Guidelines for Neonatal Parenteral Nutrition: 2019 Update by the Portuguese Neonatal Society. Part II. Micronutrients, Ready-to-use Solutions and Particular Conditions

Pereira‐da‐Silva, Luís; Pissarra, Susana; Alexandrino, Ana Margarida; Malheiro, Luísa; Macedo, Israel; Cardoso, Manuela; Silva, Pedro Vieira da; Frutuoso, Simão; Lau, Helga; Soares, Teresa

doi:10.25754/pjp.2019.16027

Cited by 3 publications

(4 citation statements)

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“…Variation in recommendations was also found when recommendations were meant for different specific groups or conditions, such as critically ill infants, 52 moderateto late-preterm infants, 29,33,39,49 and those with or at risk of necrotizing enterocolitis. 34 Regional differences in nutrient requirements might also lead to appropriate differences in recommendations, such as selenium requirement differences 19,28,36,47,50 due to soil deficits. 55 Although consistency of recommendations has been found in one systematic review of clinical practice guidelines for acute gastroenteritis in children, 56 many other systematic reviews of guidelines have found variations in recommendations, including for weight gain and nutrition during pregnancy, 57 nutrition for women with gestational diabetes mellitus, 58,59 and calcium and vitamin D supplementation in healthy children.…”

Section: Discussionmentioning

confidence: 99%

“…Seven guidelines (25.9%) were assessed as high quality, 26,27,30,31,34,35,46 seven (25.9%) as moderate quality, [16][17][18][19][20][21][22][23]28,33,37,38,45,47,52 and 13 (48.2%) as low quality 24,25,29,32,36,[39][40][41][42][43][44][48][49][50][51] (Table 2). The score for overall quality ranged between 13% and 96%.…”

Section: The Quality Of Nutrition Guidelinesmentioning

confidence: 99%

“…26,27,33,37,39,40,[42][43][44]46,48,49,52 Gaps that were recommendations based on a very low certainty of evidence were found in 10 guidelines (37%). [16][17][18][19][20][21][22][23]25,27,29,32,44,45,[47][48][49][50][51][52] We grouped the evidence gaps in the recommendations into 27 topics, of which eight were identified both by guidelines and very low certainty of evidence, 10 identified only by the guidelines, and nine identified only from a very low certainty of evidence (Table S17).…”

Section: Gaps In Recommendationsmentioning

confidence: 99%

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Nutrition guidelines for preterm infants: A systematic review

Meiliana,

Alexander,

Bloomfield

et al. 2023

J Parenter Enteral Nutr

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Background:There is no consensus on optimal nutrition for preterm infants, leading to substantial practice variation. We aimed to assess the quality of nutritional guidelines for preterm infants, the consistency of recommendations, and the gaps in recommendations.Methods:We searched databases and websites for nutritional guidelines for preterm infants before first hospital discharge, which were endorsed, prepared, or authorised by a regional, national, or international body, written in English, and published between 2012‐2023. Two reviewers independently screened articles and extracted the recommendations. Four reviewers appraised the included guidelines using AGREE II.Results:7051 records were identified, and 27 guidelines included, 26% of which were high in quality. Most guidelines lacked stakeholder involvement and rigour of development. We found considerable variation in recommendations, many of which lacked details of certainty of evidence and strength of recommendation. Recommendations for type of feed and breastmilk fortification were consistent among high quality guidelines, but recommendations varied for intakes of almost all nutrients and monitoring of nutritional adequacy. Different guidelines gave different certainty of evidence for the same recommendations. Most gaps in recommendations were due to very low certainty of evidence.Conclusions:Future development of nutritional guidelines for preterm infants should follow the standard guideline development method and ensure the rigorous process including stakeholders involvement to improve the reporting of strength of recommendation, certainty of evidence, and gaps in recommendation. Evidence is needed to support recommendations about macro and micronutrient intakes, breastmilk fortification, and markers on adequacy of intake of different nutrients.This article is protected by copyright. All rights reserved.

