Early parenteral nutrition and growth outcomes in preterm infants: a systematic review and meta-analysis1234

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ABSTRACT

Background:

The achievement of adequate nutritional intakes in preterm infants is challenging and may explain the poor growth often seen in this group. The use of early parenteral nutrition (PN) is one potential strategy to address this problem, although the benefits and harms are unknown.

Objective:

We determined whether earlier administration of PN benefits growth outcomes in preterm infants.

Design:

We conducted a systematic review of randomized controlled trials (RCTs) and observational studies.

Results:

Eight RCTs and 13 observational studies met the inclusion criteria (n = 553 and 1796 infants). The meta-analysis was limited by disparate growth-outcome measures. An assessment of bias was difficult because of inadequate reporting. Results are given as mean differences (95% CIs). Early PN reduced the time to regain birth weight by 2.2 d (1.1, 3.2 d) for RCTs and 3.2 d (2.0, 4.4 d) in observational studies. The maximum percentage weight loss with early PN was lower by 3.1 percentage points (1.7, 4.5 percentage points) for RCTs and by 3.5 percentage points (2.6, 4.3 percentage points) for observational studies. Early PN improved weight at discharge or 36 wk postmenstrual age by 14.9 g (5.3, 24.5 g) (observational studies only), but no benefit was shown for length or head circumference. There was no evidence that early PN significantly affects risk of mortality, necrotizing enterocolitis, sepsis, chronic lung disease, intraventricular hemorrhage, or cholestasis.

Conclusions:

The results of this review, although subject to some limitations, show that early PN provides a benefit for some short-term growth outcomes. No evidence that early PN increases morbidity or mortality was found. Neonatal research would benefit from the development of a set of core growth outcome measures.

Cited by (0)

1

From the National Institute for Health Research (NIHR) Southampton Biomedical Research Centre (HEM, MJJ, and AAL) and the NIHR Southampton Respiratory Biomedical Research Unit (HEM), University of Southampton and University Hospital Southampton National Health Service (NHS) Foundation Trust, Southampton, United Kingdom; the Department of Neonatal Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom (MJJ and AAL); and the Department of Primary Care and Public Health Sciences, Kings College, London, United Kingdom (VRC).

2

HEM and MJJ contributed equally to this work and are joint first authors.

3

Supported by the NIHR Southampton Nutrition, Diet and Lifestyle Biomedical Research Unit (HEM, MJJ, AAL, and VRC); the NIHR Southampton Respiratory Biomedical Research Unit (HEM and VRC); and the NIHR Southampton Biomedical Research Centre (HEM, MJJ, and AAL).

4

Address correspondence to HE Moyses, Biomedical Research Unit, University Hospital Southampton National Health Service Foundation Trust, Mailpoint 218, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, United Kingdom. E-mail: [email protected].

5

Abbreviations used: CLD, chronic lung disease; IVH, intraventricular hemorrhage; NEC, necrotizing enterocolitis; PMA, postmenstrual age; PN, parenteral nutrition; RCT, randomized controlled trial.