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Clinical nutrition

Central catheter removal timing and growth patterns in preterm infants

Abstract

Background

Early discontinuation of total parenteral nutrition (TPN) at 100 ml/kg/day of enteral feeds, compared with 140 ml/kg/day, led to significant delay in time to regain the birth weight in very low birth weight infants (birth weight < 1500 g, VLBW). Our aim was to compare the growth of infants in relation with timing of TPN discontinuation up to 2 years corrected gestational age (CGA).

Methods

Posttrial follow-up study using review of paper medical records. Participants of the randomized controlled trial studying effect of early parenteral nutrition discontinuation on time to regain birth weight in VLBW infants were included. Growth parameters inclusive of weight, length, and occipital-frontal circumference (OFC) were collected. Z-scores were calculated at five predefined time points—birth, 0–11 weeks CGA, 12–35 weeks CGA, 36–60 weeks CGA, and 61–96 weeks CGA and compared for control and intervention groups.

Results

Regarding weight, we found lower mean Z-score in the intervention group between 0 and 11 weeks CGA, with larger difference in extremely low birth weight infants (birth weight < 1000 g, ELBW), but this did not reach the statistical significance. Regarding length, the same difference, slightly delayed to 35 weeks CGA was observed and reached statistical significance for ELBW infants between 12 and 35 weeks CGA. There was no difference in OFC mean Z-scores at any timepoint.

Conclusions

The discontinuation of TPN at 100 ml/kg/day showed significantly lower Z-score for length in ELBW infants between 12 and 35 weeks CGA. There were no differences in Z-scores by 2 years CGA.

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Fig. 1: Patient flow diagram.
Fig. 2: Mean Z-scores weight.
Fig. 3: Mean Z-scores OFC and length.

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Acknowledgements

We would like to acknowledge the children involved in the POPS trial and their families. We would also like to thank the staff of the Coombe Woman and Infants University Hospital for their participation in this study.

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Contributions

JM and AD equally contributed to the conception and design of the study; AO’S, JS, and LP contributed to the design of the research; AB and JM contributed to the acquisition and analysis of the data. AD, AB, and JM contributed to the interpretation of the data and drafted the manuscript. All authors critically revised the manuscript, agree to be fully accountable for ensuring the integrity and accuracy of the work, and read and approved the final manuscript.

Corresponding author

Correspondence to A. Branagan.

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The authors declare that they have no conflict of interest.

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Branagan, A., Perrem, L., Semberova, J. et al. Central catheter removal timing and growth patterns in preterm infants. Eur J Clin Nutr 74, 1661–1667 (2020). https://doi.org/10.1038/s41430-020-0645-0

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