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Parenteral nutrition compared with transpyloric feeding
Archives of Disease in Childhood
|February 1, 1984
Summary
For premature infants under 1500g, initial total parenteral nutrition (TPN) showed no growth benefits over transpyloric feeding. TPN increased infection risk, while transpyloric feeding had higher necrotizing enterocolitis rates.
Area of Science:
- Neonatal Nutrition
- Pediatric Gastroenterology
- Intensive Care Medicine
Background:
- Premature infants with low birthweight (<1500g) require specialized nutritional support.
- Enteral feeding is preferred, but challenges exist in establishing adequate intake.
- Total parenteral nutrition (TPN) offers an alternative but carries potential risks.
Purpose of the Study:
- To compare the efficacy and safety of initial total parenteral nutrition versus transpyloric feeding in infants with birthweight less than 1500 g.
- To assess outcomes including mortality, growth, and incidence of specific morbidities.
Main Methods:
- A randomized controlled trial involving 59 infants with birthweight <1500 g.
- Infants were alternately allocated to receive either initial TPN or transpyloric feeding.
- Outcomes measured included mortality, growth parameters, ability to establish enteral nutrition, and incidence of acquired bacterial infection, conjugated hyperbilirubinaemia, and necrotising enterocolitis.
Main Results:
- Mortality rates were similar between the TPN and transpyloric feeding groups.
- Ten of 29 infants (34.5%) in the transpyloric group failed to achieve full enteral nutrition within the first week.
- No significant growth benefits were observed with TPN. Acquired bacterial infections were more frequent in the TPN group, associated with increased morbidity and mortality. Conjugated hyperbilirubinaemia occurred exclusively in the TPN group. Necrotising enterocolitis was more common in the transpyloric group.
Conclusions:
- Initial TPN does not provide appreciable benefits for growth in very low birthweight infants compared to transpyloric feeding.
- TPN is associated with a higher risk of complications, including acquired bacterial infections and conjugated hyperbilirubinaemia.
- Transpyloric feeding, despite a higher incidence of necrotising enterocolitis, may be preferable when feasible. TPN should be reserved for cases where enteral feeding is impossible.
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