Background and aims We compared the effect of 3 parenteral nutrition (PN) regimens on the short-term growth of the preterm infant (PI).

Methods We randomised 220 PI with BW^-1.d-1[Non-Protein Energy NPE = 68 Kcal^.kg < sup-1.d-1]), HPSE (AA3.5, Glu 12¸ Fat 2.5 g^.kg^-1.d-1[NPE = 68 Kca^.kg^-1.d-1]) or HPHE (AA3.5, Glu 14, Fat 3.5 g^.kg^-1.d-1[NPE = 85 Kcal∙kg-1.d-1]). PN was started at 1 h of life and intakes were increased to reach targets on day 4. The primary outcome was weight gain from birth to 36 W PMA.

Results Birth demographics and anthropometry were similar between groups. Administered AA, Glu and Fat intakes were significantly different among groups by study design. Growth data are in the Table below. There were no significant differences in the major complications of prematurity, except for Sepses occurring from day 4 to 28: SPSE 12/72 (12%), HPSE 9/74 (12%), HPHE 23/74 (31%), p = 0.01.

SPSE (n = 72) HPSE (n = 74) HPHE (n = 74) pAge at nadir of body weight (days) 4.6 ± 2.3 4.1 ± 1.6 3.9 ± 1.5 0.07 Weight loss at nadir (% of BW) 12.5 ± 5.6 11.3 ± 4.7 11.8 ± 5.9 0.4 Time from Birth to the Regained BW (days) 12.3 ± 4.5 10.8 ± 4.3 10.7 ± 5.0 0.07 Weight Gain from birth to 36 W PMA (g∙kg-1?d-1) 15.6 ± 2.0 16.2 ± 2.3 15.7 ± 2.3 0.2

Conclusions Increasing AA Intake from 2.5 to 3.5 g·kg^-1·d^-1 with 68 or 85 Kcal^.kg^-1.d^-1 of NPE did not improve (statistically and biologically) short-term growth. HPHE Infants had a significantly higher rate of sepsis. The alleged benefits of enhancing AA-Energy during PN for the PI should be carefully balanced against the odd of increasing infections.