Article Text

EARLY AGGRESSIVE PARENTERAL NUTRITION FOR EXTREMELY LOW BIRTH WEIGHT INFANTS: ARE WE ACHIEVING WHAT WE SET OUT TO DO?
  1. D J O’Rourke1,
  2. R McCarthy1,
  3. A Twomey1
  1. 1Department of Neonatology, National Maternity Hospital, Holles Street, Dublin, Ireland

Abstract

Objective We have a policy of introducing PN with the aim of providing a minimum of 2 g/kg amino acids (AA) along with 30 non-nitrogen kilocalories/kg on D1 and 2.5 g/kg of AA along with 50 non-nitrogen kilocalories/kg on D2. The aim of our study was to assess compliance with this policy.

Methods 21 ELBW infants were included in this retrospective analysis during a 6 month period. Outborn infants were excluded. Data was collected on the nutritional support provided in the first week of life.

Results 8 of 21 (38%) infants started PN within the first 24 hours of life and all by 42 hours of age. Mean time of starting PN was 21 hours (range 1–42). Mean day of commencing minimal enteral feeds was day 3 (range 1–5). Mean AA intake on day 1 was 0.3 g/kg/d (0–1.25 g/kg/day) and 1.45 g/kg/day (range 0–2.5 g/kg/day) on day 2. Mean day when 2 g/kg/d of AA was achieved was day 3 (2–6). Mean non-nitrogen energy intake on day one was 28 kcals/kg/d (16–39 kcal/kg/day) and 43 kcals/kg/d (range 23–68 kcal/kg/day) on day 2. Factors which limited the ability to advance PN included tight adherence to fluid restriction policies and delay in initiating PN.

Conclusion Despite our policy of early aggressive parenteral nutrition, the majority of our infants remained in a protein catabolic state until D3 of life. Clearly the time to starting PN can be improved. Improving the amino acid concentration of the initial stock bag of PN would ensure better amino acid provision.

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