A randomized controlled trial comparing an aggressive and a conventional parenteral nutrition regimen in very low birth weight infants

Article type: Research Article

Authors: Pappoe, Timothy A. | Wu, Shou-Yien^; | Pyati, Suma^;

Affiliations: Department of Neonatology, Memorial Hospital of Carbondale, Carbondale, IL, USA | Division of Neonatology, Department of Pediatrics, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA | Department of Pediatrics, Chicago Medical School at Rosalind Franklin University, Chicago, IL, USA

Note: [] Corresponding author: Dr. Timothy A. Pappoe, Memorial Hospital of Carbondale, 405 West Jackson St., Carbondale, IL 62902, USA. Tel.: +1 618 549 8464; Fax: +1 618 457 4735; E-mail: [email protected]

Abstract: Objective: To study the effect of aggressive versus conventional advancement of parenteral nutrition in very low birth weight (VLBW) infants. Methods: Forty-two infants weighing 600 to 1200 g were assigned to Study or Control groups. Study patients received 49 kcal/kg/d of non-protein energy (NPE), 2 g/kg/d of amino acids (AA) on D1, and advanced to 75–80 kcal/kg/d NPE, 3.5 g/kg/d of AA by D3. Control patients received 25 kcal/kg/d NPE, 1 g/kg/d AA on D1 with increase to 75–80 kcal/kg/d NPE, 3.5 g/kg/d AA by D6. Serum glucose, triglyceride and blood urea nitrogen (BUN) concentrations were monitored. Glucose intolerance in the study group was treated with an insulin infusion while the control group was treated by decreasing the glucose infusion. Primary outcomes were postnatal weight loss, weight gain in seven days, and days to regain birth weight. Result: Significantly less postnatal weight loss and greater weight gain in 7 days were observed in the Study group, patients weighing less than 801 g. These differences did not persist beyond the first week. There was an increased incidence of glucose intolerance in the study group. Hypertriglyceridemia was more frequent in Study group infants weighing < 1001 g. There was no difference in the incidence of azotemia among groups. Conclusion: Aggressive nutrition regimen improved weight gain in the first week of life for VLBW infants especially those weighing less than 801~g although there was no long-term weight benefit. There was an associated increased incidence of hyperglycemia and hypertriglyceridemia in the smallest babies.To study the effect of aggressive versus conventional advancement of parenteral nutrition in very low birth weight (VLBW) infants. Methods: Forty-two infants weighing 600 to 1200 g were assigned to Study or Control groups. Study patients received 49 kcal/kg/d of non-protein energy (NPE), 2 g/kg/d of amino acids (AA) on D1, and advanced to 75–80 kcal/kg/d NPE, 3.5 g/kg/d of AA by D3. Control patients received 25 kcal/kg/d NPE, 1 g/kg/d AA on D1 with increase to 75–80 kcal/kg/d NPE, 3.5 g/kg/d AA by D6. Serum glucose, triglyceride and blood urea nitrogen (BUN) concentrations were monitored. Glucose intolerance in the study group was treated with an insulin infusion while the control group was treated by decreasing the glucose infusion. Primary outcomes were postnatal weight loss, weight gain in seven days, and days to regain birth weight. Result: Significantly less postnatal weight loss and greater weight gain in 7 days were observed in the Study group, patients weighing less than 801 g. These differences did not persist beyond the first week. There was an increased incidence of glucose intolerance in the study group. Hypertriglyceridemia was more frequent in Study group infants weighing < 1001 g. There was no difference in the incidence of azotemia among groups. Conclusion: Aggressive nutrition regimen improved weight gain in the first week of life for VLBW infants especially those weighing less than 801 g although there was no long-term weight benefit. There was an associated increased incidence of hyperglycemia and hypertriglyceridemia in the smallest babies.

Keywords: Very low birth weight infants, aggressive parenteral nutrition, conventional parenteral nutrition, non-protein energy, glucose infusion rate

DOI: 10.3233/NPM-2009-0062

Journal: Journal of Neonatal-Perinatal Medicine, vol. 2, no. 3, pp. 149-156, 2009