Brief Parenteral Nutrition Accelerates Weight Gain, Head Growth Even in Healthy VLBWs

Abstract

IntroductionWhether parenteral nutrition benefits growth of very low birth weight (VLBW) preterm infants in the setting of rapid enteral feeding advancement is unclear. Our aim was to examine this issue using data from Japan, where enteral feeding typically advances at a rapid rate.MethodsWe studied 4005 hospitalized VLBW, very preterm (23–32 weeks' gestation) infants who reached full enteral feeding (100 ml/kg/day) by day 14, from 75 institutions in the Neonatal Research Network Japan (2003–2007). Main outcomes were weight gain, head growth, and extra-uterine growth restriction (EUGR, measurement <10th percentile for postmenstrual age) at discharge.Results40% of infants received parenteral nutrition. Adjusting for maternal, infant, and institutional characteristics, infants who received parenteral nutrition had greater weight gain [0.09 standard deviation (SD), 95% CI: 0.02, 0.16] and head growth (0.16 SD, 95% CI: 0.05, 0.28); lower odds of EUGR by head circumference (OR 0.66, 95% CI: 0.49, 0.88). No statistically significant difference was seen in the proportion of infants with EUGR at discharge. SGA infants and infants who took more than a week until full feeding had larger estimates.DiscussionEven in infants who are able to establish enteral nutrition within 2 weeks, deprivation of parenteral nutrition in the first weeks of life could lead to under nutrition, but infants who reached full feeding within one week benefit least. It is important to predict which infants are likely or not likely to advance on enteral feedings within a week and balance enteral and parenteral nutrition for these infants.

Safety of lipid emulsion in very low‐birthweight infants according to cytokine level

“…Aggressive i.v. nutrition initiated early postnatally in VLBW infants improves head circumference development . In the present patients, however, the change in the weight ( P = 0.61) and head circumference SD score ( P = 0.53) between birth and term did not differ significantly between the two groups.…”

Highest Plasma Phenylalanine Levels in (Very) Premature Infants on Intravenous Feeding; A Need for Concern

“…However, these studies are older and not only have formulas evolved but the studies did not consider the influence of the degree of prematurity [ 3 , 7 ]. In our study, significantly higher values of Phe were observed in infants requiring partial or fully intravenous feeding compared to the others, probably because of the state of health of the newborn, which required the introduction of parenteral nutrition, which in turn contains greatly increased nutrients, and proteins in particular, in order to aid growth and weight gain [ 22 ]. This same situation has been reported in an infant with phenylketonuria who presented outrageously high levels with a parenteral diet [ 15 ].…”

Improved Macro- and Micronutrient Supply for Favorable Growth and Metabolomic Profile with Standardized Parenteral Nutrition Solutions for Very Preterm Infants

“…Postnatal nutrient intake is crucial for somatic growth [ 35 ]. Improved nutrient intake not only leads to a faster regain of birth weight but was shown to improve somatic growth including body weight and head circumference until term in infants with a birth weight of less than 1500 g [ 36 ].…”