Weight growth velocity in low birth weight neonates receiving parenteral nutrition in the Neonatal Intensive Care Unit, Kandou General Hospital, Manado 2022: a retrospective observational study
Abstract
Neonates with low birth weight (LBW) have a higher risk of growth failure. To optimize their growth to target of 15-20 g/kg/d, neonates must receive adequate nutrition. Parenteral nutrition implementation is one of the approaches to provide adequate energy and nutrition to LBW neonates who can not tolerate enteral feeding. This study aims to investigate growth velocity in LBW neonates receiving parenteral nutrition in hospital settings and observe if the target growth velocity was achieved, also describes current parenteral nutrition practices in tertiary hospital settings. A retrospective observational study was conducted in the Neonatal Intensive Care Unit (NICU), Kandou General Hospital, Manado. Sample in this study were neonates with birth weight <2500 g and received only parenteral nutrition for minimum 7 d. Daily weight measurement data was collected through medical records and parenteral nutrition regimens was collected through electronic prescriptions in the Pharmacy Department. Growth velocity was assessed using two parameters, gain weight velocity and change in weight for age Z-scores (WAZ). A total of 73 neonates were used as samples. The results demonstrated that only the extremely low birth weight (ELBW) group achieved the growth velocity recommendation during parenteral nutrition, 16.17 g/kg/d. All the neonates had a negative change of weight Z-scores indicated a declining growth rate during parenteral nutrition administration. We also found lipid emulsion initiation time was later and relatively low energy intake in parenteral nutrition compared to the recommendation. Vitamin as micronutrient was not yet added in parenteral nutrition regimens. Therefore, we suggest starting lipid emulsion from the first day of parenteral nutrition and add vitamin to parenteral nutrition regimen to optimize nutrient intake in order to improve growth velocity in LBW neonates during NICU stay.
References
WHO. Global nutrition targets 2025 : low birth weight brief. World Health Organization. 2014;
Kemenkes. 2018. Laporan Nasional RISKESDAS 2018. Jakarta: Kementerian Kesehatan RI; 2019.
Sartika AN, Khoirunnisa M, Meiyetriani E, Ermayani E, Pramesthi IL, Nur Ananda AJ. Prenatal and postnatal determinants of stunting at age 0-11 months: A cross-sectional study in Indonesia. PLoS One 2021; 16(7):e0254662.
https://doi.org/10.1371/journal.pone.0254662
Risnes KR, Vatten LJ, Baker JL, Jameson K, Sovio U, Kajantie E, et al. Birthweight and mortality in adulthood: a systematic review and meta-analysis. Int J Epidemiol 2011; 40(3):647-61.
https://doi.org/10.1093/ije/dyq267
Mustapha M, Wilson KA, Barr S. Optimising nutrition of preterm and term infants in the neonatal intensive care unit. Paediatr Child Health 2021; 31(1):38-45.
https://doi.org/10.1016/j.paed.2020.10.008
Riskin A, Hartman C, Shamir R. Parenteral nutrition in very low birth weight preterm infants. Isr Med Assoc J 2015; 17(5):310-5.
Rizzo V, Capozza M, Panza R, Laforgia N, Baldassarre ME. Macronutrients and micronutrients in parenteral nutrition for preterm newborns: A narrative review. Nutrients 2022; 14(7):1530.
https://doi.org/10.3390/nu14071530
Bronsky J, Campoy C, Braegger C. ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Vitamins. Clin Nutr 2018; 37(6 Pt B):2366-78.
https://doi.org/10.1016/j.clnu.2018.06.951
Mihatsch W, Fewtrell M, Goulet O, Molgaard C, Picaud JC, Senterre T. ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Calcium, phosphorus and magnesium. Clin Nutr 2018; 37(6 Pt B):2360-5.
https://doi.org/10.1016/j.clnu.2018.06.950
Jochum F, Moltu SJ, Senterre T, Nomayo A, Goulet O, Iacobelli S, et al. ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Fluid and electrolytes. Clin Nutr 2018; 37(6 Pt B):2344-53.
https://doi.org/10.1016/j.clnu.2018.06.948
Roggero P, Giannì ML, Orsi A, Amato O, Piemontese P, Liotto N, et al. Implementation of nutritional strategies decreases postnatal growth restriction in preterm infants. PLoS One 2012; 7(12):e51166.
https://doi.org/10.1371/journal.pone.0051166
Pereira-da-Silva L, Virella D, Fusch C. Nutritional assessment in preterm infants: a practical approach in the NICU. Nutrients 2019; 11(9):1999.
