Transition From Parenteral to Enteral Nutrition and Postnatal Growth in Very Preterm Infants During Their First 28 Days of Life

Abstract

BackgroundNutrition practices for preterm infants during the first few weeks of life can be divided into three phases: the parenteral nutrition (PN), enteral nutrition (EN), and transition (TN) phases; the TN phase includes both PN and EN. Our purpose was to analyze nutrition practices for very preterm infants during the TN phase and their association with the infants' growth during the first 28 days of life.MethodsData from 268 very preterm infants <32 weeks old from six neonatal intensive care units were analyzed retrospectively. The TN phase was defined as enteral feedings of 30-120 ml/kg/d. Postnatal growth failure (PGF) was defined as a 28-day growth velocity <15 g/kg/d. Differences in protein and energy intake between the PGF and non-PGF groups during the TN phase were calculated, and risk factors for PGF were identified using multivariate regression analysis.ResultsThe total protein (parenteral + enteral) intake during the TN was 3.16 (2.89, 3.47) g/kg/d, which gradually decreased as the enteral feeding volume increased in the TN phase. The total energy (parenteral + enteral) intake during the TN phase was 115.72 (106.98, 122.60) kcal/kg/d. The PGF group had a lower total protein intake (parenteral + enteral) than the non-PGF group had [3.09 (2.85, 3.38) g/kg/d vs. 3.27 (3.06, 3.57) g/kg/d, P = 0.007, respectively]. No significant difference was found in energy intake during the TN phase. The variables associated with PGF included a lower total protein (parenteral + enteral) intake, a smaller day of age at the end of the TN phase, and a higher birth weight z-score.ConclusionIncreasing the total protein intake (parenteral + enteral) during the TN could reduce the incidence of PGF.

Clinical Outcomes Correlating to a One-Day Shift in Sustained Feeding Tolerance in Very Low Birth Weight Infants in the ‘Connection Trial’

“…This study originated from interactions with Health Authorities indicating that drug development trials on feeding tolerances would benefit from exploring what the strength and nature of clinical correlates would be to a one-day shift in the time to a sustained feeding tolerance. Establishment of such correlations has not previously been evaluated partially because a consensus definition of sustained feeding tolerance has not been established [10,11,13]. Here we provide such a definition and analyze its strength against a panel of adverse outcomes occurring in the postnatal intensive care treatment of ELBW infants.…”

“…acids or fat) and a mean daily increase in body weight of at least 10 g/kg. This definition was deliberately set as a lower limit for the identification of 'full' enteral feeding with knowledge that both greater feeding volumes and body weight increases may be aimed at in the nutritional optimization of the VLBW infant [10,11,13]. It should be emphasized, however, that by both definitions the infant must acquire at least 120 ml/kg for every consecutive day during the two periods of evaluated study time.…”

“…There is, however, consensus that full enteral feeding should be reached early in order to ascertain opti-mal growth and reduce unwanted direct and indirect effects of a prolonged parenteral nutrition like cholestasis, late onset sepsis, increased use of systemic antibiotics and delayed gut maturation [5,8,9]. The definition of a full enteral feeding usually includes a daily feeding volume of at least 120-150 ml/ kg body weight, sometimes required to persist for a few days, or an absent need for support with parenteral nutrition [10][11][12][13]. Little, however, has been explored as to clinical outcomes correlating to a full enteral feeding sustained over longer periods of time and a relevant definition of such an endpoint in drug development trials in premature infants.…”

Editorial: Topic opportunities, barriers and pitfall of current nutritional practice in preterm infants

“…This phase indicated a gradual decrease in parenteral nutrition and a gradual increase in enteral nutrition. The duration of this phase is strongly associated with the growth failure of preterm infants at discharge ( 8 ). These are the two milestones of NICU nutrition indicators.…”