Suboptimal nutrition in moderately preterm infants

Peripherally inserted central catheters optimize nutrient intake in moderately preterm infants

“…Numerous studies have shown the advantages of early nutrition and avoidance of protein deficits (10,(13)(14)(15). However, provision of adequate nutrition in the early postnatal period remains a challenge, and current clinical practices for the delivery of adequate nutrition may be insufficient (8,9,16,17). In this study, neonates who were given supplemental nutrition via PICC line received more kilocalories and protein than those who did not.…”

The efficacy and safety of peripheral intravenous parenteral nutrition vs 10% glucose in preterm infants born 30 to 33 weeks’ gestation: a randomised controlled trial

“…Caution regarding insertion of central lines in infants who are expected to reach full enteral feeds within ≈5-7 days may explain some of the variation in nutritional management practices. Results from a recent Australian and New Zealand survey [10] and a UK audit [11] in infants born 32-34 weeks' gestation show that < 20% use parenteral nutrition in this population with resulting suboptimal nutrient intakes [11].…”

“…However, central venous lines are not without risk and consequently infants requiring them are cared for in intensive care settings [12,13]. Most moderately preterm newborns [10,11], and in our experience even many less mature infants (30 to 31 weeks' gestation), do not get central venous catheters as they are considered physiologically stable enough to be able to tolerate full enteral nutrition by 5-7 days of age and thus can be cared for in Special Care Units [10,11]. Although recent recommendations state that peripheral venous parenteral nutrition can be given for short periods, the level of evidence for this is low and the risks associated with extravasation high [13,14].…”

“…Although recommendations for early parenteral amino acids and lipid support for very preterm infants (< 32 weeks’ gestation) are clear [ 7 , 8 ], the nutritional requirements of the moderately preterm infant (32 to 33 weeks’ gestation) are less well established [ 9 ]. While practices vary, in many centres moderately preterm infants receive 10% glucose using a peripheral intravenous cannula in the first week of life as enteral feeds are established [ 10 , 11 ]. Parenteral nutrition solutions are typically given via central venous catheters due to their high osmolarity and risks with extravasation if delivered peripherally [ 12 – 15 ].…”

Prematurity and programming of cardiovascular disease risk: a future challenge for public health?

“…The nutritional management of preterm infants aims to ‘achieve growth similar to foetal growth coupled with satisfactory functional development’;45 however, the optimal targets for growth in preterm infants are unclear 46. Additionally, while there are recommendations for nutritional intake in infants up to 1800 g, a high degree of uncertainty remains45 and there are fewer data for optimal intake in moderately preterm infants who are also at risk of long-term complications 47. While some studies have suggested that feeding preterm infants with unsupplemented breast milk or standard formula may adversely affect growth and later cognitive function,48 49 the use of nutrient-enriched formulas has been associated with higher childhood BP50 and with insulin resistance in adolescence, which was greatest in those with rapid postnatal weight gain 44.…”