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Delayed Macronutrients' Target Achievement in Parenteral Nutrition Reduces the Risk of Hyperglycemia in Preterm

Maria Di Chiara1, Gianluigi Laccetta1, Daniela Regoli1

  • 1Department of Maternal and Child Health, Policlinico Umberto I, Sapienza University, 00161 Rome, Italy.

Nutrients
|March 11, 2023
PubMed

Insights

Delaying parenteral nutrition (PN) macronutrient targets in very low birth weight (VLBW) newborns significantly reduced hyperglycemia. This approach also improved long-term body growth in VLBW infants.

Area of Science:

  • Neonatalogy
  • Pediatric Nutrition
  • Clinical Trials

Background:

  • Hyperglycemia (HG) is a significant risk factor for mortality and morbidity in very low birth weight (VLBW) neonates.
  • Early achievement of high parenteral nutrition (PN) intakes increases the risk of HG in VLBW infants.

Purpose of the Study:

  • To evaluate if delaying PN macronutrient target doses can reduce the incidence of hyperglycemia in VLBW neonates.
  • To assess the impact of delayed PN target achievement on long-term body growth in VLBW infants.

Main Methods:

  • A randomized controlled clinical trial involving 353 VLBW neonates.
  • Comparison of two PN protocols: early (energy within 4-5 days of life [DoL], amino acids within 3-4 DoL) versus late (energy within 10-12 DoL, amino acids within 5-7 DoL) target dose achievement.
  • Primary outcome: occurrence of HG during the first week of life. Secondary outcome: body growth at 12 months.

Main Results:

  • A significantly lower rate of HG was observed in the delayed achievement group (12.2%) compared to the early achievement group (30.7%; p = 0.003).
  • Significant improvements in body growth at 12 months were noted in the delayed group, including weight Z-score (0.22 vs. -0.86; p = 0.025) and length (0.55 vs. -1.29; p < 0.001).

Conclusions:

  • Delayed achievement of energy and amino acid targets via PN may effectively reduce the risk of hyperglycemia in VLBW neonates.
  • This strategy also appears to enhance long-term growth parameters in this vulnerable population.

Keywords:
EUGRVLBWamino acidsenergygrowthintakeneonates

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