Intravenous nutrition of the very preterm neonate

Hypertriglyceridemia in extremely low birth weight infants receiving lipid emulsions

OBJECTIVE

To determine the prevalence of high TG levels in extremely low birth weight (ELBW) infants and what the risk factors are for high TG levels.

STUDY DESIGN

We performed a prospective observational study of triglyceride concentrations in extremely low birth weight infants receiving lipid infusions. Lipid infusions were begun at 0.5 grams/kg/day at age one day and the dose advanced by 0.5 grams/kg/day. Triglyceride concentrations were drawn when the dose reached 1 and 2 grams/kg/day. We compared infants with normal triglyceride levels (≤200 mg/dl) with those with elevated triglyceride levels (>200 mg/dl) with univariate and multivariate analysis.

RESULTS

There were 75 infants included in the analysis. Twenty (26.7% , 95% CI = 16.6-36.7%) had triglyceride levels >200 mg/dl. On multiple logistic regression analysis, lower birth weight was associated with the risk of an elevated triglyceride level. Triglyceride levels >200 mg/dl did not predict future mortality or morbidity.

CONCLUSION

Elevated TG levels occur commonly in ELBW infants and are associated with a lower birth weight.

Impact of standardized feeding guidelines on enteral nutrition administration, growth outcomes, metabolic bone disease, and cholestasis in the NICU

OBJECTIVES

The objectives of this study were to determine whether the implementation of standardized feeding guidelines (SFGs) in a neonatal intensive care unit had an impact on the administration of enteral nutrition, growth, and bone and liver health.

METHODS

This was a retrospective chart review of infants ≤ 32 weeks' gestation and ≤ 1500 g at birth who received enteral nutrition either via traditional care (TC) or via SFGs. The outcomes of the study were to determine the day of life the first enteral feedings were started, the day of life full, fortified enteral feedings were established, the day of life the infant returned to birth weight, the change in weight z score from birth to day of life 30, and the presence of metabolic bone disease and cholestasis.

RESULTS

There were 128 infants in the TC group and 125 infants in the SFG group. Based on the Cox regression, no significant differences were found between the 2 groups in the length of time to the first feed (P=0.110; CI 1.03-1.70), in the length of time to full, fortified enteral feedings (P=0.334; CI 0.87-1.44), in the length of time to return to birth weight (P=0.545; CI 0.77-1.28), incidence of metabolic bone disease (P=0.990), or incidence of cholestasis (P=0.926).

CONCLUSIONS

This study provides preliminary evidence that SFGs have an effect on enteral nutrition administration, growth, and morbidity for preterm infants. Although the findings were not statistically significant, they are clinically relevant.

Review of macronutrients in parenteral nutrition for neonatal intensive care population

Parenteral nutrition (PN) has become essential in the management of sick and growing newborn populations in the NICU. In the past few decades, PN has become fundamental in the nutritional management of the very low birth weight infant (<1,500 g).1 Although the components in PN are commonly determined and ordered by the physician or neonatal nurse practitioner provider, the NICU nurse is responsible for confirming the components in the daily PN prior to infusion and is responsible for maintaining the infusion of PN. Nurses should understand the nutritional components of PN as well as the indications, side effects, and infusion limitations of each component. The purpose of this article is to review the macronutrients in PN, including carbohydrates, protein, and fat. A subsequent article will review the micronutrients in PN, including electrolytes, minerals, and vitamins.