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Randomized Trial of Early Enhanced Parenteral Nutrition and Later Neurodevelopment in Preterm Infants
Erin E Morris1, Neely C Miller2, Nicholas A Marka3
1Department of Pediatrics, Division of Neonatology, University of Minnesota, Minneapolis, MN 55454, USA.
Insights
Enhanced early parenteral nutrition (PN) in preterm infants did not improve neurodevelopmental outcomes. However, higher first-week enteral intake of calories and protein was linked to faster processing speeds.
Area of Science:
- Neonatalogy
- Neurodevelopmental Pediatrics
- Nutritional Science
Background:
- Parenteral nutrition (PN) is crucial for preterm infants.
- Previous studies suggest early PN may improve neurodevelopment.
- Optimal PN composition for neurodevelopmental outcomes requires further investigation.
Purpose of the Study:
- To evaluate the impact of an enhanced parenteral nutrition protocol on neurodevelopmental outcomes in preterm infants.
- To compare developmental assessments at 4, 12, and 24 months corrected age (CA).
Main Methods:
- Randomized controlled trial involving 90 preterm infants (<32 weeks gestational age, <1500 g).
- Intervention group received enhanced PN (higher glucose and intralipids) versus standard PN in the first week.
- Neurodevelopmental assessment using pattern-reversal visually evoked potentials (VEP) and Bayley Scales of Infant Development (BSID).
Main Results:
- Longer P100 latency (slower processing speed) observed in the enhanced PN group (145 vs. 178 ms, p = 0.01), but this was not significant in multivariable analysis.
- No significant association found between enhanced PN and BSID scores at 12 or 24 months CA.
- Higher enteral energy and protein intake during the first week were independently associated with faster processing speed at 4 months CA.
Conclusions:
- Enhanced early parenteral nutrition in preterm infants was not associated with improved neurodevelopmental outcomes.
- Early enteral nutrition (calories and protein) appears to be a significant factor in promoting faster processing speed.
- Further research should focus on optimizing both parenteral and enteral nutrition strategies for preterm infants.
Abstract:
Retrospective studies indicate that the parenteral provision of calories, proteins, and lipids in the first week of life is associated with improved later neurodevelopment. We aimed to determine whether infants randomized to an enhanced parenteral nutrition protocol had improved developmental outcomes at 4, 12, or 24 months corrected age (CA). In total, 90 preterm infants (<32 weeks gestational age and <1500 g) were randomized to receive enhanced parenteral nutrition (PN) or standard PN during the first week of life. The enhanced group received a higher glucose infusion rate and intralipids. Neurodevelopmental outcomes included pattern-reversal visually evoked potentials (VEP) at 4 months CA (n = 33) and the Bayley Scales of Infant Development (BSID) at 12 (n = 46) and 24 (n = 29) months CA. P100 latency was longer in the intervention group, indicating slower processing speed (145 vs. 178 ms, p = 0.01). This association did not hold in multivariable analysis adjusting for potentially confounding variables. BSID scores were not associated with enhanced PN. Higher enteral energy and protein intake regardless of randomization group were associated with faster processing speed at 4 months CA (p ≤ 0.02 for both). Enhanced early PN was not associated with improved neurodevelopment; however, first-week enteral caloric and protein intake were associated with improved speed of processing.
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