There have been a few systematic reviews of the effect of early administration of PN on growth outcomes. Moyses et al showed that early PN reduced the time to regain birthweight by (a mean) 2.2 days [95% confidence interval (CI) 1.1 to 3.2 days] in RCTs and 3.2 days (95% CI 2.0 to 4.4 days) in observational studies. The maximum percentage weight loss with early PN was lower by (a mean) 3.1% (95% CI 1.7% to 4.5%) for RCTs and by 3.5% (95% CI 2.6% to 4.3%) for observational studies. Early PN also improved weight at discharge or 36 weeks postmenstrual age by (a mean) 14.9 g (95% CI 5.3 to 24.5 g) in observational studies, but no benefit was shown for length or head circumference.(13)
Trivedi et al in their Cochrane review included 7 randomized …show more content…
The UK National Confidential Enquiry into the care of hospital patients receiving parenteral nutrition identified wide variation in clinical practice. They reported that good practice in relation to TPN was identified in only 24% of all cases reviewed with a significant proportion of ELBW babies not commenced on TPN in the first few days either because of a delay in identification of babies or delay in administration of TPN. (27) The reluctance to start TPN soon after birth can often be attributed to individual clinicians’ anxiety in the early introduction of TPN perhaps based on earlier studies which hinted at metabolic intolerance or acidosis in this group.However the current evidence supports a more “aggressive” approach to nutrition with early introduction of minimal enteral nutrition in combination with early use of PN. Concerns regarding this change in focus can be addressed through development of robust policies and education packages focusing on the early provision of adequate nutrition to the preterm infant.Tables 1 and 2 showshow the authors preferences for the use of TPN which are in part derived from the ESPAGHN and the East of England ODN Neonatal Network guidelines on parenteral nutrition. (7, …show more content…
Breastmilk reduces the risk of necrotizing enterocolitis, and late onset sepsis. However, unsupplemented mature human milk provides an insufficient quantity of protein to meet the requirements for growth and lean body mass accretion of very preterm infants.As discussed above, preterm infants will require a protein intake of 3.5-4g/kg/day to meet their nutritional requirements; over the first 12 weeks after delivery, the average protein content of breast milk slowly falls from 2.5g/100mls to less than 1.5g/100mls. (29)Supplementation of breast milk can be with either single component or multi component fortifiers.A Cochrane review of protein supplementation of human milk identified increases in short term weight gain, linear and head growth.(30) Commercially produced multicomponent fortifiers contain hydrolysed protein. However further research is required to determine the quality and quantity of protein to refine the formulations in view of the unique amino acid requirements of the premature
Trivedi et al in their Cochrane review included 7 randomized …show more content…
The UK National Confidential Enquiry into the care of hospital patients receiving parenteral nutrition identified wide variation in clinical practice. They reported that good practice in relation to TPN was identified in only 24% of all cases reviewed with a significant proportion of ELBW babies not commenced on TPN in the first few days either because of a delay in identification of babies or delay in administration of TPN. (27) The reluctance to start TPN soon after birth can often be attributed to individual clinicians’ anxiety in the early introduction of TPN perhaps based on earlier studies which hinted at metabolic intolerance or acidosis in this group.However the current evidence supports a more “aggressive” approach to nutrition with early introduction of minimal enteral nutrition in combination with early use of PN. Concerns regarding this change in focus can be addressed through development of robust policies and education packages focusing on the early provision of adequate nutrition to the preterm infant.Tables 1 and 2 showshow the authors preferences for the use of TPN which are in part derived from the ESPAGHN and the East of England ODN Neonatal Network guidelines on parenteral nutrition. (7, …show more content…
Breastmilk reduces the risk of necrotizing enterocolitis, and late onset sepsis. However, unsupplemented mature human milk provides an insufficient quantity of protein to meet the requirements for growth and lean body mass accretion of very preterm infants.As discussed above, preterm infants will require a protein intake of 3.5-4g/kg/day to meet their nutritional requirements; over the first 12 weeks after delivery, the average protein content of breast milk slowly falls from 2.5g/100mls to less than 1.5g/100mls. (29)Supplementation of breast milk can be with either single component or multi component fortifiers.A Cochrane review of protein supplementation of human milk identified increases in short term weight gain, linear and head growth.(30) Commercially produced multicomponent fortifiers contain hydrolysed protein. However further research is required to determine the quality and quantity of protein to refine the formulations in view of the unique amino acid requirements of the premature