J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Original Article

Volume 9, Number 4, April 2017, pages 339-344

The Effect of Individualized Versus Standardized Parenteral Nutrition on Body Weight in Very Preterm Infants

Figure 1. Mean cumulative weight gain in the first 3 weeks of life. #Significant between ITPN versus PSTPN. ^†Significant between ITPN versus STPN. *Significant between PSTPN versus STPN. ITPN: individualized total parental nutrition; PSTPN: partially standardized total parental nutrition; STPN: standardized total parental nutrition.

Figure 2. Mean daily weight gain velocity in the first 3 weeks of life. #Significant between ITPN versus PSTPN. ^†Significant between ITPN versus STPN. *Significant between PSTPN versus STPN. ITPN: individualized total parental nutrition; PSTPN: partially standardized total parental nutrition; STPN: standardized total parental nutrition.

**Table 1.** Composition of TPN
Composition per 100 mL	ITPN: BAXA compounder	PSTPN: Numeta G13%E 3C^®	STPN: NEOmix
ITPN: individualized total parental nutrition; PSTPN: partially standardized total parental nutrition; STPN: standardized total parental nutrition.
Energy (kcal)	Variable	91	66
Osmolarity (mOsmol/L)	Variable	1,155	805
Protein (g)	Variable	3.1	2.6
Triglycerides	Variable	2.5	2.0
Glucose (g)	Variable	13.3	8.9
Sodium (mmol)	Variable	2.2	2.1
Potassium (mmol)	Variable	2.1	0.66
Magnesium (mmol)	Variable	0.42	0.1
Calcium (mmol)	Variable	1.25	0.7
Phosphate (mmol)	Variable	1.26	0.93
Chloride (mmol)	Variable	3.1	1.39

Table 1. Composition of TPN

Composition per 100 mL

ITPN: BAXA compounder

PSTPN: Numeta G13%E 3C^®

STPN: NEOmix

ITPN: individualized total parental nutrition; PSTPN: partially standardized total parental nutrition; STPN: standardized total parental nutrition.

Energy (kcal)

Variable

Osmolarity (mOsmol/L)

Variable

1,155

805

Protein (g)

Variable

3.1

2.6

Triglycerides

Variable

2.5

2.0

Glucose (g)

Variable

13.3

8.9

Sodium (mmol)

Variable

2.2

2.1

Potassium (mmol)

Variable

2.1

0.66

Magnesium (mmol)

Variable

0.42

0.1

Calcium (mmol)

Variable

1.25

0.7

Phosphate (mmol)

Variable

1.26

0.93

Chloride (mmol)

Variable

3.1

1.39

**Table 2.** Nutrition Protocol for Infants With a Gestational Age (GA) < 32 Weeks
	ITPN	PSTPN and STPN
GA: gestational age; ITPN: individualized total parental nutrition; PSTPN: partially standardized total parental nutrition; STPN: standardized total parental nutrition.
Glucose (g/kg/day)	Day 0: 8 - 14 From day 1: max 18	Day 0: 6 - 7 From day 1: max 17
Amino acids (g/kg/day)	Day 0: 1 Day 1: 2 From day 2: max 3	Day 0: 3 From day 1: max 4
Lipids (g/kg/day)	Day 0: 0, stepwise each day plus 0.5 g/kg/day to max 3.5 at day 6	Day 0: 0 From day 1: max 3.5
Fluid intake (equal in all groups)	Day 0: 60 - 80 mL/kg (depending on birth weight), stepwise increase 20 mL/kg to max 160 - 180 mL/kg/day
Enteral intake (equal in all groups)	Days 1 - 3: start minimal enteral feeding (MEF) 6 - 12 × 0.5 mL breastmilk or Nenatal^® (depending on birth weight) From day 4: stepwise increase 20 mL/kg/day, max 160 - 180 mL/kg/day If enteral feeding ≥ 120 mL/kg/day, TPN is substituted by glucose 10%

Table 2. Nutrition Protocol for Infants With a Gestational Age (GA) < 32 Weeks

ITPN

PSTPN and STPN

GA: gestational age; ITPN: individualized total parental nutrition; PSTPN: partially standardized total parental nutrition; STPN: standardized total parental nutrition.

Glucose (g/kg/day)

Day 0: 8 - 14
From day 1: max 18

Day 0: 6 - 7
From day 1: max 17

Amino acids (g/kg/day)

Day 0: 1
Day 1: 2
From day 2: max 3

Day 0: 3
From day 1: max 4

Lipids (g/kg/day)

Day 0: 0, stepwise each day plus 0.5 g/kg/day to max 3.5 at day 6

Day 0: 0
From day 1: max 3.5

Fluid intake (equal in all groups)

Day 0: 60 - 80 mL/kg (depending on birth weight), stepwise increase 20 mL/kg to max 160 - 180 mL/kg/day

Enteral intake (equal in all groups)