https://doi.org/10.3390/nu11091999
Fenton TR, Anderson D, Groh-Wargo S, Hoyos A, Ehrenkranz RA, Senterre T. An attempt to standardize the calculation of growth velocity of preterm infants—evaluation of practical bedside methods. J Pediatr 2018; 196:77-83.
https://doi.org/10.1016/j.jpeds.2017.10.005
Tai D, Dick P, To T, Wright JG. Development of pediatric comorbidity prediction model. Arch Pediatr Adolesc Med 2006; 160(3):293-9.
https://doi.org/10.1001/archpedi.160.3.293
Torres-Espíndola LM, Demetrio-Ríos J, Carmona-Aparicio L, Galván-Díaz C, Pérez-García M, Chávez-Pacheco JL, et al. Comorbidity index as a predictor of mortality in pediatric patients with solid tumors. Front Pediatr 2019; 7:48.
https://doi.org/10.3389/fped.2019.00048
Patel AL, Engstrom JL, Meier PP, Jegier BJ, Kimura RE. Calculating postnatal growth velocity in very low birth weight (VLBW) premature infants. J Perinatol 2009; 29(9):618-22.
https://doi.org/10.1038/jp.2009.55
Fenton TR, Kim JH. A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants. BMC Pediatr 2013; 13:59.
https://doi.org/10.1186/1471-2431-13-59
WHO. Length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age; methods and development. Onis M de, editor. Geneva: WHO Press; 2006. 312 p. (WHO child growth standards).
Frondas-Chauty A, Simon L, Branger B, Gascoin G, Flamant C, Ancel PY, et al. Early growth and neurodevelopmental outcome in very preterm infants: impact of gender. Arch Dis Child Fetal Neonatal Ed 2014; 99(5):F366-72.
https://doi.org/10.1136/archdischild-2013-305464
Wang N, Cui L, Liu Z, Wang Y, Zhang Y, Shi C, et al. Optimizing parenteral nutrition to achieve an adequate weight gain according to the current guidelines in preterm infants with birth weight less than 1500 g: a prospective observational study. BMC Pediatr 2021; 21(1):303.
https://doi.org/10.1186/s12887-021-02782-1
Mchaile D, Shayo A. Growth velocity and factors associated with poor postnatal growth rate among preterm infants at KCMC: A prospective cohort study. RRN 2020; 10:59-66.
Lapillonne A, Fidler Mis N, Goulet O, van den Akker CHP, Wu J, Koletzko B, et al. ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Lipids. Clin Nut 2018; 37(6 Pt B):2324-36.
https://doi.org/10.1016/j.clnu.2018.06.946
IDAI. Konsensus Asuhan Nutrisi Prematur. 2016.
Mesotten D, Joosten K, van Kempen A, Verbruggen S. ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Carbohydrates. Clin Nutr 2018; 37(6):2337-43.
https://doi.org/10.1016/j.clnu.2018.06.947
van Goudoever JB, Carnielli V, Darmaun D, Sainz de Pipaon M. ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Amino acids. Clin Nutr 2018; 37(6 Pt B):2315-23.
https://doi.org/10.1016/j.clnu.2018.06.945
Uthaya S, Liu X, Babalis D, Doré CJ, Warwick J, Bell J, et al. Nutritional evaluation and optimisation in neonates: a randomized, double-blind controlled trial of amino acid regimen and intravenous lipid composition in preterm parenteral nutrition. Am J Clin Nutr 2016; 103(6):1443-52.
https://doi.org/10.3945/ajcn.115.125138
Joosten K, Embleton N, Yan W, Senterre T. ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Energy. Clin Nutr 2018; 37(6):2309-14.
https://doi.org/10.1016/j.clnu.2018.06.944
Fischer CJ, Maucort-Boulch D, Essomo Megnier-Mbo CM, Remontet L, Claris O. Early parenteral lipids and growth velocity in extremely-low-birth-weight infants. Clin Nutr 2014; 33(3):502-8.
https://doi.org/10.1016/j.clnu.2013.07.007.
Fu M, Song W, Yu G, Yu Y, Yang Q. Risk factors for length of NICU stay of newborns: A systematic review. Front Pediatr 2023; 11:1121406.
https://doi.org/10.3389/fped.2023.1121406
Różańska A, Wójkowska-Mach J, Adamski P, Borszewska-Kornacka M, Gulczyńska E, Nowiczewski M, et al. Infections and risk-adjusted length of stay and hospital mortality in Polish Neonatology Intensive Care Units. Int J Infect Dis 2015; 35:87-92.
https://doi.org/10.1016/j.ijid.2015.04.017
Verstraete EH, Mahieu L, De Coen K, Vogelaers D, Blot S. Impact of healthcare-associated sepsis on mortality in critically ill infants. Eur J Pediatr 2016; 175(7):943-52.
