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Does TPN provide adequate nutrition during the transitional phase in preterm infants?

Presented at the Neonatal Society 2001 Summer Meeting (programme).

Smith CM1, Coombs RC2, Eastell R1

1 Bone Metabolism Group, Division of Clinical Sciences, University of Sheffield, Sheffield, UK
Jessop Wing, Royal Hallamshire Hospital, Sheffield, UK.

Background: Nutrition during the transitional phase (TP) is likely to be an important determinant of weight change (Berry, 1997).

Aim: To investigate the relationship between weight loss and nutrition during TP.

Methods: 49 preterm infants were studied up to discharge. Bodyweight was assessed twice weekly. Daily nutritional intake was estimated using fluid charts.

Results: * denotes p<0.05, ** p<0.01. Median (range) gestational age (GA) and birth weight (BW) were 32 (25 to 35) weeks and 1.62 (0.79 to 2.57) kg respectively. 39 infants (79.6%) received parenteral nutrition. During TP there was a significant mean (SD) reduction of weight SDS of 0.85 (0.34), which was not regained thereafter. Energy and protein intakes were within the Tsang (1993) recommendations. However, there was a proportion of infants whose intakes did not meet the minimum requirements. Using backwards stepwise regression, 30.4%** change in weight SDS was predicted by GA and the time to full oral feeds. Other associations included energy:protein ratio (E:Pr), duration of TPN and use of caffeine (r = -0.33*, -0.47**, -0.27** respectively). Nutrient intakes were negatively associated with duration of parenteral nutrition, with the exception of E:Pr.

Conclusions: The use of PN is an independent contributor to reduction in weight SDS in the TP. The clinical goal of TPN during TP is to maintain homeostasis. However, this goal may be inadequate, since the reduction in weight SDS is not recovered. The use of caffeine may exacerbate weight loss. The clinical goal and nutrient content of transitional parenteral feeding regimens should be reassessed.

Berry MA et al 1997 Pediatrics. 100: 640-646

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