Standardized versus individualized parenteral nutrition in very low birth weight infants: a comparative study

Area of Science:

• Neonatology
• Pediatric Nutrition
• Intensive Care Medicine

Background:

• Parenteral nutrition (PN) is crucial for the growth and outcomes of very low birth weight (VLBW) infants.
• The optimal composition of PN, whether standard (STD-PN) or individualized (IND-PN), remains a subject of debate.
• This study aims to resolve this controversy by comparing IND-PN and STD-PN.

Purpose of the Study:

• To compare individualized parenteral nutrition (IND-PN) with standard parenteral nutrition (STD-PN) in VLBW infants.
• To evaluate differences in nutritional parameters, growth, complications, and cost between IND-PN and STD-PN.
• To determine the optimal PN strategy for VLBW infants.

Main Methods:

• A cohort of 140 VLBW infants was studied, with 70 neonates in the IND-PN group matched to 70 neonates in the STD-PN group based on gestational age (GA; +/-4 days).
• Data collected included demographic, maternal, intrapartum, neonatal, interventional, growth, and nutritional parameters.
• Statistical analysis was performed to compare outcomes between the two groups.

Main Results:

• IND-PN infants exhibited significantly greater weight gain SDS during the first week (p = 0.036) and first month (p = 0.0004) compared to STD-PN infants.
• IND-PN infants showed higher discharge weight SDS (p = 0.012) and head circumference SDS (p = 0.006).
• IND-PN infants received higher mean daily caloric intakes, had shorter durations of exclusive PN, and required fewer electrolyte corrections.

Conclusions:

• IND-PN leads to significantly better growth in VLBW infants compared to STD-PN, without increased clinical or laboratory complications.
• IND-PN resulted in a shorter period of exclusive PN and reduced need for electrolyte corrections.
• IND-PN aligns with an aggressive nutritional approach and appears optimal for VLBW infants, although adequately composed STD-PN is a suitable alternative.