Parenteral Nutrition in Premature Infants

Senterre, Thibault; Terrin, Gianluca; Curtis, Mario De; Rigo, Jacques

doi:10.1007/978-3-319-17169-2_7

Cited by 15 publications

(22 citation statements)

References 109 publications

(157 reference statements)

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“…Our standard practice of including EFV in fluid and nutrient calculations from as early as 20 mL/kg/day contributed to suboptimal AA intakes amongst some VLBW infants but exclusion of higher volumes, i.e., ≥40 mL/kg/day would have led to excessive AA intakes. Our data analysis supports the recent recommendation of excluding enteral feeds < 40 mL/kg/day in fluid calculations [ 4 ], and identifying this as the optimal EFV to begin weaning PN, i.e., start of TN phase. Nutrient modeling ensured nutritional strategies, i.e., PN concentration and BM fortification worked together in a complementary manner to support the achievement of target AA intakes, without exposing infants to excessive intakes, and may support the development and refinement of integrated TN phase protocols.…”

Section: Discussionsupporting

confidence: 86%

“…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 ]. Despite some studies showing that early, high amino acid (AA) intakes were associated with improvements in growth, glycaemic tolerance and electrolyte homeostasis [ 4 ], the TN phase has recently been exposed as a period of cumulative nutrient deficits, in particular AA [ 1 ], and compromised growth [ 3 ]. It has been reported that infants who experience growth failure in the TN phase are five times more likely to be discharged with a weight < 10th centile for corrected gestational age (GA) [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionsupporting

confidence: 86%

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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“…A number of studies demonstrated that high protein intake may limit EUGR (2). Thus, current guidelines for preterm newborns recommend the administration of high macronutrient doses since the first hours of life, through parenteral route (3,4). The effect of this nutritional strategy on brain growth is widely debated.…”

Section: Introductionmentioning

confidence: 99%

Early Protein Intake Influences Neonatal Brain Measurements in Preterms: An Observational Study

et al. 2020

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Introduction: To limit extrauterine growth restriction, recent guidelines on nutrition of preterm neonates recommended high protein intake since the first day of life (DOL). The impact of this nutritional strategy on the brain is still controversial. We aimed to evaluate the effects of protein intake on early cerebral growth in very low birth weight newborns. Materials and Methods: We performed serial cranial ultrasound (cUS) scans at 3-7 DOL and at 28 DOL in very low birth weight newborns consecutively observed in the neonatal intensive care unit. We analyzed the relation between protein intake and cerebral measurements at 28 DOL performed by cUS. Results: We enrolled 100 newborns (gestational age 29 ± 2 weeks, birth weight 1,274 ± 363 g). A significant (p < 0.05) positive correlation between enteral protein intake and biparietal diameter (r = 0.490 * *), occipital-frontal diameter (r = 0.608 * *), corpus callosum (length r = 0.293 * , genu r = 0.301 *), caudate head (right r = 0.528 * * , left r = 0.364 * *), and cerebellum (transverse diameter r = 0.440 * * , vermis height r = 0.356 * * , vermis width r = 0.377 * *) was observed at 28 DOL. Conversely, we found a significant negative correlation of protein intake given by parenteral nutrition (PN) with biparietal diameter (r = −0.524 * *), occipital-frontal diameter (r = −0.568 * *), body of corpus callosum (r = −0.276 *), caudate head (right r = −0.613 * * , left r = −0.444 * *), and cerebellum (transverse diameter r = −0.403 * * , vermis height r = −0.274 * , vermis width r = −0.462 * *) at 28 DOL. Multivariate regression analysis showed that measurements of occipital-frontal diameter, caudate head, and cerebellar vermis at 28 DOL depend positively on protein enteral intake (r = 0.402 * , r = 0.305 * , and r = 0.271 *) and negatively by protein parenteral intake (r = −0.278 * , r = −0.488 * , and r = −0.342 *). Conclusion: Brain development in neonatal life depends on early protein intake. High protein intake affects cerebral structures' measurements of preterm newborn when administered by PN. Positive impact on brain development encourages the administration of recommended protein intake mainly by enteral nutrition.

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“…Growth failure has been reported among up to 90% of preterm newborns at discharge from the neonatal intensive care unit (NICU) and it may persist in the first years of life [1,2]. The post-natal growth retardation remains a challenge for neonatologists.…”

Section: Introductionmentioning

confidence: 99%

“…If a low caloric intake may impair growth, an energy overload may increase the risk of side effects associated with PN (i.e. hyperglycemia, hypertriglyceridemia, metabolic acidosis), particularly dangerous for critically ill individuals [1,6,7].…”

Section: Introductionmentioning

confidence: 99%

Long-term effects on growth of an energy-enhanced parenteral nutrition in preterm newborn: A quasi-experimental study

et al. 2020

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Parenteral Nutrition in Premature Infants

Cited by 15 publications

References 109 publications

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

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

Early Protein Intake Influences Neonatal Brain Measurements in Preterms: An Observational Study

Long-term effects on growth of an energy-enhanced parenteral nutrition in preterm newborn: A quasi-experimental study

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