Standardized Parenteral Nutrition for the Transition Phase in Preterm Infants: A Bag That Fits

Ann-Marie Brennan, Mairead E Kiely, Sarah Fenton, Brendan P Murphy, Ann-Marie Brennan, Mairead E Kiely, Sarah Fenton, Brendan P Murphy

Abstract

The optimal composition of standardized parenteral nutrition (SPN) is not yet known, contributing to nutrient deficit accrual and growth failure, with the period of parenteral nutrition weaning, i.e., transition (TN) phase, being identified as particularly vulnerable. We created a comprehensive nutrition database, representative of the nutritional course of a diverse range of preterm infants (n = 59, birth weight ≤ 1500 g, gestation < 34 weeks) by collecting hourly macronutrient intake data as part of a prospective, observational study over 19 months. Using a nutrient modeling technique for the TN phase, various amino acid (AA) concentrations of SPN were tested within the database, whilst acknowledging the nutritional contribution from enteral feeds until target AA intakes were consistently achieved. From the modeling, the AA composition of SPN was determined at 3.5 g/100 mL, which was the maximum to avoid exceeding target intakes at any point in the TN phase. However, in order to consistently achieve target AA intakes, additional nutritional strategies were required, which included increasing the exclusion of enteral feeds in fluid and nutrient calculations from <20 mL/kg/day to <40 mL/kg/day, and earlier fortification of breastmilk at 80 mL/kg/day. This data-driven nutrient modeling process supported the development of an improved SPN regimen for our preterm population in the TN phase.

Keywords: amino acids; enteral nutrition; nutrient modeling; preterm infants; standardized parenteral nutrition; transition phase.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of nutrient modeling steps. TN: transition; EFV: enteral feed volume; PN: parenteral nutrition; EN: enteral nutrition; AA: amino acid; SPN: standardized parenteral nutrition; BM: breastmilk. * PN recommendations [6]. ** EN recommendations [5].
Figure 2
Figure 2
Mean (SEM) modeled versus observed total (sum of parenteral and enteral) amino acid/protein intakes during the transition (TN) phase (previously defined as enteral feeds ≥ 20 and A); VLBW < 30 weeks (B) and VLBW ≥ 30 weeks (C) infants, compared with parenteral nutrition (PN) recommended intakes (RI) [6] during the PN-dominant TN phase (enteral feeds < 80 mL/kg/day; light grey banding), and enteral nutrition (EN) RI [5] during the EN-dominant TN phase (enteral feeds ≥ 80 mL/kg/day; dark grey banding).

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