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Published on: February 15, 2018
Intrauterine-like growth rates can be achieved with premixed parenteral nutrition solution in preterm infants
Jacques Rigo1, Thibault Senterre
1University of Liege, Liege, Belgium.
Insights
Early aggressive parenteral nutrition (PN) using ready-to-use solutions improves growth in preterm infants. This approach reduces nutritional deficits and postnatal growth restriction in neonatal intensive care units.
Area of Science:
- Neonatology
- Pediatric Nutrition
- Intensive Care Medicine
Background:
- Neonatal intensive care units face challenges with infant growth failure.
- Early "aggressive" parenteral nutrition (PN) is recommended to meet preterm infant needs.
- Nutritional practices and adherence to guidelines vary across hospitals.
Purpose of the Study:
- To evaluate two ready-to-use (RTU), premixed parenteral solutions (PSs) for preterm infants.
- To assess the impact of these PSs on nutritional intake and growth outcomes.
- To determine if RTU premixed PSs reduce early nutritional deficits and postnatal growth restriction.
Main Methods:
- Prospective evaluation of two RTU premixed PSs: a hospital pharmacy binary PS and a commercial 3-chamber bag.
- Assessment of nitrogen and energy delivery from the first day of life.
- Comparison of nutritional intakes with international guidelines and growth outcomes.
Main Results:
- Premixed PSs provide recommended nitrogen and energy intakes for preterm infants.
- These solutions reduce or eliminate early cumulative nutritional deficits in very-low-birth-weight infants.
- The use of RTU premixed PSs helps avoid postnatal growth restriction.
Conclusions:
- RTU premixed parenteral solutions are effective in meeting the nutritional needs of preterm infants.
- These solutions support optimal growth and reduce the incidence of growth restriction.
- Balanced PN with amino acids, energy, minerals, and electrolytes from day one is crucial for preterm infants.
Abstract:
Growth failure in neonatal intensive care units is a major challenge for pediatricians and neonatologists. The use of early "aggressive" parenteral nutrition (PN), with >2.5 g/(kg ·d) of amino acids and at least 40 kcal/(kg ·d) of energy from the first day of life, has been shown to provide nutritional intakes in the range recommended by international guidelines, reducing nutritional deficit and the incidence of postnatal growth restriction in preterm infants. However, nutritional practices and adherence to recommendations may vary in different hospitals. Two ready-to-use (RTU), premixed parenteral solutions (PSs) designed for preterm infants have been prospectively evaluated: a binary RTU premixed PS from our hospital pharmacy and a commercially premixed 3-chamber bag (Baxter Healthcare). These premixed PSs provide nitrogen and energy intakes in the range of the most recent recommendations, reducing or eliminating the early cumulative nutritional deficit in very-low-birth-weight infants, and avoiding the development of postnatal growth restriction. A further rationale for RTU premixed PSs is that preterm infants require balanced PN that contains not only amino acids and energy but also minerals and electrolytes from the first day of life in order to reduce the incidence of metabolic disorders frequently reported in extremely-low-birth-weight infants during the early weeks of life.
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