Protein Intakes during Weaning from Parenteral Nutrition Drive Growth Gain and Body Composition in Very Low Birth Weight Preterm Infants

Abstract

Weaning from parenteral to enteral nutrition is a critical period to maintain an adequate growth in very low birth weight preterm infants (VLBWI). We evaluated the actual daily nutritional intakes during the transition phase (TP) in VLBWI with adequate and inadequate weight growth velocity (GV ≥ 15 vs. GV < 15 g/kg/day). Fat-free mass (FFM) at term-corrected age (TCA) was compared between groups. Based on actual nutritional intakes of infants with adequate growth, we defined a standardized parenteral nutrition bag (SPB) for the TP. One hundred and six VLBWI were categorized as group 1 (G1): [GV < 15 (n = 56)] and group 2 (G2): [GV ≥ 15 (n = 50)]. The TP was divided into two periods: main parenteral nutritional intakes period (parenteral nutritional intakes >50%) (M-PNI) and main enteral nutritional intakes period (enteral nutritional intakes >50%) (M-ENI). Anthropometric measurements were assessed at discharge and TCA, FFM deposition at TCA. During M-PNI, G2 showed higher enteral protein intake compared to G1 (p = 0.05). During M-ENI, G2 showed higher parenteral protein (p = 0.01) and energy intakes (p < 0.001). A gradual reduction in SPB volume, together with progressive increase in enteral volume, allowed nutritional intakes similar to those of G2. At TCA, G2 had higher FFM compared to G1 (p = 0.04). The reasoned use of SPB could guarantee an adequate protein administration, allowing an adequate growth and higher FFM deposition.

Early Enteral Feeding in Preterm Infants: A Narrative Review of the Nutritional, Metabolic, and Developmental Benefits

“…Nutrition management during this transitional period must be carefully evaluated and modified to meet infant needs, especially given the length of this period may vary significantly based on unit nutrition protocols, birth weight and/or gestational age, and infant illness severity. Liotto et al demonstrated the importance of close observation and monitoring during the transitional phase, as low protein provision during this period was associated with decreased growth velocity and fat-free mass composition at term-corrected age in very low birth weight infants [ 84 ]. Likewise, Brennan et al compared hourly intakes of macronutrients during the transitional phase, exemplifying the need for higher parenteral volume when enteral feeding was <40 mL/kg/day as well as early fortification of human milk to achieve targeted protein provision when infants began receiving more enteral compared to parenteral nutrition [ 85 ].…”

Effect of parenteral nutrition duration on patterns of growth and body composition in very low‐birth‐weight premature infants

“…35 During the transition from PN to EN, infants in both groups received adequate and comparable protein, energy, and protein-energy ratios. 36 The significantly higher weekly nutrient provision in the short-PN group is expected, considering the higher proportion of their nutrition being provided enterally and the higher enteral macronutrient requirements to compensate for intestinal digestion and hepatic first-pass metabolism. The difference in BM exposure might be another factor at play; infants in the short-PN group had significantly more BM exposure.…”

“…4,17,39 It is possible that the comparable EN initiation and advancement and PN durations in previous studies masked their effect on FFM accretion. 4,8,36,40,41 Furthermore, the correlation between delayed enteral feeding and dysbiosis could theoretically stimulate low-grade chronic inflammation and could be implicated in the pathogenesis of insulin resistance and metabolic syndrome. 42,43 Further studies are ongoing by this group to describe the relationship between neonatal body composition and gut microbiome.…”

“…In addition, the significantly higher protein provision in the short‐PN group during the first week of life might be a contributor 35 . During the transition from PN to EN, infants in both groups received adequate and comparable protein, energy, and protein‐energy ratios 36 . The significantly higher weekly nutrient provision in the short‐PN group is expected, considering the higher proportion of their nutrition being provided enterally and the higher enteral macronutrient requirements to compensate for intestinal digestion and hepatic first‐pass metabolism.…”

New Insights in Preterm Nutrition

“…This is a very vulnerable period, since the absorption of various nutrients from the intestinal lumen to the splanchnic district varies according to the type of amino acids. Therefore, it is crucial to carefully perform this transition to ensure adequate intake, mainly of protein, and consequently achieve adequate growth [20][21][22].…”