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Nutrition during the early life cycle

Which birth weight threshold to start parenteral nutrition? A single center experience



To analyze the need for parenteral nutrition (PN) in infants with a birth weight (BW) between 1250 and 1499 g.


Retrospective evaluation of clinical, nutritional, growth and neurodevelopmental data of infants with a BW between 1250 and 1499 g consecutively admitted to our institution between 2004 and 2020.


Of the 503 infants admitted during the study period, 130 (26%) received PN: in 97 (19%) PN was medically indicated, while in 33 (7%) there was no clear indication. Patients who received medically indicated PN were younger, smaller, and sicker than the 373 infants who were managed with enteral nutrition, and their weight gain was lower (14.6 ± 4.1 vs 16.9 ± 4.2 g∙kg−1 ∙ d−1, p = 0.000). Body size at 36 weeks and 2-year anthropometry and neurodevelopment of the infants managed with enteral nutrition were not different from our reference values.


After lowering the BW threshold for bridging PN from 1500 to 1250 g, we found that PN was started in only 20% of infants with a BW between 1250 and 1500 g. Withholding PN if not medically indicated did not result neither in growth faltering nor in reduced neurodevelopment.

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Fig. 1: Distribution of PN need in infants with a BW between 1250 and 1499 g according to the predefined indications groups (IND).
Fig. 2: Growth and neurodevelopment of the EN infants with a BW between 1250 and 1499 g that were enterally fed in comparison with our regional reference data for anthropometry (36W and 2Y corrected age) and for neurodevelopment at 2Y corrected age.

Data availability

Additional data are available from the corresponding author on reasonable request.


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The authors are grateful to the infants’ parents and to the NICU nursing staff.

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Authors and Affiliations



Contribution of each author: VPC was responsible for the study design; CB conducted research, contributed to data collection and wrote the paper; EA, AMFG, RD and IB contributed to data collection; LA, MPB contributed to data collection and analysis; PEC and AC were in charge of the statistical analysis. All authors read and approved the final manuscript.

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Correspondence to Virgilio P. Carnielli.

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The authors declare no competing interests.

Ethical approval

This retrospective study was approved by the local ethics committee (Prot. N. 2017 0503 OR; Det. N. 145/DG) and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Specific national laws have been observed, too.

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Biagetti, C., Correani, A., Antognoli, L. et al. Which birth weight threshold to start parenteral nutrition? A single center experience. Eur J Clin Nutr 77, 474–480 (2023).

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