Abstract
AimEuropean Society for Clinical Nutrition and Metabolism released the guidelines on pediatric parenteral nutrition in 2018. We aimed to compare the parenteral nutrition (PN) regimen with the current guidelines, evaluate weight gain and explore the correlation of parenteral macronutrient and energy intakes with weight gain outcome in preterm infants with birth weight less than 1500 g.MethodsA prospective observational study was conducted. Parenteral macronutrients and energy intakes were described. Weight gain during PN was assessed. Nutritional factors associated with weight gain outcome after PN were identified using a cox proportional hazards model.ResultsA total of 163 infants were included in this study, in which 41 were extremely low birth weight (ELBW) infants and 122 were very low birth weight (VLBW) infants. Average glucose, amino acid, lipid, and energy during the first postnatal week were 7.5 g/kg/d, 2.4 g/kg/d, 0.8 g/kg/d, 48 kcal/kg/d. Median maximum glucose, amino acid, lipid, and energy were 11.1 g/kg/d, 3.5 g/kg/d, 3 g/kg/d, 78 kcal/kg/d. Median days to maximum glucose, amino acid, lipid, and energy were 10, 9, 12, 11 days. The proportion of appropriate for gestational age (AGA) infants was 76.9%. The ratio of infants without poor weight gain outcome after PN was 38%. With every 0.1 g/kg/d decrease of maximum amino acid and average lipid during the first postnatal week, the probability of appropriate weight gain outcome decreased by 77.6 and 74.4% respectively. With each additional day to maximum glucose and energy, the probability of appropriate weight gain outcome decreased by 5.6 and 6.1% respectively.ConclusionsMost preterm infants with birth weight less than 1500 g remain below the latest recommended nutrition goals. The poor weight gain outcome of these infants after PN is related to insufficient parenteral macronutrient and energy intakes. PN strategies should be improved according to the latest evidence-based recommendations.
Highlights
Parenteral nutrition (PN) is critical for the care of preterm infants [1] and provides relatively safe means of meeting nutrient intakes [2], as their immature gastrointestinal (GI) tract cannot tolerate sufficient energy and nutrients enterally to meet nutrient requirements [3]
Preterm infants, who were admitted to the Neonatal intensive care units (NICU) immediately after birth from July 20, 2018, to January 27, 2020, with gestational age (GA) < 37 weeks, birth weight (BW) < 1500 g were eligible for enrollment
The treatment of 44 infants was withdrawn by parents for reasons as follows: worry about a poor prognosis (19 infants); discharge against medical advice as clinical conditions improved (19 infants); transfer to a specialized hospital for congenital heart diseases (3 infants); inability to pay for treatment (3 infants)
Summary
Parenteral nutrition (PN) is critical for the care of preterm infants [1] and provides relatively safe means of meeting nutrient intakes [2], as their immature gastrointestinal (GI) tract cannot tolerate sufficient energy and nutrients enterally to meet nutrient requirements [3]. PN for preterm infants is a highly complex combination of amino acids, lipid emulsions, carbohydrates, electrolytes, vitamins, and minerals that differs significantly from the adult PN [1]. Chinese Society of Parenteral and Enteral Nutrition (CSPEN) guidelines for nutrition support in neonates have been used in our center since 2013 [5]. Subtle differences exist between the guidelines in terms of amino acids, lipid emulsions, glucose and energy intakes, and timings. The fact that nutrition practice differs from the recommendations established in the guidelines and the recommended intake is not administered in most cases is widespread [10, 11]
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