Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Pediatrics
Published in: BMC Pediatrics 1/2021

Open Access 01-12-2021 | Nutrition | Research

Optimizing parenteral nutrition to achieve an adequate weight gain according to the current guidelines in preterm infants with birth weight less than 1500 g: a prospective observational study

Authors: Nan Wang, Lianlian Cui, Zhen Liu, Yan Wang, Yuhua Zhang, Changsong Shi, Yanbo Cheng

Published in: BMC Pediatrics | Issue 1/2021

Login to get access

Abstract

Aim

European Society for Clinical Nutrition and Metabolism released the guidelines on pediatric parenteral nutrition in 2018. We aimed to compare the parenteral nutrition (PN) regimen with the current guidelines, evaluate weight gain and explore the correlation of parenteral macronutrient and energy intakes with weight gain outcome in preterm infants with birth weight less than 1500 g.

Methods

A prospective observational study was conducted. Parenteral macronutrients and energy intakes were described. Weight gain during PN was assessed. Nutritional factors associated with weight gain outcome after PN were identified using a cox proportional hazards model.

Results

A total of 163 infants were included in this study, in which 41 were extremely low birth weight (ELBW) infants and 122 were very low birth weight (VLBW) infants. Average glucose, amino acid, lipid, and energy during the first postnatal week were 7.5 g/kg/d, 2.4 g/kg/d, 0.8 g/kg/d, 48 kcal/kg/d. Median maximum glucose, amino acid, lipid, and energy were 11.1 g/kg/d, 3.5 g/kg/d, 3 g/kg/d, 78 kcal/kg/d. Median days to maximum glucose, amino acid, lipid, and energy were 10, 9, 12, 11 days. The proportion of appropriate for gestational age (AGA) infants was 76.9%. The ratio of infants without poor weight gain outcome after PN was 38%. With every 0.1 g/kg/d decrease of maximum amino acid and average lipid during the first postnatal week, the probability of appropriate weight gain outcome decreased by 77.6 and 74.4% respectively. With each additional day to maximum glucose and energy, the probability of appropriate weight gain outcome decreased by 5.6 and 6.1% respectively.

