Standardized versus Individualized Parenteral Nutrition in Very Low Birth Weight Infants: A Comparative Study

Abstract

Background: Parenteral nutrition (PN) improves the growth and outcome of very low birth weight (VLBW) infants. Optimal PN composition, standard (STD-PN) or individualized (IND-PN), is still controversial. Aim: To compare IND-PN and STD-PN as to nutritional and growth parameters, complications and cost. Patients and Methods: 140 VLBW infants were studied. Each of the 70 neonates from the IND-PN group was matched with a neonate of similar gestational age (GA; ±4 days) on STD-PN. Data collection included demographic, maternal, intrapartum, neonatal, interventional, growth and nutritional data. Results: Compared to STD-PN infants, IND-PN infants had a significantly lower mean birth weight, greater need for resuscitation at birth and interventions thereafter. Nevertheless, IND-PN infants showed significantly greater weight gain SDS during the 1st week (p = 0.036) and the 1st month of life (p = 0.0004), and higher discharge weight SDS (p = 0.012) and head circumference SDS (p = 0.006). IND-PN infants received higher mean daily caloric intakes. They also had significantly shorter durations of exclusive PN and needed less electrolyte corrections. Conclusions: Compared to STD-PN infants, IND-PN infants achieved significantly better growth without added clinical or laboratory complications, had a shorter period of exclusive PN and less electrolyte corrections. IND-PN, in accordance with the current more aggressive nutritional approach, appears optimal for PN of VLBW infants. Yet, STD-PN with adequate composition is an appropriate alternative.

Standardised Parenteral Nutrition

“…The studies comparing nutrient intakes during SPN and IPN are mostly non-randomised cohort studies, some favouring IPN while others SPN (Table 1) [26,27,28,29,30,31]. The only randomized controlled trial (RCT) comparing IPN with SPN enrolled only a small number of neonates [27].…”

“…Smolkin et al in a retrospective observational study involving 140 VLBW neonates reported that IPN was associated with significantly greater weight gain during the first month of life, greater discharge weight, shorter duration of PN requirement and more electrolyte stability [30]. The authors attributed the difference to the “richer” nutrition contents of IPN as compared with SPN.…”

“…The authors attributed the difference to the “richer” nutrition contents of IPN as compared with SPN. A weakness of the study was a long interval of six years between the two study periods, SPN cohort from year 2000 to 2001 and IPN cohort from year 2006 to 2007, with the possibility of change in the clinical care contributing to the outcome [30]. …”

Automated Compounding of Parenteral Nutrition for Pediatric Patients: Characterization of Workload and Costs

“…Some recently published studies demonstrated the feasibility of using standardized, even commercial PN in pediatrics and neonatology, although no clear advantage has been demonstrated. [14][15][16][17][18][19] A survey from Israel conducted in 2005 showed that 18 of 25 neonatal intensive care units used commercial PN bags, whereas all others used standardized PN compounded on-site. 20 Standardized commercial PN, albeit theoretically lower in costs and workload, may be inappropriate in several clinical situations, and it forces reliance on the availability of such a product, which, as the recent drug shortage crisis has demonstrated, is not always consistent.…”

S3-Leitlinie der Deutschen Gesellschaft für Ernährungsmedizin (DGEM) in Zusammenarbeit mit der Gesellschaft für klinische Ernährung der Schweiz (GESKES), der Österreichischen Arbeitsgemeinschaft für klinische Ernährung (AKE), die Deutsche Gesellschaft für Kinder- und Jugendmedizin (DGKJ) und die Gesellschaft für Neonatologie und pädiatrische Intensivmedizin (GNPI)

“…Beide Studiengruppen wiesen eine ähnliche Gewichtszunahme und ähnliche biochemische Parameter auf [278]. Im Gegenteil dazu demonstrierte eine andere aktuelle Studie eine bessere Gewichtszunahme, eine kürzere Dauer der totalen PE und seltenere Elektrolytkorrekturen bei einer individualisierten PE [279]. Die Autoren kamen zu dem Schluss, dass eine Standard-PE mit einer adäquaten Zusammensetzung eine angemessene und vorteilhafte Alternative zur individuellen Verschreibung sein kann.…”