Parenteral Nutrition in Moderately Preterm, Otherwise Healthy Neonates Is Not Associated With Improved Short‐Term Growth Outcomes

Abstract

Background: Parenteral nutrition (PN) serves a crucial role in providing nutrition to extremely premature infants who are at high risk for malnutrition. However, little is known about the impact of PN on short-term growth outcomes in moderately preterm infants. Methods: In this retrospective cohort analysis, patients were included in the study if they were born at ≥32 but <34 weeks gestational age and had no major comorbidities. The primary outcome of this study was to determine whether initiation of early PN for these patients has any effect on daily weight gain compared with standard dextrose-containing fluids (DCFs). Secondary outcomes were to evaluate the differences in time to regain birth weight, length of stay, and change in weight, length, and head circumference percentiles from birth to discharge. Incidence of necrotizing enterocolitis, antibiotic usage, or supplemental oxygen utilization was also evaluated. Results: There were 89 patients in the PN group and 35 patients in the DCF group. The mean daily weight gain was not different between PN and DCF groups when calculated from birth to discharge (11.8 vs 10 g/kg/d, respectively; P = .09). There were also no differences when weight gain was calculated from nadir to discharge: 16.8 vs 15.2 g/kg/d, respectively (P = .1). Lack of differences persisted even when propensity matching was performed. Conclusion: Based on the study findings, neonates born ≥32 weeks of gestational age without any major comorbidities are unlikely to benefit from PN supplementation.

Total Parenteral Nutrition for Neonates

“…2 It was conducted between September 2016 and June 2018 at a university teaching hospital. The second included study was a retrospective cohort study 4 that analyzed data of neonates admitted in 1 of 7 neonatal intensive care unit (NICU) facilities of a teaching hospital during the 2014 and 2016 calendar years. Data of patients born during 2015 were excluded because the NICU was in the educational and transitional phase of new nutrition guidelines.…”

“…The investigators performed a propensity matching of patients to control for nonrandom assignment and reported separate results before and after the propensity matching. 4 Both studies 2,4 were published in 2020.…”

“…1,2 Enteral nutrition presents several physiologic advantages with generally fewer complications than PN. 3 Parenteral nutrition provides optimal energy without forcing high volumes of enteral nutrition, 4 and may be used in preterm neonates to reduce the risk of postnatal growth failure, long-term malnutrition, and poor neurodevelopmental outcomes where immaturity of gastrointestinal motor function precluded enteral feeding. 5,6 Compared to the volume of literature on PN for infants born at fewer than 32 weeks gestation, the literature (including guidelines) is scarce concerning the use of PN for those with gestational age between 32-and 34-weeks.…”

“…This situation may lead to the extrapolation of recommendations for PN use from 1 neonatal population to another without supporting evidence. 4 However, there is concern around the use of PN due to the associated challenges such as central venous catheter-related sepsis, thrombosis, peripheral-line extravasations, liver disease, bone disease, and metabolic disturbance. 4,5 The objective of this report is to identify and summarize evidence of clinical effectiveness and evidence-based recommendations concerning TPN use in term or moderate-to-late preterm neonates weighing 1,500 g or more at birth.…”

“…Of these 31 articles, 29 publications were excluded for various reasons. Two papers -1 randomized controlled trial (RCT) 2 and 1 retrospective cohort study 4 -met the inclusion criteria and were included in this report. Appendix 1 presents the PRISMA 8 flow chart of the study selection.…”