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Published on: September 20, 2019
[Parenteral nutrition in premature babies with a birth weight <1500g: a systematic single-center analysis and
Melanie Sirch1, Martin Poryo2, Mona Butte1
1Klinik für Allgemeine Pädiatrie und Neonatologie, Universitätsklinikum des Saarlandes, Geb. 9, Kirrberger Str., 66421, Homburg, Deutschland.
Insights
Parenteral nutrition in preterm infants was often inadequate, not meeting German guidelines, leading to poor early growth. Metabolic issues in extremely low birth weight infants complicate guideline adherence, with long-term outcomes still uncertain.
Area of Science:
- Neonatal intensive care
- Pediatric nutrition
- Perinatal medicine
Background:
- Parenteral and enteral nutrition are crucial for preterm infant growth and development.
- Debate exists regarding optimal nutritional growth rates and substrate delivery via parenteral nutrition.
- Very low birth weight (VLBW) and extremely low birth weight (ELBW) infants require specialized nutritional support.
Purpose of the Study:
- To evaluate parenteral nutrition practices for VLBW and ELBW infants.
- To compare substrate delivery in a neonatal intensive care unit (NICU) against German guidelines.
- To assess the impact of parenteral nutrition on early growth and neurodevelopmental outcomes.
Main Methods:
- Retrospective audit conducted at a tertiary NICU.
- Data collected from January 2009 to December 2010.
- Included 100 preterm neonates with birth weights <1500g (VLBW/ELBW).
Main Results:
- Only glucose provision met German guidelines; other substrates were often inadequate.
- Hyperglycemia requiring insulin treatment was observed, particularly in ELBW infants.
- Initial growth faltering in the first 3 weeks was followed by catch-up growth by 2 years corrected age.
- 78.6% of infants showed normal development at 2 years corrected age (Bayley II test).
Conclusions:
- Parenteral nutrition in the studied NICU often deviated from German guidelines, correlating with inadequate early growth.
- Metabolic disturbances, especially in ELBW neonates, hinder guideline implementation.
- The long-term benefits of guideline adherence on growth and neurodevelopment require further investigation.
Background:
Parenteral and enteral nutrition are essential for both growth and development of preterm infants. Based on the results of many studies, the rate of nutritional growth and the amount of substrate delivered parenterally are under debate.
Objective:
The main aim of this study was to assess parenteral nutrition in very and extremely immature preterm infants, i.e. very low birth weight (VLBW, birth weight <1500g) and extremely low birth weight (ELBW, birth weight <1000g) neonates, and to compare the amount of parenterally delivered substrate in our neonatal intensive care unit (NICU) to current German guidelines.
Methods:
Retrospective audit at our tertiary NICU at the University Children's Hospital of Saarland, Homburg, Germany between 1 January 2009 and 31 December 2010.
Results:
In total, 100 premature neonates were included. The mean gestational age was 29.6 weeks (range 24.4-34.1 weeks) and the mean birth weight was 1119 g ± 260 g (range 570 g-1490 g). Comparing the amount of fluids, glucose, amino acids, lipids and kcals with the current guidelines of the German Society for Nutritional Medicine in preterm infants, only glucose was adequately given; however, a substantial number of weight-dependent (more often in ELBW neonates) episodes of hyperglycemia requiring insulin treatment were also seen. During the first 3 weeks of life a substantial drop in body weight, length and head circumference occurred in our study cohort. In contrast, at 2 years corrected age, catch-up growth was seen in our cohort with anthropometric data now comparable to healthy term infants. Using the Bayley II test for developmental outcome assessment, at 2 years corrected age 78.6% (33/42) of infants demonstrated normal development.
Conclusions:
This retrospective data analysis demonstrated inadequate provision of parenteral nutrition in our NICU, which was often not in line with current German guidelines. This was associated with inadequate growth in our cohort, most notably during the first 3 weeks of life; however, implementation of current guidelines is impeded by metabolic disturbances in this cohort, most notably in ELBW neonates. Whether adherence to published guidelines will result in better early ex utero growth, and whether this normalized growth pattern will translate into better long-term outcome on a metabolic and neurological level, remains unclear.
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