible for the study newborns with gestational age (GA) ≤ 29 + 6/7 weeks of postmenstrual age (PMA)

Summary

Introduction

Current guidelines for preterm neonates recommend high nutritional intakes in order to limit extrauterine growth restriction (EUGR) and the possible long-term consequences of malnutrition [1,2]. During the first postnatal week, when para-physiological intestinal insufficiency limits the use of enteral nutrition (EN), parenteral nutrition (PN) is essential to meet nutritional needs in this vulnerable population [1,2,3]. In adults and children observed in an intensive care unit (ICU), a nutritional approach based on a high macronutrient intake significantly affects morbidity and mortality [10,11,12]. It is not always feasible to reach a full enteral feeding (FEF) Recent evidence reported a higher risk of metabolic complications in newborns receiving enhanced PN [8].

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