Enhanced Parenteral Nutrition Is Feasible and Safe in Very Low Birth Weight Preterm Infants: A Randomized Trial

Nagel, Emily; González, Juan David Rodas; Bye, Jeffrey K.; Super, Jennifer; Demerath, Ellen W.; Ramel, Sara E.

doi:10.1159/000527552

Cited by 7 publications

(2 citation statements)

References 24 publications

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“…A mixed-cohort study showed that fortified human milk resulted in higher energy, fat, and carbohydrate intakes but a lower protein-to-energy ratio [ 21 ]. Similarly, enhanced parenteral nutrition in the very-low birth weight preterm infants resulted in increased energy intake and was feasible with no side effects [ 44 ]. In our study, the weight gain velocity was highest in the very preterm subgroup, obviously revealing an increased need for protein intake, which could not be achieved in this subcohort.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Estimated Energy and Protein Balances on Extrauterine Growth in Preterm Infants

Lygerou,

Ilia,

Briassoulis

et al. 2023

Nutrients

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Background: Nutritional support of preterm infants remains a field of debate in the literature and clinical practice varies significantly. Adequate nutrition should promote growth and aim for optimal later neurodevelopment. However, it is often impaired by prematurity-associated morbidity and the physiologic immaturity of preterm infants. This study assessed the impact of energy and macronutrient provision on growth velocity and outcome and explored differences attributed to the heterogeneity of the preterm population. Methods: We retrospectively collected clinical and nutritional data from neonates hospitalized in two separate Neonatal Intensive Care Units (NICUs). Estimated energy and protein balance were calculated based on the ESPGHAN guidelines and their association with the growth outcome was explored. Growth assessment was based on somatometry Delta (Δ) z-scores at discharge. Results: In total, 174 neonates were included in the study. By day 14, most preterm infants were exclusively enterally fed, whereas there were infants in the <28 and 28–31+6 subgroups fed exclusively parenterally. Energy balance was positive for all gestational age (GA) subgroups except for those born <28 weeks. Protein balance was consistently positive for extremely premature but negative for late preterms. Cumulative substrates provisions were strong predictors of a positive energy or protein balance in the <34 weeks GA preterms on days 14 (ROC analyses, p < 0.001) and 7 (p < 0.05). A higher GA (p = 0.013) and enteral nutrition (p = 0.005) were additional predictors of a positive energy balance. All GA subgroups had a negative Δ z-score of weight at discharge. In the <34 GA subcohorts, a positive protein balance on day 14 (p = 0.009) and a short time to regain birth weight (exp(B) 3.1 (p = 0.004) were independently associated with a positive Δ z-score of weight at discharge. Conclusions: Early achievement of a positive energy and protein balance, based on the ESPGHAN guidelines, is crucial to ensure optimal postnatal growth and prevent extrauterine growth restriction, a relatively common occurrence in preterm infants.

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Section: Discussionmentioning

confidence: 99%

The Impact of Estimated Energy and Protein Balances on Extrauterine Growth in Preterm Infants

Lygerou,

Ilia,

Briassoulis

et al. 2023

Nutrients

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“…Nagel et al studied the feasibility and safety of enhanced early PN (early initiation of intravenous lipid emulsions and faster advancement of glucose infusion rate) during the first week of life for VLBW preterm infants. 8 90 VLBW preterm infants (<32 weeks gestational age at birth), stratified by gestational age and randomised to enhanced nutrition versus a standard PN protocol. Enrolled infants were stratified by gestational age groups and randomised to either the enhanced nutrition protocol (intervention group) or the standard PN protocol (standard group).…”

Section: Introductionmentioning

confidence: 99%

Nutrition strategies to prevent short-term adverse outcomes in preterm neonates

Rodriguez,

de la Cruz,

Neu

2024

BMJNPH

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With preterm neonates surviving earlier gestational ages, comorbidities such as bronchopulmonary dysplasia, retinopathy of prematurity, delayed neuronal development, intestinal injury, osteopenia, and parenteral nutrition-associated liver disease have become more common. This has been a topic of much deliberation and research to identify mitigation strategies. We explore nutrition approaches and risk factors for each condition individually, even though some strategies may overlap due to similar disease mechanisms. These conditions have long-lasting effects on preterm neonates, calling for ongoing assessment of practical and adjustable interventions. Recent studies elucidate the utility of nutrition optimization for the prevention of bronchopulmonary dysplasia, retinopathy of prematurity, delayed neuronal development, intestinal injury, osteopenia, and parenteral nutrition-associated liver disease. Specifically, amino acids, lipids, breastmilk, and Vitamins A, D, and E have been shown to effectively mitigate the risk these common morbidities affection preterm neonates. Further studies are needed to identify targeted ranges of macronutrients, vitamins, and minerals essential to the varying gestational ages and high-risk populations.

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Monitoring and management of hypertriglyceridemia in extremely low birth weight neonates receiving intravenous lipid emulsions: A national survey

Gabriel,

Hovater,

Gao

et al. 2023

Early Human Development

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Enhanced Parenteral Nutrition Is Feasible and Safe in Very Low Birth Weight Preterm Infants: A Randomized Trial

Cited by 7 publications

References 24 publications

The Impact of Estimated Energy and Protein Balances on Extrauterine Growth in Preterm Infants

The Impact of Estimated Energy and Protein Balances on Extrauterine Growth in Preterm Infants

Nutrition strategies to prevent short-term adverse outcomes in preterm neonates

Monitoring and management of hypertriglyceridemia in extremely low birth weight neonates receiving intravenous lipid emulsions: A national survey

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