Guidelines for parenteral nutrition in preterm infants: The American Society for Parenteral and Enteral Nutrition

Daniel T. Robinson*, Kara L. Calkins, Yimin Chen, M. Petrea Cober, Gustave H. Falciglia, David D. Church, Jacob Mey, Liam McKeever, Timothy Sentongo

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

13 Scopus citations

Abstract

Background: Parenteral nutrition (PN) is prescribed for preterm infants until nutrition needs are met via the enteral route, but unanswered questions remain regarding PN best practices in this population. Methods: An interdisciplinary committee was assembled to answer 12 questions concerning the provision of PN to preterm infants. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) process was used. Questions addressed parenteral macronutrient doses, lipid injectable emulsion (ILE) composition, and clinically relevant outcomes, including PNALD, early childhood growth, and neurodevelopment. Preterm infants with congenital gastrointestinal disorders or infants already diagnosed with necrotizing enterocolitis or PN-associated liver disease (PNALD) at study entry were excluded. Results: The committee reviewed 2460 citations published between 2001 and 2023 and evaluated 57 clinical trials. For most questions, quality of evidence was very low. Most analyses yielded no significant differences between comparison groups. A multicomponent oil ILE was associated with a reduction in stage 3 or higher retinopathy of prematurity (ROP) compared to an ILE containing 100% soybean oil. For all other questions, expert opinion was provided. Conclusion: Most clinical outcomes were not significantly different between comparison groups when evaluating timing of PN initiation, amino acid dose, and ILE composition. Future clinical trials should standardize outcome definitions to permit statistical conflation of data, thereby permitting more evidence based recommendations in future guidelines. This guideline has been approved by the ASPEN 2022-2023 Board of Directors.

Original languageEnglish (US)
Pages (from-to)830-858
Number of pages29
JournalJournal of Parenteral and Enteral Nutrition
Volume47
Issue number7
DOIs
StatePublished - Sep 2023

Keywords

  • amino acids
  • intensive care
  • lipids
  • neonatal intensive care
  • neonates
  • nutrition
  • parenteral nutrition
  • pediatrics
  • prematurity
  • preterm

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Nutrition and Dietetics

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