Clinical endpoints in premature infants with different regimens of weaning total parenteral nutrition

BACKGROUND: Nutrition of premature newborns, especially very low birth weight (VLBW) infants in early periods of life is provided by total parenteral nutrition (TPN) support. There have been an increasing number of studies in recent years about the starting time, how to begin and how to increase TPN dose and, commonly accepted recommendations were generated. There is no clear study data or author recommendations concerning any regimen about weaning TPN and passing to full enteral nutrition. OBJECTIVE: A new weaning regimen from TPN was compared with the older one in premature infants of lower than 32 weeks gestational age. The nutrition protocols were prepared to fully provide the necessary levels of protein, lipid and energy needs in those infants in the stage of weaning TPN. Biochemical parameters, growth measurements, prematurity disorders, hospitalization durations and extrauterine growth retardation were compared between groups clinical endpoints. MATERIAL AND METHODS: 50 premature newborn born at ?32 weeks gestational age and followed in our neonatal intensive care unit between May 2012 and May 2013 were included. The older protocol was given to the newborns for first 6 months and the newer protocol was given in the 2nd 6 month period of time. Data of demographics, major morbidities, treatments given, laboratory results, detailed anthropometric measurements and nutrition protocol given were recorded. Substraction of z-scores at the date of hospital discharge and delivery, and growth velocities determined at hospital discharge were calculated. RESULTS: Initial anthropometric evalaution of the 50 premature newborns showed SGA rates were 12% (n=3) and 8% (n=2) in control and study groups, respectively. There were no difference between maternal, perinatal and clinical features among groups. Mean birth weigth (BW), BW percentile and BW z-score, birth length (BL), BL percentile and BL z-score, head circumference (HC), HC percentile and HC z-score were similar among groups. But reached body weight (BW) z score and BW percentile found at antropometric measurements performed at hospital discharge were statistically different in study group (p_0,03 and p=0,02, respectively). Time period of reaching birth weight, growth velocities calculated at 36th week and hospital discharge and changes in z-scores were similar in both groups. EUGR was found higher in control group at a statistical significant level (p=0.009). Nutritional features found with measurement as starting day of enteral nutrition, beginning day of full enteral nutrition and number of days of enteral nutrition were not diiferent among groups. There were no differences between total protein, lipid and caloric amounts provided at postnatal first week among both group. But those amounts were found higher in study group at the first week of increasing enteral nutrition and weaning TPN at statistically significant levels (p<0.001, p<0.001 and p<0.001, respectively). These statistically significant differences in daily total protein, lipid and caloric intake amounts were found to be continued at this period of time (p<0.001, p<0.001 and p<0.001, respectively). Daily and weekly calculated protein and caloric intakes were similarly higher in study group in the first 2 weeks time of weaning TPN. Mean protein intake was found as 2.5 g/kg/day in control and 3.6 g/kg/day in study groups. Differences between daily and weekly protein intakes were statistically significant at the 3rd week of weaning TPN (p=0.00). Routine biochemistry results and complete blood count levels were similar at the first postnatal week. But BUN and total protein levels were higher in study group at 4th postnatal week at statistically significant levels. CONCLUSIONS: Two different weaning TPN regimens were given to newborns with ?32 weeks of gestational age with similar maternal and perinatal fetaures. The new regimen which is targeting a fixed rate of stable intake of protein, lipid and calorie provided a higher BW percentile and z-score and, EUGR rates were significantly decreased. This new regimen did not increase the morbidities, caused a better profile of anthropometric meaasurements and biochemical results, and might support a better nurodevelopment in VLBW infants. KEYWORDS: Preterm infant; nutrition