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The enigma to achieve normal postnatal growth in preterm infants – using parenteral or enteral nutrition?
Author(s) -
Christmann V,
Visser R,
Engelkes M,
Grauw AM,
Goudoever JB,
Heijst AFJ
Publication year - 2013
Publication title -
acta paediatrica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.772
H-Index - 115
eISSN - 1651-2227
pISSN - 0803-5253
DOI - 10.1111/apa.12188
Subject(s) - medicine , parenteral nutrition , enteral administration , gestational age , cohort , birth weight , pediatrics , head circumference , weight gain , gastroenterology , body weight , pregnancy , biology , genetics
Aim To evaluate whether increasing the amount of amino acids and energy in parenteral nutrition combined with rapid increment of enteral feeding improves postnatal growth in preterm infants. Methods Observational study; two consecutive year‐cohorts of preterm infants; C ohort 2 received higher supplementation of parenteral amino acids and energy with more rapid enhancement of enteral feeding than C ohort 1. Nutritional intake, weight and head circumference ( HC ) were compared. Results Cohort 2 [ N : 79, gestational age ( GA ): 29.8 ± 2.2 weeks, birth weight ( BW ): 1248 ± 371 g] achieved full enteral feeds earlier (p < 0.001) and had a higher protein/energy intake during the first week (p < 0.001) than C ohort 1 ( N : 68, GA : 29.5 ± 2.3 weeks, BW : 1261 ± 339 g). Both cohorts developed cumulative protein/energy deficits, but less in C ohort 2 (p < 0.01). Appropriate for gestational age infants ( AGA ) of C ohort 2 improved weight gain until week 5 (p < 0.01) compared to AGA of C ohort 1, nevertheless all infants demonstrated a decline in mean standard deviation score (>1) for weight at term. Small for GA infants failed to improve HC . Conclusion Improved parenteral intake may lead to improved short‐term postnatal weight gain. Faster increase of enteral nutrition was well tolerated but failed to prevent nutritional deficits. Practising early enteral feeding with higher supplementation of nutrients may be needed and requires further study.