The Effect of Individualized Versus Standardized Parenteral Nutrition on Body Weight in Very Preterm Infants

Vincent H M Evering, Peter Andriessen, Carola E P M Duijsters, Jeroen Brogtrop, Luc J J Derijks, Vincent H M Evering, Peter Andriessen, Carola E P M Duijsters, Jeroen Brogtrop, Luc J J Derijks

Abstract

Background: This study was designed to evaluate whether standardizing total parenteral nutrition (TPN) is at least non-inferior to TPN with individualized composition in premature infants with a gestational age (GA) < 32 weeks.

Methods: In this retrospective cohort study, all preterm born in or transferred to Maxima Medical Center (MMC) within 24 hours after birth with a GA < 32 weeks were included. The individualized group (2011) was compared to the partially standardized group (2012) and completely standardized group (2014) consequently. The primary endpoint was difference in growth. Secondary endpoints included differences in electrolyte concentrations.

Results: A total of 299 preterm were included in this study. When comparing weight gain, the infants in the (partially) standardized group demonstrated significantly (P < 0.05) less weight loss during the first days of life and grew faster subsequently in the following days than the individualized TPN regimen. Furthermore, significant differences in abnormal serum sodium, chloride, calcium, creatinine, magnesium and triglycerides values were demonstrated.

Conclusion: TPN with a (partially) standardized composition revealed to be at least non-inferior to TPN with an individualized composition.

Keywords: Parenteral nutrition; Preterm infant; Weight gain.

Figures

Figure 1
Figure 1
Mean cumulative weight gain in the first 3 weeks of life. #Significant between ITPN versus PSTPN. †Significant between ITPN versus STPN. *Significant between PSTPN versus STPN. ITPN: individualized total parental nutrition; PSTPN: partially standardized total parental nutrition; STPN: standardized total parental nutrition.
Figure 2
Figure 2
Mean daily weight gain velocity in the first 3 weeks of life. #Significant between ITPN versus PSTPN. †Significant between ITPN versus STPN. *Significant between PSTPN versus STPN. ITPN: individualized total parental nutrition; PSTPN: partially standardized total parental nutrition; STPN: standardized total parental nutrition.

References

    1. Doublet J, Vialet R, Nicaise C, Loundou A, Martin C, Michel F. Achieving parenteral nutrition goals in the critically ill newborns: standardized better than individualized formulations? Minerva Pediatr. 2013;65(5):497–504.
    1. Lafeber HN, Zoeren-Grobben D van, Beek RHT van, Christmann V. Werkboek enterale en parenterale voeding van pasgeborenen. 3rd ed. Amsterdam: VU uitgeverij; 2012.
    1. Valentine CJ, Fernandez S, Rogers LK, Gulati P, Hayes J, Lore P, Puthoff T. et al. Early amino-acid administration improves preterm infant weight. J Perinatol. 2009;29(6):428–432. doi: 10.1038/jp.2009.51.
    1. Turpin RS, Canada T, Liu FX, Mercaldi CJ, Pontes-Arruda A, Wischmeyer P. Nutrition therapy cost analysis in the US: pre-mixed multi-chamber bag vs compounded parenteral nutrition. Appl Health Econ Health Policy. 2011;9(5):281–292. doi: 10.2165/11594980-000000000-00000.
    1. Iacobelli S, Bonsante F, Vintejoux A, Gouyon JB. Standardized parenteral nutrition in preterm infants: early impact on fluid and electrolyte balance. Neonatology. 2010;98(1):84–90. doi: 10.1159/000276979.
    1. Riskin A, Shiff Y, Shamir R. Parenteral nutrition in neonatology - to standardize or individualize? Isr Med Assoc J. 2006;8(9):641–645.
    1. Lafeber HN, Zoeren-Grobben D van, Beek RHT van, Gerards LJ. Werkboek enterale en parenterale voeding van pasgeborenen. 2nd ed. Amsterdam: VU uitgeverij; 2003.
    1. Anchieta LM, Xavier CC, Colosimo EA, Souza MF. Weight of preterm newborns during the first twelve weeks of life. Braz J Med Biol Res. 2003;36(6):761–770. doi: 10.1590/S0100-879X2003000600012.
    1. Smolkin T, Diab G, Shohat I, Jubran H, Blazer S, Rozen GS, Makhoul IR. Standardized versus individualized parenteral nutrition in very low birth weight infants: a comparative study. Neonatology. 2010;98(2):170–178. doi: 10.1159/000282174.
    1. Bertino E, Coscia A, Mombro M, Boni L, Rossetti G, Fabris C. et al. Postnatal weight increase and growth velocity of very low birthweight infants. Arch Dis Child Fetal Neonatology. 2006;91(5):349–356. doi: 10.1136/adc.2005.090993.
    1. Moyses HE, Johnson MJ, Leaf AA, Cornelius VR. Early parenteral nutrition and growth outcomes in preterm infants: a systematic review and meta-analysis. Am J Clin Nutr. 2013;97(4):816–826. doi: 10.3945/ajcn.112.042028.
    1. SmPC Numeta G13%E. Date of first approval 7 April 2011

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir