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Aggressive nutrition in extremely low birth weight infants: impact on parenteral nutrition associated cholestasis and
Andreas Repa1, Ruth Lochmann1, Lukas Unterasinger1
1Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna , Vienna , Austria.
Insights
Aggressive nutrition in extremely low birth weight (ELBW) infants significantly reduced parenteral nutrition-associated cholestasis (PNAC) and improved postnatal growth. This approach enhances infant outcomes by optimizing nutritional strategies.
Area of Science:
- Neonatology
- Pediatric Gastroenterology
- Nutritional Science
Background:
- Parenteral nutrition-associated cholestasis (PNAC) is common in extremely low birth weight (ELBW) infants.
- Pathogenesis involves parenteral nutrition (PN) composition, duration, and enteral feed (EF) tolerance.
- "Aggressive" nutrition is used to enhance ELBW infant growth, but its impact on PNAC is unclear.
Purpose of the Study:
- To analyze the influence of an "aggressive" nutritional regimen on PNAC incidence and growth in ELBW infants.
- To compare outcomes between "aggressive" and "conservative" nutritional strategies.
Main Methods:
- ELBW infants received either "conservative" (2005-6) or "aggressive" (2007-9) nutritional regimens.
- Regimens differed in PN composition and EF advancement timing and composition.
- PNAC incidence was analyzed, corrected for confounders; growth until discharge and neonatal morbidities were secondary outcomes.
Main Results:
- The "aggressive" nutrition group had a significantly lower incidence of PNAC (27% vs. 46%).
- Infants on "aggressive" nutrition showed significantly higher body weight, head circumference, and length at discharge.
- Extra-uterine growth failure was significantly reduced, and growth became more proportionate.
Conclusions:
- "Aggressive" nutrition in ELBW infants is linked to a significant reduction in PNAC.
- "Aggressive" nutrition markedly improved postnatal growth and reduced growth failure in ELBW infants.
Background:
Parenteral nutrition associated cholestasis (PNAC) is a frequently observed pathology in extremely low birth weight (ELBW) infants. Its pathogenesis is determined by the composition and duration of parenteral nutrition (PN) as well as the tolerance of enteral feeds (EF). "Aggressive" nutrition is increasingly used in ELBW infants to improve postnatal growth. Little is known about the effect of "aggressive" nutrition on the incidence of PNAC. We analyzed the influence of implementing an "aggressive" nutritional regimen on the incidence of PNAC and growth in a cohort of ELBW infants.
Methods:
ELBW infants were nourished using a "conservative" (2005-6; n = 77) or "aggressive" (2007-9; n = 85) nutritional regimen that differed in the composition of PN after birth as well as the composition and timing of advancement of EFs. We analyzed the incidence of PNAC (conjugated bilirubin > 1.5 mg/dl (25 µmol/l)) corrected for confounders of cholestasis (i.e., NEC and/or gastrointestinal surgery, sepsis, birth weight, Z-score of birth weight, time on PN and male sex), growth until discharge (as the most important secondary outcome) and neonatal morbidities.
Results:
The incidence of PNAC was significantly lower during the period of "aggressive" vs. "conservative "nutrition (27% vs. 46%, P < 0.05; adjusted OR 0.275 [0.116-0.651], P < 0.01). Body weight (+411g), head circumference (+1 cm) and length (+1 cm) at discharge were significantly higher. Extra-uterine growth failure (defined as a Z-score difference from birth to discharge lower than -1) was significantly reduced for body weight (85% vs. 35%), head circumference (77% vs. 45%) and length (85% vs. 65%) (P < 0.05). The body mass index (BMI) at discharge was significantly higher (11.1 vs. 12.4) using "aggressive" nutrition and growth became more proportionate with significantly less infants being discharged below the 10th BMI percentile (44% vs. 9%), while the percentage of infants discharged over the 90th BMI percentile (3% vs. 5%) did not significantly increase.
Discussion:
"Aggressive" nutrition of ELBW infants was associated with a significant decrease of PNAC and marked improvement of postnatal growth.
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