Abstract
Weaning from parenteral to enteral nutrition is a critical period to maintain an adequate growth in very low birth weight preterm infants (VLBWI). We evaluated the actual daily nutritional intakes during the transition phase (TP) in VLBWI with adequate and inadequate weight growth velocity (GV ≥ 15 vs. GV < 15 g/kg/day). Fat-free mass (FFM) at term-corrected age (TCA) was compared between groups. Based on actual nutritional intakes of infants with adequate growth, we defined a standardized parenteral nutrition bag (SPB) for the TP. One hundred and six VLBWI were categorized as group 1 (G1): [GV < 15 (n = 56)] and group 2 (G2): [GV ≥ 15 (n = 50)]. The TP was divided into two periods: main parenteral nutritional intakes period (parenteral nutritional intakes >50%) (M-PNI) and main enteral nutritional intakes period (enteral nutritional intakes >50%) (M-ENI). Anthropometric measurements were assessed at discharge and TCA, FFM deposition at TCA. During M-PNI, G2 showed higher enteral protein intake compared to G1 (p = 0.05). During M-ENI, G2 showed higher parenteral protein (p = 0.01) and energy intakes (p < 0.001). A gradual reduction in SPB volume, together with progressive increase in enteral volume, allowed nutritional intakes similar to those of G2. At TCA, G2 had higher FFM compared to G1 (p = 0.04). The reasoned use of SPB could guarantee an adequate protein administration, allowing an adequate growth and higher FFM deposition.
Highlights
The nutritional care of preterm neonates remains a challenge in clinical practice [1,2,3]
Progress has been made to improve the nutrition of very low birth weight preterm infants (VLBWI); the transition phase (TP) from parenteral to enteral nutrition still remains a critical period for the achievement of adequate growth [4]
One hundred and seventy-six were eligible infants; among these infants 70 could not be assessed for body composition at term-corrected age
Summary
The nutritional care of preterm neonates remains a challenge in clinical practice [1,2,3]. Progress has been made to improve the nutrition of very low birth weight preterm infants (VLBWI); the transition phase (TP) from parenteral to enteral nutrition still remains a critical period for the achievement of adequate growth [4]. It has been demonstrated that the optimization of nutrition during the TP, as well as maintaining appropriate nutrient intakes, improves growth rates in preterm infants [5,6,7]. Brennan AM et al derived a target amino-acid intake of 3.5 g/100 mL during TP, using a database of daily nutrient intakes among 59 very low preterm infants [8]. The nutrients deficit may determine poor growth rate and may result in an altered body composition, characterized by a deficit of fat-free mass at term-corrected age (TCA) [9,10]
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