Abstract
The optimal composition of standardized parenteral nutrition (SPN) is not yet known, contributing to nutrient deficit accrual and growth failure, with the period of parenteral nutrition weaning, i.e., transition (TN) phase, being identified as particularly vulnerable. We created a comprehensive nutrition database, representative of the nutritional course of a diverse range of preterm infants (n = 59, birth weight ≤ 1500 g, gestation < 34 weeks) by collecting hourly macronutrient intake data as part of a prospective, observational study over 19 months. Using a nutrient modeling technique for the TN phase, various amino acid (AA) concentrations of SPN were tested within the database, whilst acknowledging the nutritional contribution from enteral feeds until target AA intakes were consistently achieved. From the modeling, the AA composition of SPN was determined at 3.5 g/100 mL, which was the maximum to avoid exceeding target intakes at any point in the TN phase. However, in order to consistently achieve target AA intakes, additional nutritional strategies were required, which included increasing the exclusion of enteral feeds in fluid and nutrient calculations from <20 mL/kg/day to <40 mL/kg/day, and earlier fortification of breastmilk at 80 mL/kg/day. This data-driven nutrient modeling process supported the development of an improved SPN regimen for our preterm population in the TN phase.
Highlights
The nutrition course of the preterm infant has more recently been described as three discrete nutrition phases, i.e., the parenteral nutrition (PN) phase when the infant in entirely dependent on PN for nutrition, the enteral nutrition (EN) phase when the infant is fully established on milk feeds, and the transition (TN) phase [1,2,3] when PN is being weaned with advancing enteral feeds
Despite some studies showing that early, high amino acid (AA) intakes were associated with improvements in growth, glycaemic tolerance and electrolyte homeostasis [4], the TN phase has recently been exposed as a period of cumulative nutrient deficits, in particular AA [1], and compromised growth [3]
We describe a novel process to determine the optimal AA composition of standardized parenteral nutrition (SPN) for the TN phase using nutrient modeling of a preterm nutrition database based on actual nutrient intake data [21]
Summary
The nutrition course of the preterm infant has more recently been described as three discrete nutrition phases, i.e., the parenteral nutrition (PN) phase when the infant in entirely dependent on PN for nutrition, the enteral nutrition (EN) phase when the infant is fully established on milk feeds, and the transition (TN) phase [1,2,3] when PN is being weaned with advancing enteral feeds. The TN phase is an extremely complex nutritional period characterized by multiple nutrient sources (PN and EN), and has been reported to last from 7 [1] to 10 days [2]. There is a lack of specific nutrition recommendations. International recommended nutrient intakes (RI) are based on the infant being either solely on PN [5,6,7] or EN [5,6,8] with no specific guidelines in relation to weaning PN, whilst minimizing the disruption to nutrient delivery during the incremental introduction of enteral feeds [1]
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