Early Aggressive Total Parenteral Nutrition to Premature Infants in Neonatal Intensive Care Unit

Kae Shih Law, Lee Gaik Chan
7.013 6.751

Abstract


Introduction: Iatrogenic intrauterine growth restriction in NICU has been a prevailing problem in these days when smaller babies are being salvaged. Early aggressive TPN is defined when total of 4g/kg/day of amino acid is administrated via standardized TPN to neonates over first week of life. Our main objective of the study is to evaluate the efficacy, safety and tolerability of early aggressive standardized TPN to infants. We also explore the impact of early and high dose of amino acid with hypophosphatemia in extreme low birth weight (ELBW) infants, growth velocity in infants with TPN therapy and TPN cost when the hang time is extended from 24 hours to 48 hours. Methods: This is a prospective study on premature infants in NICU, Sarawak General Hospital for 6 months. Demographics and anthropometric data of eligible infants were collected. Biochemical test, growth velocity and cost of TPN therapy were analysed. Results: There are 69 eligible infants recruited. Serum electrolytes of all infants were found to be within normal range throughout TPN therapy except serum phosphate concentration. We found that incidence of hypophosphatemia is high with high amino acid supply in ELBW infants. There is a negative correlation (-0.26) between serum urea concentration and birth weight. Targeted growth velocity is achieved with standardized TPN and ELBW premature infants were found to have highest weight growth velocity. By extending TPN hang time to 48 hours, TPN related cost is associated with minimizing and resulted in yearly savings of RM 62556.60, exclusive of labour cost and nursing cost. Conclusion: Early aggressive PN therapy is safe and it achieved goal of postnatal growth velocity and body composition in premature infants. This study also demonstrated that the current practice of extending hang time is financially beneficial to hospital.


Keywords


Preterm infants, low birth weight infants, aggressive PN therapy, electrolytes, serum phosphate concentration, urea, growth velocity, hang time, TPN related cost

Full Text:

e242


DOI: http://dx.doi.org/10.17334/jps.14027

References


Moyses HE, Johnson MJ, Leaf AA, Cornelius VR. Early parenteral nutrition and growth outcomes in preterm infants: a systematic review and meta-analysis. Am J ClinNutr; 2013; 97(4):816- 2.

Usmani SS, Cavaliere T, Casatelli J, Harper RG. Plasma ammonia levels in very low birth weight preterm infants. The Journal of pediatrics; 1993; 123:797-800. 3.

Christmann V, Visser R, Engelkes M, de Grauw A, van Goudoever J, van Heijst A. The enigma to achieve normal postnatal growth in preterm infants - using parenteral or enteral nutrition? ActaPaediatr; 2013; 102(5):471-9. 4.

Guidelines on paediatric parenteral nutrition society of gastroenterology, hepatology

(ESPGHAN). J PediatrGastroenterolNutr; 2005; 41 (2):81-84. 5. of and

nutrition Koletzko B, Goulet O, Hunt J, Krohn K, Shamir R. Guidelines on paediatric parenteral nutrition of the european society of paediatric gastroenterology,

(ESPGHAN) and the european society for clinical nutrition and metabolism (ESPEN), Supported by the european society of paediatric research (ESPR). Journal of pediatric gastroenterology and nutrition; 2005; 41(2):S1-87. 6. and

nutrition Kleinman RE. AAP. Pediatric Nutrition Handbook. 2009; 6th Ed. 7.

De Onis M, Blossner M. The world health organization global database on child growth and malnutrition: methodology and applications. Int J Epidemiol; 2003; 32 (4): 518-26. 8.

Emily Z, Kristin K, Melanie NAL. Weight gain velocity in very low-birth-weight infants: effects of exposure to biological maternal sounds. American journal perinatology; 2012; 0735-1631 9.

Ridout E, Melara D, Rottinghaus S, Thureen PJ. Blood urea nitrogen concentration as a marker of amino-acid intolerance in neonates with birthweight less than 1250g. J Perinatol; 2005; 25:130–133 10.

Early amino acids and the metabolic response of ELBW infants (1000g) in three time periods. J Perinatol; 2009; 29:433–437. 11.

urea nitrogen concentrations in low-birth-weight preterm infants during parenteral and enteral nutrition. J Pediatr Gastroenterol Nutr; 2010; 51:213– 215. 12.

of IV fat in neonates. Nutr Clin Pract; 2006; 21; 4374-380. 13. gastroenterology,

(ESPGHAN). Journal of Pediatric Gastroenterology and Nutrition; 2005; 41: S19–S27. 14.

DS, Dutton EB, Carrillo DW. Influence of intravenous fat emulsion on serum bilirubin in very low birthweight neonates; Arch Dis Child; 1987; 62(2):156-60. 15.

and Robert EK. Calculating postnatal growth velocity in very low birth weight (VLBW) premature infants. J Perinatol; 2009; 29(9): 618–622. 16.

parenteral nutrition in preterm infants. S Afr J Clin Nutr; 2011; 24(3): S27-S31 17.

organization global database on child growth and malnutrition: methodology and applications. Int J Epidemiol; 2003; 32 (4): 518-26. 18.

babies: babson and benda's chart. BMC Pediatrics; 2003; 10:3-13. 19.

W, Lisa AW, Kenneth WP. Growth in the neonatal intensive care unit influences neurodevelopmental and growth outcomes of extremely low birth weight infants. Pediatrics; 2006; 117;1253-1261 20.

Wattimena DJ, Huijmans JG, van Goudoever JB. Amino acid administration to premature infants directly after birth. J Pediatr; 2005; 147: 457–461. 21.

Rigo, Claudio DF, Pierre YR, Jean BG. Initial amino acid intake influences phosphorus and calcium homeostasis in preterm infants – it is time to change the composition of the early parenteral nutrition. PLOS ONE; 2013;8(8)

Mizumoto H, Mikami M, Oda H, Hata D. Refeeding syndrome in a small-for-dates micro- preemie receiving early parenteral nutrition. Pediatr Int. 2012; 54: 715-717.

Kiran KBV, Mohammad IA, Kaye S, Nadia B. Extending total parenteral nutrition hang time in the neonatal intensive care unit: is it safe and cost effective? Journal of Paediatrics and Child Health. 2013; 49: E57–E61