Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Nutrition during the early life cycle

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

European Journal of Clinical Nutrition volume 77, pages 474–480 (2023)Cite this article

Subjects

Abstract

Objectives

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

Methods

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.

Results

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.

Conclusions

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.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Get just this article for as long as you need it

$39.95

Learn more

Prices may be subject to local taxes which are calculated during checkout

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.

References

  1. Patel P, Bhatia J. Total parenteral nutrition for the very low birth weight infant. Semin Fetal Neonatal Med. 2017;22:2–7.

    Article  PubMed  Google Scholar 

  2. Carnielli VP, Correani A, Giretti I, Rita DAA, Bellagamba MP, Burattini I, et al. Practice of parenteral nutrition in preterm infants. World Rev Nutr Dietetics. 2021;122:198–211.

    Article  Google Scholar 

  3. van Goudoever JB, Carnielli V, Darmaun D, Sainz de Pipaon M, nutrition EEECwgopp. ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Amino acids. Clin Nutr. 2018;37:2315–23.

    Article  PubMed  Google Scholar 

  4. Lapillonne A, Carnielli VP, Embleton ND, Mihatsch W. Quality of newborn care: adherence to guidelines for parenteral nutrition in preterm infants in four European countries. BMJ Open. 2013;3:e003478.

    Article  PubMed  PubMed Central  Google Scholar 

  5. American Dietetic Association. Nutrition Care Manual ®. Available from: http://www.nutritioncaremanual.org.

  6. Ehrenkranz RA, Dusick AM, Vohr BR, Wright LL, Wrage LA, Poole WK. Growth in the neonatal intensive care unit influences neurodevelopmental and growth outcomes of extremely low birth weight infants. Pediatrics. 2006;117:1253–61.

    Article  PubMed  Google Scholar 

  7. Greenbury SF, Angelini ED, Ougham K, Battersby C, Gale C, Uthaya S, et al. Birthweight and patterns of postnatal weight gain in very and extremely preterm babies in England and Wales, 2008–19: a cohort study. Lancet Child Adolesc Health. 2021;5:719–28.

    Article  PubMed  Google Scholar 

  8. Bayley N, Infant S. Bayley scales of infant and toddler development–Third Edition: Technical manual. 2006.

  9. Bertino E, Di Nicola P, Varalda A, Occhi L, Giuliani F, Coscia A. Neonatal growth charts. J Matern Fetal Neonatal Med. 2012;25:67–9.

    Article  PubMed  Google Scholar 

  10. Biagetti C, Correani A, D'Ascenzo R, Bellagamba MP, Marchionni P, Antognoli L, et al. Does intravenous fish oil affect the growth of extremely low birth weight preterm infants on parenteral nutrition?. Clin Nutr. 2019;38:2319–24. https://doi.org/10.1016/j.clnu.2018.10.009.

    Article  CAS  PubMed  Google Scholar 

  11. Stoll BJ, Hansen NI, Bell EF, Walsh MC, Carlo WA, Shankaran S, et al. Trends in care practices, morbidity, and mortality of extremely preterm neonates, 1993–2012. JAMA: J Am Med Assoc. 2015;314:1039–51.

    Article  CAS  Google Scholar 

  12. Sweet DG, Carnielli V, Greisen G, Hallman M, Ozek E, Te Pas A, et al. European consensus guidelines on the management of respiratory distress syndrome - 2019 Update. Neonatology. 2019;115:432–50.

    Article  PubMed  Google Scholar 

  13. Ancel PY, Goffinet F, Kuhn P, Langer B, Matis J, Hernandorena X, et al. Survival and morbidity of preterm children born at 22 through 34 weeks’ gestation in France in 2011: results of the EPIPAGE-2 cohort study. JAMA Pediatrics. 2015;169:230–8.

    Article  PubMed  Google Scholar 

  14. Santhakumaran S, Statnikov Y, Gray D, Battersby C, Ashby D, Modi N. Survival of very preterm infants admitted to neonatal care in England 2008–2014: time trends and regional variation. Arch Dis Child Fetal Neonatal Ed. 2018;103:F208–f15.

    Article  PubMed  Google Scholar 

  15. Morgan J, Young L, McGuire W. Delayed introduction of progressive enteral feeds to prevent necrotising enterocolitis in very low birth weight infants. Cochrane Database Syst Rev. 2014;2014:Cd001970.

    PubMed  PubMed Central  Google Scholar 

  16. Bozzetti V, Martin CR. The practice of enteral nutrition in very low and extremely low birth weight infants. World Rev Nutr Dietetics. 2021;122:265–80.

    Article  Google Scholar 

  17. Oddie SJ, Young L, McGuire W. Slow advancement of enteral feed volumes to prevent necrotising enterocolitis in very low birth weight infants. Cochrane Database Syst Rev. 2017;8:Cd001241.

    PubMed  Google Scholar 

  18. Abiramalatha T, Thanigainathan S, Ninan B. Routine monitoring of gastric residual for prevention of necrotising enterocolitis in preterm infants. Cochrane Database Syst Rev. 2019;7:Cd012937.

    PubMed  Google Scholar 

  19. Fanaro S. Feeding intolerance in the preterm infant. Early Hum Dev. 2013;89:S13–20.

    Article  PubMed  Google Scholar 

  20. Li YF, Lin HC, Torrazza RM, Parker L, Talaga E, Neu J. Gastric residual evaluation in preterm neonates: a useful monitoring technique or a hindrance? Pediatrics Neonatol. 2014;55:335–40.

    Article  Google Scholar 

  21. Lucchini R, Bizzarri B, Giampietro S, De Curtis M. Feeding intolerance in preterm infants. How to understand the warning signs. J Matern Fetal Neonatal Med. 2011;24:72–4.

    Article  PubMed  Google Scholar 

  22. Pierrat V, Marchand-Martin L, Arnaud C, Kaminski M, Resche-Rigon M, Lebeaux C, et al. Neurodevelopmental outcome at 2 years for preterm children born at 22 to 34 weeks’ gestation in France in 2011: EPIPAGE-2 cohort study. Bmj. 2017;358:j3448.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Wood NS, Marlow N, Costeloe K, Gibson AT, Wilkinson AR. Neurologic and developmental disability after extremely preterm birth. EPICure Study Group. N Engl J Med. 2000;343:378–84.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

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

Author information

Authors and Affiliations

  1. Division of Neonatology, Polytechnic University of Marche, Salesi Children’s Hospital, Via Corridoni 11, 60123, Ancona, Italy

    Chiara Biagetti, Alessio Correani, Luca Antognoli, Ilaria Burattini, Rita D’Ascenzo, Maria Paola Bellagamba, Emanuela Andresciani, Angela Maria Felicita Garzone & Virgilio P. Carnielli

  2. Department of Medicine, University Hospital S Maria della Misericordia, University of Udine, Piazzale Kolbe 3, 33100, Udine, Italy

    Paola Cogo

Authors
  1. Chiara Biagetti
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alessio Correani
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Luca Antognoli
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ilaria Burattini
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Rita D’Ascenzo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Maria Paola Bellagamba
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Emanuela Andresciani
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Angela Maria Felicita Garzone
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Paola Cogo
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Virgilio P. Carnielli
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

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.

Corresponding author

Correspondence to Virgilio P. Carnielli.

Ethics declarations

Competing interests

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.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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). https://doi.org/10.1038/s41430-022-01257-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41430-022-01257-5

Search

Advanced search

Quick links