The enigma to achieve normal postnatal growth in preterm infants - using parenteral or enteral nutrition?

• Published in: Acta Paediatrica Vol. 102; no. 5; pp. 471 - 479
• Main Authors: Christmann, V, Visser, R, Engelkes, M, de Grauw, AM, van Goudoever, JB, van Heijst, AFJ
• Format: Journal Article
• Language: English
• Published: Norway Blackwell Publishing Ltd 01.05.2013; Wiley Subscription Services, Inc
• Subjects: Amino acids; Amino Acids - administration & dosage; Child Development; Cohort Studies; Energy Intake; Enteral feeding; Enteral Nutrition; Female; Growth retardation; Human milk; Humans; Infant, Newborn; Infant, Premature - growth & development; Male; Parenteral Nutrition; Parenteral Nutrition Solutions; Preterm infant
• ISSN: 0803-5253; 1651-2227
• DOI: 10.1111/apa.12188

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; Cohort 2 received higher supplementation of parenteral amino acids and energy with more rapid enhancement of enteral feeding than Cohort 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 Cohort 1 (N: 68, GA: 29.5 ± 2.3 weeks, BW: 1261 ± 339 g). Both cohorts developed cumulative protein/energy deficits, but less in Cohort 2 (p < 0.01). Appropriate for gestational age infants (AGA) of Cohort 2 improved weight gain until week 5 (p < 0.01) compared to AGA of Cohort 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.