From Parenteral to Enteral Nutrition

Miller, Malki; Vaidya, Ruben; Rastogi, Deepa; Bhutada, Alok; Rastogi, Shantanu

doi:10.1177/0148607113487926

Cited by 62 publications

(24 citation statements)

References 37 publications

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“…3 We also previously reported that the slowest extrauterine growth was during the transition phase, which predicted growth failure at discharge and was related to inadequate energy and protein intakes during this phase. 4 To address this vulnerable period and promote continued growth, we established a nutrient-based transition protocol that resulted in significantly improved energy and protein intakes during the transition phase. The improvements in growth outcomes observed are consistent with previous studies that found better growth with increasing energy and protein intake throughout the NICU stay, 15–18 although these improvements were not specifically associated with the critical period of extrauterine growth failure during the transition phase in these studies.…”

Section: Discussionmentioning

confidence: 99%

“…Although current nutrition recommendations aim to achieve postnatal growth rates approximating the intrauterine growth of a normal fetus of the same postmenstrual age, 1 we recently observed growth failure rates in our unit of close to 50%, with other studies reporting growth failure rates of 30%–97% among preterm infants. 2–4 Poor nutrition is associated with adverse short-term outcomes, including sepsis, chronic lung disease, and prolonged need for mechanical ventilation, as well as impaired cognitive and neurological development in the long term. 5–9 Therefore, maintaining adequate nutrition and growth in this high-risk population is an important goal in the neonatal intensive care unit (NICU).…”

Section: Introductionmentioning

confidence: 99%

“…We previously showed the transition phase to be most vulnerable to inadequate nutrition, negatively affecting growth outcomes at discharge. 4 Infants demonstrating growth inadequacy during this phase were 5 times more likely to be discharged with weights below the 10th percentile for corrected gestational age (CGA), with poor growth during this phase likely related to suboptimal energy and protein provision with a volume-based PN transition protocol. Our unit has since revised the PN guidelines to optimize nutrient provision throughout the duration of the transition phase, moving from our previous “volume-based” transition protocol to a “nutrient-based” transition protocol.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Transitioning Preterm Infants From Parenteral Nutrition: A Comparison of 2 Protocols

Miller

Donda

Bhutada

et al. 2016

J Parenter Enteral Nutr

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Background Growth in preterm infants is compromised during the transition phase of nutrition, when parenteral nutrition (PN) volumes are weaned with advancing enteral nutrition (EN) feeds, likely due to suboptimal nutrient intakes during this time. We implemented new PN guidelines designed to maintain optimal nutrient intakes during the transition phase and compared growth outcomes of this cohort with a control group. Materials and Methods A chart review was conducted on infants born <32 weeks’ gestation, before (control group) and after (study group) a new transition PN protocol was implemented in the neonatal intensive care unit. Weight parameters and nutrient intakes were calculated for the transition phase and compared between the 2 groups. Results Demographic and clinical characteristics of the 2 groups were comparable except for higher rates of sepsis in control group. Weight-for-age z scores at birth, at 1 week of life, and at the start of the transition phase were similar. At the end of the transition phase, infants in the study group had significantly higher z scores compared with the control group, even when corrected for sepsis, a difference that persisted at 35 weeks’ gestation. During the transition phase, study infants gained 16.1 ± 4.6 g/kg/d compared with 13.2 ± 5.4 g/kg/d in control group (P < .001). Similar results were observed in the subset of expressed breastmilk–only fed infants (15.9 ± 4.6 g/kg/d in the study group compared with 13.2 ± 5.4 g/kg/d in the control group, P < .004). Conclusion Optimizing nutrition by the use of concentrated PN during the transition phase to maintain appropriate nutrient intakes improves growth rates in preterm infants.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Transitioning Preterm Infants From Parenteral Nutrition: A Comparison of 2 Protocols

Miller

Donda

Bhutada

et al. 2016

J Parenter Enteral Nutr

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“…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 ].…”

Section: Introductionmentioning

confidence: 99%

Standardized Parenteral Nutrition for the Transition Phase in Preterm Infants: A Bag That Fits

et al. 2018

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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.

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“…Furthermore, maintaining a gestational age appropriate amino acid supply is important for growth of individual organs and tissues, particularly the brain, and this is important to do as IV nutrition is gradually reduced and enteral feedings advanced, as far too often, IV nutrition is minimized before full enteral feedings are achieved, leading to often extensive periods in which total nutrition, particularly of protein, is insufficient [ 45 46 ].…”

Section: (Parenteral) Feedingmentioning

confidence: 99%

Nutritional Support Strategies for the Preterm Infant in the Neonatal Intensive Care Unit

Hay

2018

Pediatr Gastroenterol Hepatol Nutr

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The goal of nutrition of the preterm infant is to “provide nutrients to approximate the rate of growth and composition of weight gain for a normal fetus of the same postmenstrual age and to maintain normal concentrations of blood and tissue nutrients” (American Academy of Pediatrics 2014). Failure to provide the necessary amounts of all of the essential nutrients to preterm infants has produced not only growth failure, but also increased morbidity and less than optimal neurodevelopment. This continues to be true despite many efforts to increase nutrition of the preterm infants. In contrast, enhanced nutrition of very preterm infants, both intravenous and enteral, beginning right after birth, promotes positive energy and protein balance and improves longer term neurodevelopmental outcomes. The benefits are long lasting too, particularly for prevention of later life chronic diseases.

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From Parenteral to Enteral Nutrition

Abstract: Growth was compromised during the transitional phase, likely related to decreased protein intake. Optimizing protein provision while PN is weaned is an important strategy to prevent postnatal growth failure.

Cited by 62 publications

References 37 publications

Transitioning Preterm Infants From Parenteral Nutrition: A Comparison of 2 Protocols

Transitioning Preterm Infants From Parenteral Nutrition: A Comparison of 2 Protocols

Standardized Parenteral Nutrition for the Transition Phase in Preterm Infants: A Bag That Fits

Nutritional Support Strategies for the Preterm Infant in the Neonatal Intensive Care Unit

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