Improving early protein intake for very preterm infants using a standardised concentrated parenteral nutrition formulation

Morgan, Colin; Badhawi, Isam; Grime, Christopher; Herwitker, Shakeel

doi:10.1016/j.eclnm.2009.09.004

Cited by 9 publications

(10 citation statements)

References 25 publications

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“…This inefficiency means that increasing the protein content of a PN formulation does not necessarily result in the expected increase in actual protein intake, particularly in individualized PN prescribing 8 . We have previously shown that a standardized, concentrated neonatal PN (scNPN) regimen can deliver 20% more protein in the first 14 days of life when compared with a nutritionally identical individualized neonatal PN prescription 9 …”

Section: Methodsmentioning

confidence: 99%

“…Routine monitoring data were collected to measure the improvement in protein intake following the change from the scNPN1 regimen to the scNPN2 regimen. Details of the scNPN1 regimen 9 and the scNPN2 regimen 16 have already been reported. In brief, both PN regimens are standardized formulations comprising an 85‐mL/kg/d aqueous PN component (containing the amino acids), a 15‐mL/kg/d lipid component, and a 50‐mL/kg/d supplementary dextrose infusion.…”

Section: Methodsmentioning

confidence: 99%

“…Enteral feeds were introduced and incrementally increased in accordance with the LWH feeding policy under the supervision of the consultant neonatologist. PN was incrementally decreased as enteral feeds were increased as described previously 9 , 16 . Mother's own milk was used where possible, with donor milk used if maternal milk was unavailable (preterm formula was used only when consent for donor milk not given).…”

Section: Methodsmentioning

confidence: 99%

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Increasing Early Protein Intake Is Associated With a Reduction in Insulin‐Treated Hyperglycemia in Very Preterm Infants

2012

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Increasing Early Protein Intake Is Associated With a Reduction in Insulin‐Treated Hyperglycemia in Very Preterm Infants

2012

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Introduction A standardised, concentrated neonatal parenteral nutrition (scNPN1) regimen can increase very preterm protein intake 1. Our aim was to compare macronutrient intake and metabolic tolerance using a modified regimen (scNPN2) designed to introduce protein within 4 h of birth.

Methods

Local audit committee approval was obtained.

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mentioning

confidence: 99%

Increasing early protein intake is associated with a reduction in insulin-treated hyperglycaemia in very preterm infants

Mahaveer

Grime

Morgan

2011

Archives of Disease in Childhood - Fetal and Neonatal Edition

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Introduction A standardised, concentrated neonatal parenteral nutrition (scNPN1) regimen can increase very preterm protein intake.1 Our aim was to compare macronutrient intake and metabolic tolerance using a modified regimen (scNPN2) designed to introduce protein within 4 h of birth. Methods Local audit committee approval was obtained. 14-day fluid/drug infusion and biochemical data for infants <29 weeks were collected from NICU electronic patient data management systems using the previous methodology. This allowed evaluation of metabolic stability and actual daily parenteral/enteral macronutrient intake to be calculated and compared. Both regimens had identical formulations, intravenous glucose regimens and protocols for managing hyperglycaemia. Results Infants (n=38): median (range) birthweight 935 g (440–1350) receiving scNPN2 were compared to previous study (n=38): birthweight 890 g (470–1330). No differences in actual daily glucose/carbohydrate, early lipid or enteral intake were identified. scNPN2 regimen increased mean early protein intake (p<0.001) mainly by starting PN soon after birth (p<0.001). This was associated with fewer insulin treated infants (p<0.02) and less insulin usage: Abstract PB.02 Table 1 PN start (age:h) Protein intake (g/kg/7 days) Insulin (no. of infants) Total insulin (IU/kg/14 days) scNPN1 23 (5–62) 11.9 (±2.4) 20/38 335.5 scNPN2 3.5 (1.5–18) 15.3 (±2.7) 10/38 154.9 The pattern of glucose intolerance (both groups) showed peak insulin use between days 6–9. No violations of the hyperglycaemia treatment protocol were identified. Conclusion The scNPN2 regimen improved early protein intake as intended. This was associated with a clinically important fall in insulin-treated hyperglycaemia requiring further study.

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“…This lead to a 20% increase in the first 14 day protein intake when compared to a nutritionally identical iNPN regimen [60]. Significant cost reductions were also achieved (38%) similar to those reported for other standardised regimens [57].…”

Section: Introductionmentioning

confidence: 79%

SCAMP: standardised, concentrated, additional macronutrients, parenteral nutrition in very preterm infants: a phase IV randomised, controlled exploratory study of macronutrient intake, growth and other aspects of neonatal care

et al. 2011

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BackgroundInfants born <29 weeks gestation are at high risk of neurocognitive disability. Early postnatal growth failure, particularly head growth, is an important and potentially reversible risk factor for impaired neurodevelopmental outcome. Inadequate nutrition is a major factor in this postnatal growth failure, optimal protein and calorie (macronutrient) intakes are rarely achieved, especially in the first week. Infants <29 weeks are dependent on parenteral nutrition for the bulk of their nutrient needs for the first 2-3 weeks of life to allow gut adaptation to milk digestion. The prescription, formulation and administration of neonatal parenteral nutrition is critical to achieving optimal protein and calorie intake but has received little scientific evaluation. Current neonatal parenteral nutrition regimens often rely on individualised prescription to manage the labile, unpredictable biochemical and metabolic control characteristic of the early neonatal period. Individualised prescription frequently fails to translate into optimal macronutrient delivery. We have previously shown that a standardised, concentrated neonatal parenteral nutrition regimen can optimise macronutrient intake.MethodsWe propose a single centre, randomised controlled exploratory trial of two standardised, concentrated neonatal parenteral nutrition regimens comparing a standard macronutrient content (maximum protein 2.8 g/kg/day; lipid 2.8 g/kg/day, dextrose 10%) with a higher macronutrient content (maximum protein 3.8 g/kg/day; lipid 3.8 g/kg/day, dextrose 12%) over the first 28 days of life. 150 infants 24-28 completed weeks gestation and birthweight <1200 g will be recruited. The primary outcome will be head growth velocity in the first 28 days of life. Secondary outcomes will include a) auxological data between birth and 36 weeks corrected gestational age b) actual macronutrient intake in first 28 days c) biomarkers of biochemical and metabolic tolerance d) infection biomarkers and other intravascular line complications e) incidence of major complications of prematurity including mortality f) neurodevelopmental outcome at 2 years corrected gestational ageTrial registrationCurrent controlled trials: ISRCTN76597892; EudraCT Number: 2008-008899-14

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Improving early protein intake for very preterm infants using a standardised concentrated parenteral nutrition formulation

Cited by 9 publications

References 25 publications

Increasing Early Protein Intake Is Associated With a Reduction in Insulin‐Treated Hyperglycemia in Very Preterm Infants

Increasing Early Protein Intake Is Associated With a Reduction in Insulin‐Treated Hyperglycemia in Very Preterm Infants

Increasing early protein intake is associated with a reduction in insulin-treated hyperglycaemia in very preterm infants

SCAMP: standardised, concentrated, additional macronutrients, parenteral nutrition in very preterm infants: a phase IV randomised, controlled exploratory study of macronutrient intake, growth and other aspects of neonatal care

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