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Published on: September 20, 2019
Two-Year Follow-up of a Randomized Controlled Nutrition Intervention Trial in Very Low-Birth-Weight Infants
Jorine A Roelants1,2, Hester Vlaardingerbroek1,3, Chris H P van den Akker1,3
1Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands.
Insights
Early aggressive parenteral nutrition (PN) in very low-birth-weight (VLBW) infants did not improve survival or neurodevelopmental outcomes. While growth was enhanced in some groups, the study found no overall benefit for high-dose amino acids or mixed fat emulsions.
Area of Science:
- Neonatal Medicine
- Pediatric Nutrition
- Developmental Pediatrics
Background:
- Very low-birth-weight (VLBW) infants face significant risks for neurodevelopmental impairment.
- Early nutritional support is critical for the growth and development of VLBW infants.
- Parenteral nutrition (PN) is a common method for feeding these vulnerable infants.
Purpose of the Study:
- To assess the long-term neurodevelopmental and survival outcomes of VLBW infants receiving early aggressive parenteral nutrition (PN).
- To compare the effects of different PN regimens, including varying doses of amino acids (AAs) and types of fat emulsions, on VLBW infants.
- To evaluate the impact of PN on major disability, neurodevelopmental scores, and anthropometry at 2 years corrected age.
Main Methods:
- A randomized controlled trial involving 142 VLBW infants (birth weight <1500 g) assigned to 5 different PN regimens or control.
- Intervention groups received glucose, AAs (standard or high-dose), and lipids (soybean oil or mixed emulsion) from birth.
- Primary outcome: composite of death or major disability at 2 years corrected age; secondary outcomes included neurodevelopmental scores and growth.
Main Results:
- No significant differences in the composite outcome of death or major disability were observed between intervention groups and controls (35/134, 26%).
- Increased odds of death were noted in the standard-dose AA-mixed fat emulsion group (OR 5.4, 95% CI 1.1-27.0).
- Growth was enhanced in the high-dose AA-mixed fat emulsion group compared to controls at 2 years corrected age (+0.51 weight SDS).
Conclusions:
- Early aggressive parenteral nutrition with high-dose amino acids and mixed fat emulsions did not demonstrate a beneficial effect on survival or neurodevelopmental outcomes in VLBW infants.
- While enhanced growth was observed in one intervention group, the overall findings suggest no significant advantage of the tested aggressive PN strategies.
- This hypothesis-generating study highlights the need for further research into optimal nutritional strategies for VLBW infants.
Background:
Very low-birth-weight (VLBW) infants are at risk for neurodevelopment impairment. This study assessed the effect of early aggressive parenteral nutrition (PN) on long-term outcome in VLBW infants.
Materials And Methods:
Directly after birth, VLBW infants (birth weight <1500 g, n = 142) were randomized to 5 different PN regimes. Controls (n = 46) received glucose and standard-dose amino acids (AAs; 2.4 g/[kg·d]) from birth onward and pure soybean oil fat emulsion (SOY) on the second day of life. Two intervention groups received glucose, standard-dose AAs, and lipids from birth onward: SOY (n = 24) or mixed fat emulsion (MIX, n = 25). The 2 other intervention groups received glucose, high-dose AAs (3.6 g/[kg·d]), and lipids from birth onward: SOY (n = 24) or MIX (n = 23). The primary outcome of this follow-up study was the composite outcome of "death or major disability" at 2 years corrected age. Secondary outcomes were death, major disabilities, neurodevelopmental scores, and anthropometry.
Results:
Follow-up rate was 92% (n = 134). Thirty-five (26%) infants had died or had a major disability, with no differences between intervention groups and controls. Increased odds for death were observed in the standard-dose AA-MIX group (odds ratio, 5.4; 95% confidence interval [CI], 1.1-27.0). Neurodevelopmental scores and incidence of major disabilities did not differ between groups. Growth in the high-dose AA-MIX group was enhanced compared with growth in controls at 2 years corrected age (+0.51 [0.01-1.02] weight SDS).
Conclusion:
This randomized controlled hypothesis-generating study demonstrated no beneficial effect of early high-dose AA administration and mixed fat emulsions on survival and neurodevelopmental outcome in VLBW infants, although growth was enhanced.
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