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Section: Discussionmentioning

confidence: 99%

Section: The Quality Of Nutrition Guidelinesmentioning

confidence: 99%

Section: Gaps In Recommendationsmentioning

confidence: 99%

See 1 more Smart Citation

Nutrition guidelines for preterm infants: A systematic review

Meiliana,

Alexander,

Bloomfield

et al. 2023

J Parenter Enteral Nutr

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“…As detailed elsewhere [ 33 , 34 ], the institutional neonatal nutrition protocol was followed considering the more recent international and national guidelines for parenteral and enteral nutrition [ 19 , 36 , 37 , 38 , 39 ]. In brief, parenteral nutrition was initiated within the first 2 postnatal hours and early trophic feeding was initiated within the first 2 to 4 postnatal days preferentially using MOM, and DHM when MOM was insufficient.…”

Section: Methodsmentioning

confidence: 99%

Individualized Fortification Based on Measured Macronutrient Content of Human Milk Improves Growth and Body Composition in Infants Born Less than 33 Weeks: A Mixed-Cohort Study

et al. 2023

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The optimal method for human milk (HM) fortification has not yet been determined. This study assessed whether fortification relying on measured HM macronutrient content (Miris AB analyzer, Upsala, Sweden) composition is superior to fortification based on assumed HM macronutrient content, to optimize the nutrition support, growth, and body composition in infants born at <33 weeks’ gestation. In a mixed-cohort study, 57 infants fed fortified HM based on its measured content were compared with 58 infants fed fortified HM based on its assumed content, for a median of 28 and 23 exposure days, respectively. The ESPGHAN 2010 guidelines for preterm enteral nutrition were followed. Growth assessment was based on body weight, length, and head circumference Δ z-scores, and the respective growth velocities until discharge. Body composition was assessed using air displacement plethysmography. Fortification based on measured HM content provided significantly higher energy, fat, and carbohydrate intakes, although with a lower protein intake in infants weighing ≥ 1 kg and lower protein-to-energy ratio in infants weighing < 1 kg. Infants fed fortified HM based on its measured content were discharged with significantly better weight gain, length, and head growth. These infants had significantly lower adiposity and greater lean mass near term-equivalent age, despite receiving higher in-hospital energy and fat intakes, with a mean fat intake higher than the maximum recommended and a median protein-to-energy ratio intake (in infants weighing < 1 kg) lower than the minimum recommended.

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The Role of Nutrition in the Prevention and Management of Bronchopulmonary Dysplasia: A Literature Review and Clinical Approach

Rocha

Guimarães

Pereira‐da‐Silva

2021

IJERPH

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Bronchopulmonary dysplasia (BPD) remains the most common severe complication of preterm birth, and nutrition plays a crucial role in lung growth and repair. A practical nutritional approach for infants at risk of BPD or with established BPD is provided based on a comprehensive literature review. Ideally, infants with BPD should receive a fluid intake of not more than 135‒150 mL/kg/day and an energy intake of 120‒150 kcal/kg/day. Providing high energy in low volume remains a challenge and is the main cause of growth restriction in these infants. They need a nutritional strategy that encompasses early aggressive parenteral nutrition and the initiation of concentrated feedings of energy and nutrients. The order of priority is fortified mother’s own milk, followed by fortified donor milk and preterm enriched formulas. Functional nutrient supplements with a potential protective role against BPD are revisited, despite the limited evidence of their efficacy. Specialized nutritional strategies may be necessary to overcome difficulties common in BPD infants, such as gastroesophageal reflux and poorly coordinated feeding. Planning nutrition support after discharge requires a multidisciplinary approach to deal with multiple potential problems. Regular monitoring based on anthropometry and biochemical markers is needed to guide the nutritional intervention.

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Guidelines for Neonatal Parenteral Nutrition: 2019 Update by the Portuguese Neonatal Society. Part II. Micronutrients, Ready-to-use Solutions and Particular Conditions

Cited by 3 publications

References 0 publications

Nutrition guidelines for preterm infants: A systematic review

Nutrition guidelines for preterm infants: A systematic review

Individualized Fortification Based on Measured Macronutrient Content of Human Milk Improves Growth and Body Composition in Infants Born Less than 33 Weeks: A Mixed-Cohort Study

The Role of Nutrition in the Prevention and Management of Bronchopulmonary Dysplasia: A Literature Review and Clinical Approach

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