Conclusions

Most preterm infants with birth weight less than 1500 g remain below the latest recommended nutrition goals. The poor weight gain outcome of these infants after PN is related to insufficient parenteral macronutrient and energy intakes. PN strategies should be improved according to the latest evidence-based recommendations.
Appendix
Available only for authorised users
Literature
1.
Turpin RS, Liu FX, Prinz M, Macahilig C, Malinoski F. Parenteral nutrition prescribing pattern: a medical chart review of 191 preterm infants. Nutr Clin Pract. 2013;28(2):242–6.PubMedCrossRef
2.
Riskin A, Hartman C, Shamir R. Parenteral nutrition in very low birth weight preterm infants. Isr Med Assoc J. 2015;17(5):310–5.PubMed
3.
Neu J. Gastrointestinal development and meeting the nutritional needs of premature infants. Am J Clin Nutr. 2007;85(2):629s–34s.PubMedCrossRef
4.
Darmaun D, Lapillonne A, Simeoni U, Picaud JC, Rozé JC, Saliba E, et al. Parenteral nutrition for preterm infants: issues and strategy. Arch Pediatr. 2018;25(4):286–94.PubMedCrossRef
5.
Working Group Of Pediatrics Chinese Society Of P, Enteral N, working group of neonatology Chinese society of P, working group of neonatal surgery Chinese society of pediatric S. CSPEN guidelines for nutrition support in neonates. Asia Pac J Clin Nutr. 2013;22(4):655–63.
6.
van Goudoever JB, Carnielli V, Darmaun D, Sainz de Pipaon M. ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Amino acids. Clin Nutr (Edinburgh, Scotland). 2018;37(6 Pt B):2315–23.CrossRef
7.
Mesotten D, Joosten K, van Kempen A, Verbruggen S. ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Carbohydrates. Clin Nutr (Edinburgh, Scotland). 2018;37(6 Pt B):2337–43.CrossRef
8.
Lapillonne A, Fidler Mis N, Goulet O, van den Akker CHP, Wu J, Koletzko B. ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Lipids. Clin Nutr (Edinburgh, Scotland). 2018;37(6 Pt B):2324–36.CrossRef
9.
Joosten K, Embleton N, Yan W, Senterre T. ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Energy. Clin Nutr (Edinburgh, Scotland). 2018;37(6 Pt B):2309–14.CrossRef
10.
Embleton ND, Simmer K. Practice of parenteral nutrition in VLBW and ELBW infants. World Rev Nutr Diet. 2014;110:177–89.PubMedCrossRef
11.
Ng DVY, Brennan-Donnan J, Unger S, Bando N, Gibbins S, Nash A, et al. How close are we to achieving energy and nutrient goals for very low birth weight infants in the first week? JPEN J Parenter Enteral Nutr. 2017;41(3):500–6.PubMedCrossRef
12.
13.
Schneider J, Fischer Fumeaux CJ, Duerden EG, Guo T, Foong J, Graz MB, et al. Nutrient intake in the first two weeks of life and brain growth in preterm neonates. Pediatrics. 2018;141(3):e20172169.PubMedCrossRef
14.
Lapillonne A, Griffin IJ. Feeding preterm infants today for later metabolic and cardiovascular outcomes. J Pediatr. 2013;162(3 Suppl):S7–16.PubMedCrossRef
15.
Villar J, Giuliani F, Barros F, Roggero P, Coronado Zarco IA, Rego MAS, et al. Monitoring the postnatal growth of preterm infants: a paradigm change. Pediatrics. 2018;141(2):e20172467.PubMedCrossRef
16.
Fenton TR, Cormack B, Goldberg D, Nasser R, Alshaikh B, Eliasziw M, et al. “Extrauterine growth restriction” and “postnatal growth failure” are misnomers for preterm infants. J Perinatol. 2020;40(5):704–14.PubMedCrossRef
17.
Ballard O, Morrow AL. Human milk composition: nutrients and bioactive factors. Pediatr Clin N Am. 2013;60(1):49–74.CrossRef
18.
Peila C, Spada E, Giuliani F, Maiocco G, Raia M, Cresi F, et al. Extrauterine growth restriction: definitions and predictability of outcomes in a cohort of very low birth weight infants or preterm neonates. Nutrients. 2020;12(5):1224.PubMedCentralCrossRef
19.
Lapillonne A, Bronsky J, Campoy C, Embleton N, Fewtrell M, Fidler Mis N, et al. Feeding the late and moderately preterm infant: a position paper of the European Society for Paediatric Gastroenterology, hepatology and nutrition committee on nutrition. J Pediatr Gastroenterol Nutr. 2019;69(2):259–70.PubMedCrossRef
20.
Grover A, Khashu M, Mukherjee A, Kairamkonda V. Iatrogenic malnutrition in neonatal intensive care units: urgent need to modify practice. JPEN J Parenter Enteral Nutr. 2008;32(2):140–4.PubMedCrossRef
21.
Ahmed M, Irwin S, Tuthill DP. Education and evidence are needed to improve neonatal parenteral nutrition practice. JPEN J Parenter Enteral Nutr. 2004;28(3):176–9.PubMedCrossRef
22.
Liu MY, Chen YY, Hu SH, Chen YK, Chang SJ. The influence of aggressive parenteral nutrition to preterm and very low birth weight infants. Glob Pediatr Health. 2015;2:2333794x14567192.PubMedPubMedCentral
23.
Thureen PJ, Melara D, Fennessey PV, Hay WW Jr. Effect of low versus high intravenous amino acid intake on very low birth weight infants in the early neonatal period. Pediatr Res. 2003;53(1):24–32.PubMedCrossRef
24.
Hans DM, Pylipow M, Long JD, Thureen PJ, Georgieff MK. Nutritional practices in the neonatal intensive care unit: analysis of a 2006 neonatal nutrition survey. Pediatrics. 2009;123(1):51–7.PubMedCrossRef
25.
Bulbul A, Okan F, Bulbul L, Nuhoglu A. Effect of low versus high early parenteral nutrition on plasma amino acid profiles in very low birth-weight infants. J Matern Fetal Neonatal Med. 2012;25(6):770–6.PubMedCrossRef
26.
