Aggressive Early TPN

Aggressive Early Total Parental Nutrition in Low-Birth-Weight Infants. Ibrahim HM, Jeroudi MA, Baier RJ, et al. Journal of Perinatology (August 2004); 24:482-6.

Objective. This study aimed to compare nitrogen balance and biochemical tolerance of early aggressive versus late total parenteral nutrition in very-low-birth-weight (VLBW) infants over the first week of life.

Study Design. In all, 32 ventilator-dependent preterm infants were prospectively randomized into two groups. The Early Total Parenteral Nutrition (ETPN) group received 3.5 g/kilo-day amino acids (AA), and 3 g/kilo-day of 20% Intralipid (IL), starting within 1 hour after birth. The Late Total Parenteral Nutrition group (LTPN), started on a solution containing glucose during the first 48 hours of life, followed by 2 g/kilo-day of AA and 0.5 g/kilo-day of IL. For the LTPN group AA and IL were each increased by 0.5 g/kilo-day to a maximum of 3.5 and 3 g/kilo-day, respectively.

Results. Nitrogen retention was significantly greater in all infants in the ETPN group throughout the 7-day study period. All infants in the LTPN group were in negative nitrogen balance during the first 48 hours of life, while those in the ETPN group were in positive nitrogen balance throughout. The mean (±SD) nitrogen retention in the ETPN was 384.5 mg/kilo-day (±20.2), compared to 203.4 mg/kilo-day (±20.9) in the LTPN group (p <0.001). In each of the first 5 days of life, energy intake was significantly greater in the ETPN group compared to the LTPN group (p <0.001). Mean fluid intake during the study period was similar between, the ETPN and the LTPN groups (162 and 165 cm³/kilo-day, respectively). The mean weight gain was similar in the ETPN and LTPN groups. Plasma levels of cholesterol, triglycerides, bicarbonate, blood urea nitrogen, creatinine, and pH were similar in both groups during the study period. Mean (±SD) serum glucose in the LTPN group was higher, but remained in normal range (101.1±5.2 and 80.8±5.4 mg/kilo-day, respectively). The mean peak serum bilirubin was significantly higher in the ETPN group, compared to The LTPN group (7.7 and 6.2 mg/dl).

Conclusion. This study shows that aggressive intake of AA and IL can be tolerated immediately after birth by VLBW infants. Also, ETPN significantly increased positive nitrogen balance and caloric intake, without increasing the risk of metabolic acidosis, hypercholesterolemia, or hypertriglyceridemia.

Comments. Early aggressive TPN appears to be surprisingly well tolerated in VLBW infants. I was surprised that despite increased energy intake and improved nitrogen retention, the ETPN group did not gain weight better. ABK.

Date: 27 Oct 2004
Time: 03:17:22

I used 3.5 g/kg of aminoacid supplementation in parenteral nutrition as the initial fluid in 3 premature (<29 week) neonates last month. There was no increase in BUN or creatinine. But the initial newborn screen showed a very abnormal pattern of aminoacids (Positive screen for PKU and MSUD).

UserName: Satyan Lakshminrusimha MD
Institution: Children's Hospital of Buffalo
telephone: 7168787673
email: pueblopeds@hotmail.com

UserName: S.Venkat seshan
Institution: PGIMER, Chandigarh
telephone: 09417303432
email: sesh6@rediffmail.com

Date: 23 Jan 2006
Time: 06:12:00

Hello we did not use immediate TPN. Rather delayed. and we made increases depending the hepatica function and sanguinea chemistry..... to avoid complications...

Hello, We made an electronic calculator that includes venous TPN, A-line fluid, and enteral feeds. Most importantly our ranges based on recommendations for TPN published by the American Academy of Pediatrics (AAP), Nutritional needs of the preterm infant4, as well as some recent nutritional updates for premature babies see refrences 5, 6,7,8 We made our ranges based on recommendations for TPN published by the American Academy of Pediatrics (AAP), Nutritional needs of the preterm infant4, as well as some recent nutritional updates for premature babies5, 6,7,8 of Dennis T. Costakos Of Lobsters, Electronic Medical Records, and Neonatal Total Parenteral NutritionPediatrics 2006; 117: e328-e332. Furthermore, the orders are legible and the math by the provider is reduced. Dennis T. Costakos, MD Director NICU LaCrosse, WI Mayo Health and Mayo Clinic College of Medicine.

UserName: Dennis Costakos, MD, FAAP
Institution: Mayo Health System
telephone: 608 785-0940
email: costakos.dennis@mayo.edu

UserName: j:Angel serapio Mtz
Institution: pemex madero
telephone: 833 2 14 55 90
email: jserapio@aol.com

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