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Nutrients 2018, 10(2), 170; https://doi.org/10.3390/nu10020170

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

1
Department of Clinical Nutrition and Dietetics, Cork University Maternity Hospital, T12 YE02 Cork, Ireland
2
Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, T12 DFK4 Cork, Ireland
3
Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, T12 Y337 Cork, Ireland
4
Pharmacy Department, Cork University Hospital, T12 YE02 Cork, Ireland
5
Department of Neonatology, Cork University Maternity Hospital, T12 YE02 Cork, Ireland
*
Author to whom correspondence should be addressed.
Received: 12 December 2017 / Revised: 12 January 2018 / Accepted: 30 January 2018 / Published: 2 February 2018
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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. View Full-Text
Keywords: standardized parenteral nutrition; transition phase; nutrient modeling; amino acids; enteral nutrition; preterm infants standardized parenteral nutrition; transition phase; nutrient modeling; amino acids; enteral nutrition; preterm infants
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Brennan, A.-M.; Kiely, M.E.; Fenton, S.; Murphy, B.P. Standardized Parenteral Nutrition for the Transition Phase in Preterm Infants: A Bag That Fits. Nutrients 2018, 10, 170.

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