Days 1 - 3: start minimal enteral feeding (MEF) 6 - 12 × 0.5 mL breastmilk or Nenatal^® (depending on birth weight)
From day 4: stepwise increase 20 mL/kg/day, max 160 - 180 mL/kg/day
If enteral feeding ≥ 120 mL/kg/day, TPN is substituted by glucose 10%

**Table 3.** Characteristics of 299 Infants < 32 Weeks of GA Hospitalized in the NICU
	ITPN (n = 94)	PSTPN (n = 101)	STPN (n = 104)	P-value
^aChi-square test. ^bKruskal-Wallis. ^cFisher’s exact test. NICU: neonatal intensive care unit; GA: gestational age; ITPN: individualized total parental nutrition; PSTPN: partially standardized total parental nutrition; STPN: standardized total parental nutrition; RDS: respiratory distress syndrome; IVH: intraventricular hemorrhage; NEC: necrotizing enterocolitis; TPN: total parenteral nutrition. Normal data are expressed as mean ± SD, otherwise median (interquartile range).
Male gender (%)	39 (41)	46 (46)	56 (54)	n.s.^a
Gestational age (day)	210 (24)	210 (16)	207 (28)	n.s.^b
Birth weight (g)	1,243 ± 347	1,281 ± 313	1,213 ± 382	n.s.^a
Antenatal Mg (%)	16 (17)	19 (19)	69 (66)	< 0.01^a
Singleton births (%)	53 (56)	63 (62)	66 (63)	n.s.^a
Apgar score 5 min	8 (3)	8 (2)	8 (3)	n.s.^b
Apgar score 10 min	9 (1)	9 (1)	9 (1)	n.s.^b
Endotracheal intubation (%)	52 (55)	44 (44)	44 (42)	n.s.^a
Fluid challenge with sodium chloride 0.9% IV < 72 h (%)	12 (13)	10 (10)	13 (13)	n.s.^a
Erythrocyte transfusion < 72 h (%)	17 (18)	12 (12)	19 (18)	n.s.^a
Morbidity (%)
Culture proven sepsis	35 (37)	16 (16)	40 (38)	< 0.01^a
RDS	51 (54)	69 (68)	59 (57)	n.s.^a
IVH	21 (22)	15 (15)	14 (14)	n.s.^a
NEC	8 (9)	5 (5)	6 (6)	n.s.^a
Hyperbilirubinemia	77 (82)	78 (77)	66 (63)	0.01^a
Central line (%)	35 (37)	25 (25)	41 (41)	n.s.^a
Mortality (%)	4 (4)	3 (3)	6 (6)	n.s.^c
Hospitalization time NICU (day)	13 (23)	13 (15)	14 (24)	n.s.^b
TPN duration (day)	6 (6)	5 (3)	5 (5)	0.01^b

Table 3. Characteristics of 299 Infants < 32 Weeks of GA Hospitalized in the NICU

ITPN (n = 94)

PSTPN (n = 101)

STPN (n = 104)

P-value

^aChi-square test. ^bKruskal-Wallis. ^cFisher’s exact test. NICU: neonatal intensive care unit; GA: gestational age; ITPN: individualized total parental nutrition; PSTPN: partially standardized total parental nutrition; STPN: standardized total parental nutrition; RDS: respiratory distress syndrome; IVH: intraventricular hemorrhage; NEC: necrotizing enterocolitis; TPN: total parenteral nutrition. Normal data are expressed as mean ± SD, otherwise median (interquartile range).

Male gender (%)

39 (41)

46 (46)

56 (54)

n.s.^a

Gestational age (day)

210 (24)

210 (16)

207 (28)

n.s.^b

Birth weight (g)

1,243 ± 347

1,281 ± 313

1,213 ± 382

n.s.^a

Antenatal Mg (%)

16 (17)

19 (19)

69 (66)

< 0.01^a

Singleton births (%)

53 (56)

63 (62)

66 (63)

n.s.^a

Apgar score 5 min

8 (3)

8 (2)

8 (3)

n.s.^b

Apgar score 10 min

9 (1)

n.s.^b

Endotracheal intubation (%)

52 (55)

44 (44)

44 (42)

n.s.^a

Fluid challenge with sodium chloride 0.9% IV < 72 h (%)

12 (13)

10 (10)

13 (13)

n.s.^a

Erythrocyte transfusion < 72 h (%)

17 (18)

12 (12)

19 (18)

n.s.^a

Morbidity (%)

Culture proven sepsis

35 (37)

16 (16)

40 (38)

< 0.01^a

RDS

51 (54)

69 (68)

59 (57)

n.s.^a

IVH

21 (22)

15 (15)

14 (14)

n.s.^a

NEC

8 (9)

5 (5)

6 (6)

n.s.^a

Hyperbilirubinemia

77 (82)

78 (77)

66 (63)

0.01^a

Central line (%)

35 (37)

25 (25)

41 (41)

n.s.^a

Mortality (%)

4 (4)

3 (3)

6 (6)

n.s.^c

Hospitalization time NICU (day)

13 (23)

13 (15)

14 (24)

n.s.^b

TPN duration (day)

6 (6)

5 (3)

5 (5)

0.01^b