Effects of aggressive parenteral nutrition on growth and clinical outcome in preterm infants

Area of Science:

• Neonatalogy
• Pediatric Nutrition
• Intensive Care Medicine

Background:

• Optimal nutrition is crucial for preterm infants to achieve growth similar to fetal development.
• Adequate protein intake is essential for postnatal growth in extremely low-birthweight infants.

Purpose of the Study:

• To investigate if higher amino acid and lipid administration in preterm infants (<34 weeks gestational age) improves growth at 40 weeks gestation.
• To determine the preventive effect of aggressive parenteral nutrition on retinopathy of prematurity (ROP).

Main Methods:

• A prospective study included 53 neonates born before 34 weeks gestational age.
• Infants were randomized into two groups: aggressive parenteral nutrition (PN) (amino acids 3 g/kg/day, lipids 2 g/kg/day) and conventional PN (amino acids 1.5 g/kg/day, lipids 1 g/kg/day).
• Comparisons included anthropometric measurements, clinical outcomes, and serum levels of IGF-I, IGFBP, and thyroid hormones.

Main Results:

• Infants receiving aggressive PN showed significantly higher height, head circumference, and serum IGF-I and IGFBP3 at 40 weeks gestation.
• Thyroid hormone levels were not significantly affected by the aggressive PN regimen.
• Lower IGF-I and IGFBP3 levels in the conventional PN group correlated negatively with ROP development.

Conclusions:

• Aggressive parenteral nutrition positively influences anthropometric measurements at 40 weeks gestation in preterm neonates.
• Higher intake of amino acids and lipids may reduce the incidence or severity of retinopathy of prematurity (ROP).
• The beneficial effects of aggressive PN may be mediated by elevated levels of insulin-like growth factor-I (IGF-I) and IGF binding protein 3 (IGFBP3).