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Neonatal intestinal failure: Growth pattern and nutrition intakes in accordance with weaning from parenteral
Paola Roggero1, Nadia Liotto1, Pasqua Piemontese1
1Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit, Milan, Italy.
Insights
Infants with intestinal failure showed similar growth whether weaned from parenteral nutrition (PN) or not. The Belza score and PN dependency index (PNDI%) predict successful weaning from PN.
Area of Science:
- Pediatrics
- Gastroenterology
- Nutrition Science
Background:
- Short bowel syndrome is a leading cause of intestinal failure (IF) in infants.
- Parenteral nutrition (PN) is a critical intervention for IF, but weaning is a key goal.
Purpose of the Study:
- To evaluate growth, nutritional intake, and identify predictors for weaning infants from PN.
- To compare outcomes between infants who were weaned from PN and those who continued PN.
Main Methods:
- A cohort of 23 infants with IF was studied.
- Growth parameters (weight/length z-scores) and nutritional intake were monitored.
- Logistic regression identified predictors of PN weaning, including the Belza score and PN dependency index (PNDI%).
Main Results:
- No significant differences in weight or length z-scores were observed between weaned and not-weaned infants.
- Weaned infants showed lower PN energy and protein intake after six months.
- Lower PN dependency index (PNDI%) and a higher Belza score at 6 months predicted successful weaning.
Conclusions:
- Infants with IF can achieve similar growth regardless of PN weaning status.
- The Belza score and PNDI% are clinically relevant predictors for successful PN weaning in infants.
Background:
Short bowel syndrome is the most common cause of intestinal failure (IF) in infants. We aimed to evaluate growth, nutrition intakes, and predictors of weaning from parenteral nutrition (PN) of infants with IF.
Methods:
Clinical parameters, nutrition intakes, body weight and length z-scores were compared monthly from the 1st to 12th and at 18 and 24 months among infants receiving PN and those weaned. Logistic regression analysis was conducted to explore the predictors of weaning.
Results:
We included 23 infants (10/23 weaned). Median [range: minimum; maximum] birth weight and gestational age were 1620 [590; 3490] g and 31 [24; 39] weeks, respectively. All infants showed growth retardation with similar median delta weight z-score from birth to discharge: -1.48 [-1.92; -0.94] in not-weaned and -1.18 [-2.70; 0.31] in weaned infants (P = 0.833) and a subsequent regain after the discharge: 0.20 [-3.47; 3.25] and 0.84 [-0.03; 2.58], respectively (P = 0.518). No differences in length z-score were found. After the sixth month, infants weaned from PN received lower PN energy and protein intakes compared with those not-weaned. Infants weaned from PN showed lower PN dependency index (PNDI%) from 5 months onward (45% for weaned and 113% for not-weaned infants at 5 months: P < 0.001). The Belza score, a predictor of enteral autonomy computed at 6 months, is associated with being weaned from PN within 24 months (odds ratio: 1.906; P = 0.039).
Conclusion:
Infants weaned and not-weaned showed similar growth patterns. Our findings support the clinical relevance of Belza score and PNDI% as predictors of weaning from PN.
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