Should parenteral nutrition start at a lower birth weight threshold?

A recent single-centre study, which reduced the birth weight (BW) threshold for bridging parenteral nutrition (PN) from 1,500 to 1,250 g, has found that PN was initiated in about one in four infants with a BW between 1,250 and 1,500 g.

Notably, if not medically indicated, withholding PN does not seem to lead to growth faltering or reduced neurodevelopment.

In this study, the authors carried out a retrospective evaluation of clinical, nutritional, growth, and neurodevelopmental data of infants with a BW between 1,250 and 1,499 g who were consecutively admitted at a single institution between 2004 and 2020. They then analysed the need for PN in this paediatric population.

A total of 503 infants were admitted during the study period, of which 130 (26 percent) received PN. Among those who received PN, 97 (19 percent) were medically indicated, while 33 (7 percent) had no clear indication.

Infants who received medically indicated PN were younger, smaller, and sicker than the 373 infants who received enteral nutrition. In addition, their weight gain was lower (14.6 vs 16.9 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,” the authors said.