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Does parenteral nutrition influence electrolyte and fluid balance in preterm infants in the first days after birth?
Liset E Elstgeest1, Shirley E Martens, Enrico Lopriore
1Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands.
Insights
New guidelines for very preterm infants involving early total parenteral nutrition (TPN) and restricted fluids did not alter serum electrolytes. However, early TPN did reduce fluid loss and body weight changes in the initial days.
Area of Science:
- Neonatal Medicine
- Pediatric Nutrition
- Clinical Pediatrics
Background:
- New national guidelines advocate for restricted fluid intake and early total parenteral nutrition (TPN) in very preterm infants.
- These changes aim to optimize outcomes for vulnerable newborns.
Purpose of the Study:
- To evaluate the impact of new Dutch guidelines on serum sodium and potassium levels in very preterm infants.
- To assess the effect on fluid balance, including diuresis and body weight changes, during the first three postnatal days.
Main Methods:
- Retrospective comparison of two cohorts of infants born before (<28 weeks gestational age) and after the guideline implementation.
- Analysis of serum electrolytes, diuresis, and body weight changes within the first 72 hours after birth.
Main Results:
- No significant differences in mean serum sodium or potassium levels were observed between the late-TPN and early-TPN groups.
- Infants receiving early TPN exhibited significantly decreased diuresis (3.2 vs 4.5 ml/kg/h).
- A reduced loss of body weight was noted in the early-TPN cohort (-0.8% vs -6.0%).
Conclusions:
- Early initiation of TPN and restricted fluid intake do not appear to affect serum sodium and potassium levels in the first three postnatal days for very preterm infants.
- Further investigation is required to determine if decreased diuresis and body weight loss reflect delayed postnatal adaptation or improved energy balance.
Background:
New national guidelines recommend more restricted fluid intake and early initiation of total parenteral nutrition (TPN) in very preterm infants. The aim was study the effect of these guidelines on serum sodium and potassium levels and fluid balance in the first three days after birth.
Methods:
Two cohorts of infants <28 weeks gestational age, born at the Leiden University Medical Center in the Netherlands, were compared retrospectively before (2002-2004, late-TPN) and after (2006-2007, early-TPN) introduction of the new Dutch guideline. Outcome measures were serum sodium and potassium levels, diuresis, and changes in body weight in the first three postnatal days.
Results:
In the first three postnatal days no differences between late-TPN (N = 70) and early-TPN cohort (N = 73) in mean (SD) serum sodium (141.1 (3.8) vs 141.0 (3.7) mmol/l) or potassium (4.3 (0.5) vs 4.3 (0.5) mmol/l) were found, but in the early-TPN cohort diuresis (4.5 (1.6) vs 3.2 (1.4) ml/kg/h) and loss of body weight were decreased (-6.0% (7.7) vs -0.8% (8.0)).
Conclusions:
Initiation of TPN immediately after birth and restricted fluid intake in very preterm infants do not seem to influence serum sodium and potassium levels in first three postnatal days. Further research is needed to see if a decreased diuresis and loss of body weight in the first days is the result of a delayed postnatal adaptation or better energy balance.
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