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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.


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

    Article  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  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  Google Scholar 

  5. American Dietetic Association. Nutrition Care Manual ®. Available from:

  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  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  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  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.

    Article  CAS  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  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  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  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.

    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.

    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.

    Google Scholar 

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

    Article  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  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  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  Google Scholar 

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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 (2023).

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