Influence of Parenteral Nutrition Delivery Techniques on Growth and Neurodevelopment of Very Low Birth Weight Newborns: A Randomized Trial.

Ilona Aldakauskienė,Kastytis Šmigelskas,Inesa Rimdeikienė,Vitalija Marmienė,Rasa Tamelienė,Rimantas Kėvalas

doi:10.3390/medicina55040082

Ilona Aldakauskienė, Kastytis Šmigelskas + Show 4 more

Open Access

https://doi.org/10.3390/medicina55040082

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Abstract

Background and Objectives: In very low birth weight (VLBW) newborns, parenteral nutrition (PN) is delivered via a peripheral venous catheter (PVC), a central venous catheter (CVC), or a peripherally inserted central venous catheter (PICC). Up to 45% of PICCs are accompanied by complications, the most common being sepsis. A PVC is an unstable PN delivery technique requiring frequent change. The growth and neurodevelopment of VLBW newborns may be disturbed because of catheters used for early PN delivery and complications thereof. The aim of the conducted study was to evaluate the effect of two PN delivery techniques (PICC and PVC) on anthropometric parameters and neurodevelopment of VLBW newborns. Materials and Methods: A prospective randomized clinical trial was conducted in VLBW (≥750–<1500 g) newborns that met the inclusion criteria and were randomized into two groups: PICC and PVC. We assessed short-term outcomes (i.e., anthropometric parameters from birth until corrected age (CA) 36 weeks) and long-term outcomes (i.e., anthropometric parameters from CA 3 months to 12 months as well as neurodevelopment at CA 12 months according to the Bayley II scale). Results: In total, 108 newborns (57 in the PICC group and 51 in the PVC group) were randomized. Short-term outcomes were assessed in 47 and 38 subjects, and long-term outcomes and neurodevelopment were assessed in 38 and 33 subjects of PICC and PVC groups, respectively. There were no differences observed in anthropometric parameters between the subjects of the two groups in the short- and long-term. Mental development index (MDI) < 85 was observed in 26.3% and 21.2% (p = 0.781), and psychomotor development index (PDI) < 85 was observed in 39.5% and 54.5% (p = 0.239) of PICC and PVC subjects, respectively. Conclusions: In the short- and long-term, no differences were observed in the anthropometric parameters of newborns in both groups. At CA 12 months, there was no difference in neurodevelopment in both groups.

Highlights

Significant delay in weight gain is observed at an early postnatal stage among very low birth weight (VLBW) newborns who survive [1]
The aim of the study was to assess the effect of two parenteral nutrition (PN) delivery techniques (PICC and peripheral venous catheter (PVC)) on anthropometric parameters and psychomotor neurodevelopment of VLBW newborns
The duration of PN, the amounts of nutrients taken in during PN, the catheters used for PN and the complications thereof, as well as painful catheter insertion procedures experienced by newborns affect the growth and neurodevelopment of preterm newborns at an early and later phase

Summary

Introduction

Significant delay in weight gain is observed at an early postnatal stage among very low birth weight (VLBW) newborns who survive [1]. This is caused by morbidities (respiratory distress syndrome, patent ductus arteriosus, bronchopulmonary dysplasia, late-onset neonatal sepsis, necrotic enterocolitis, intraventricular hemorrhage grade III-IV) [2], as well as the calorie and protein deficit during the first weeks. Among CVCs, peripherally inserted central venous catheters (PICCs) are most common at a neonatal age. In very low birth weight (VLBW) newborns, parenteral nutrition (PN) is delivered via a peripheral venous catheter (PVC), a central venous catheter (CVC), or a peripherally inserted central venous catheter (PICC). We assessed short-term outcomes (i.e., anthropometric parameters from birth until corrected age (CA) 36 weeks) and long-term outcomes

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Discussion

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