Poindexter BB, Langer JC, Dusick AM, Ehrenkranz RA. Early provision of parenteral amino acids in extremely low birth weight infants: relation to growth and neurodevelopmental outcome. J Pediatr. 2006;148(3):300–5.PubMedCrossRef
27.
Blanco CL, Falck A, Green BK, Cornell JE, Gong AK. Metabolic responses to early and high protein supplementation in a randomized trial evaluating the prevention of hyperkalemia in extremely low birth weight infants. J Pediatr. 2008;153(4):535–40.PubMedCrossRef
28.
29.
Pillai A, Albersheim S, Elango R. High-dose parenteral amino acid intake in very low birthweight infants: what is the current evidence? Curr Opin Clin Nutr Metab Care. 2019;22(3):236–41.PubMedCrossRef
30.
Martin CR, Brown YF, Ehrenkranz RA, O'Shea TM, Allred EN, Belfort MB, et al. Nutritional practices and growth velocity in the first month of life in extremely premature infants. Pediatrics. 2009;124(2):649–57.PubMedCrossRef
31.
Roelants JA, Joosten KFM, van der Geest BMA, Hulst JM, Reiss IKM, Vermeulen MJ. First week weight dip and reaching growth targets in early life in preterm infants. Clin Nutr (Edinburgh, Scotland). 2018;37(5):1526–33.CrossRef
32.
Costa S, Cocca C, Barone G, Catenazzi P, Gallini F, Maggio L, et al. Growth of head circumference and body length in preterm infants receiving a multicomponent vs a soybean-based lipid emulsion: a randomized controlled trial. JPEN J Parenter Enteral Nutr. 2021;45(1):94–101.PubMedCrossRef
33.
Patel P, Bhatia J. Total parenteral nutrition for the very low birth weight infant. Semin Fetal Neonatal Med. 2017;22(1):2–7.PubMedCrossRef
34.
Brennan AM, Murphy BP, Kiely ME. Optimising preterm nutrition: present and future. Proc Nutr Soc. 2016;75(2):154–61.PubMedCrossRef
35.
Embleton NE, Pang N, Cooke RJ. Postnatal malnutrition and growth retardation: an inevitable consequence of current recommendations in preterm infants? Pediatrics. 2001;107(2):270–3.PubMedCrossRef
36.
Lanigan J, Singhal A. Early nutrition and long-term health: a practical approach. Proc Nutr Soc. 2009;68(4):422–9.PubMedCrossRef
37.
Embleton ND. Early nutrition and later outcomes in preterm infants. World Rev Nutr Diet. 2013;106:26–32.PubMed
38.
39.
Lucas A, Morley R, Cole TJ, Gore SM. A randomised multicentre study of human milk versus formula and later development in preterm infants. Arch Dis Child Fetal Neonatal Ed. 1994;70(2):F141–6.PubMedPubMedCentralCrossRef
40.
Stoltz Sjöström E, Öhlund I, Ahlsson F, Engström E, Fellman V, Hellström A, et al. Nutrient intakes independently affect growth in extremely preterm infants: results from a population-based study. Acta Paediatr. 2013;102(11):1067–74.PubMed
41.
Fischer CJ, Maucort-Boulch D, Essomo Megnier-Mbo CM, Remontet L, Claris O. Early parenteral lipids and growth velocity in extremely-low-birth-weight infants. Clin Nutr (Edinburgh, Scotland). 2014;33(3):502–8.CrossRef
42.
dit Trolli SE, Kermorvant-Duchemin E, Huon C, Bremond-Gignac D, Lapillonne A. Early lipid supply and neurological development at one year in very low birth weight (VLBW) preterm infants. Early Hum Dev. 2012;88 Suppl 1:S25–9.PubMedCrossRef
43.
Yunis KA, Oh W, Kalhan S, Cowett RM. Glucose kinetics following administration of an intravenous fat emulsion to low-birth-weight neonates. Am J Phys. 1992;263(5 Pt 1):E844–9.
44.
Cormack BE, Bloomfield FH. Increased protein intake decreases postnatal growth faltering in ELBW babies. Arch Dis Child Fetal Neonatal Ed. 2013;98(5):F399–404.PubMedCrossRef
45.
Burattini I, Bellagamba MP, Spagnoli C, D'Ascenzo R, Mazzoni N, Peretti A, et al. Targeting 2.5 versus 4 g/kg/day of amino acids for extremely low birth weight infants: a randomized clinical trial. J Pediatr. 2013;163(5):1278–1282.e1271.PubMedCrossRef
46.
Haymond MW, Sunehag A. Controlling the sugar bowl. Regulation of glucose homeostasis in children. Endocrinol Metab Clin N Am. 1999;28(4):663–94.CrossRef
Metadata
Title
Optimizing parenteral nutrition to achieve an adequate weight gain according to the current guidelines in preterm infants with birth weight less than 1500 g: a prospective observational study
Authors
Nan Wang
Lianlian Cui
Zhen Liu
Yan Wang
Yuhua Zhang
Changsong Shi
Yanbo Cheng
Publication date
01-12-2021
Publisher
BioMed Central
Keyword
Nutrition
Published in
BMC Pediatrics / Issue 1/2021
Electronic ISSN: 1471-2431
DOI
https://doi.org/10.1186/s12887-021-02782-1

Other articles of this Issue 1/2021

BMC Pediatrics 1/2021 Go to the issue

Research article

Nonresection management of the pancreas for grade III and IV blunt pancreatic injuries in children: a single center’s experience

Research article

Thymus size and its correlates among children admitted with severe acute malnutrition: a cross-sectional study in Uganda

Research article

Anesthesia, sex and miscarriage history may influence the association between cesarean delivery and autism spectrum disorder

Study protocol

Motor-enriched learning for improving pre-reading and word recognition skills in preschool children aged 5–6 years – study protocol for the PLAYMORE randomized controlled trial

Research article

Prevalence of functional gastrointestinal disorders in infants and young children in China

Research article

Addressing the quality of paediatric primary care: health worker and caregiver perspectives from a process evaluation of PACK child, a health systems intervention in South Africa