Long-term effects on growth of an energy-enhanced parenteral nutrition in preterm newborn: A quasi-experimental study.

Gianluca Terrin,Giovanni Boscarino,Elisa Onestà,Francesca Faccioli,Maria Di Chiara,Lucia Dito,Mario De Curtis,Alessandra Coscia,Carla Greco,Marina Aloi,Viviana Cardilli,Daniela Regoli,Salvatore Oliva,Samson Gebremedhin

doi:10.1371/journal.pone.0235540

Gianluca Terrin, Giovanni Boscarino + Show 12 more

Open Access

https://doi.org/10.1371/journal.pone.0235540

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Journal: PloS one	Publication Date: Jul 6, 2020
Citations: 15	License type: CC BY 4.0

Affiliation: Policlinico Umberto I, University of Turin

Abstract

AimTo assess the best energy intake in Parenteral Nutrition (PN) for preterm newborns, considering both possible benefits for growth and risk of complications.MethodsQuasi-experimental study comparing two cohorts of newborns, receiving Energy-Enhanced vs. Standard PN (Cohort A, from 1st January 2015 to 31 January 2016 and Cohort B from 1st February 2016 to 31 March 2017; respectively) after implementation of a change in the PN protocol. The primary outcome measure was growth at 24 months of life. The PN associated complications were also measured.ResultsWe enrolled 132 newborns in two Cohorts, similar for prenatal and postnatal clinical characteristics. Although, body weight and length at 24 months of life were significantly higher (p<0.05) in the Cohort A (11.1, 95% CI 10.6 to 11.6 Kg; 85.0 95% CI 83.8 to 86.2 cm) compared with Cohort B (10.4, 95% CI 9.9 to 10.9 Kg; 81.3 95% CI 79.7 to 82.8 cm), body weight and length Z-Score in the first 24 months of life were similar between the two Cohorts. The rate of PN associated complications was very high in both study Cohorts (up to 98% of enrolments). Multivariate analysis showed that length at 24 months was significantly associated with receiving standard PN (cohort A) in the first week of life and on the energy intake in the first week of life. We also found a marginally insignificant association between Cohort A assignment and body weight at 24 months of life (p = 0.060).ConclusionsEnergy-enhanced PN in early life has not significant effects on long-term growth in preterm newborns. The high prevalence of PN associated complications, poses concerns about the utility of high energy intake recommended by current guidelines for PN.

Highlights

Growth failure has been reported among up to 90% of preterm newborns at discharge from the neonatal intensive care unit (NICU) and it may persist in the first years of life [1,2]
The high prevalence of parenteral nutrition (PN) associated complications, poses concerns about the utility of high energy intake recommended by current guidelines for PN
Aggressive nutrition essentially consists in the administration of high doses of amino acids throughout parenteral nutrition (PN) since the first days of life (DOL)

Summary

Introduction

Growth failure has been reported among up to 90% of preterm newborns at discharge from the neonatal intensive care unit (NICU) and it may persist in the first years of life [1,2]. Adequate nutritional support immediately after birth is essential for preterm newborns to limit growth retardation [3,4]. The early “aggressive” nutrition has been adopted in NICU to achieve a neonatal growth as close as possible to that of a fetus of the same gestational age (GA). Aggressive nutrition essentially consists in the administration of high doses of amino acids throughout parenteral nutrition (PN) since the first days of life (DOL). A body of trials support the administration of high doses of parenteral amino acids in preterm newborns to improve nitrogen balance and guidelines for PN, published by the most important scientific societies, recommend to adopt this nutritional strategy to improve growth [3,4,5]

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