Original ArticleRandomized Controlled Trial of Early Parenteral Nutrition Cycling to Prevent Cholestasis in Very Low Birth Weight Infants
Section snippets
Methods
This prospective randomized controlled trial was conducted in a level 3 neonatal intensive care unit (NICU) with all inborn patients from an inner city population. The study was approved by the hospital's Institutional Review Board. Inclusion criteria were birth weight ≤1250 g and enrollment within the first 5 days after birth. Infants with major congenital anomalies, congenital hepatic disease, and clinically apparent congenital viral infection were excluded.
Informed consent was obtained
Results
A total of 83 patients were enrolled in the study between November 2007 and July 2010; 70 patients (34 in the cycle parenteral nutrition group and 36 in the continuous parenteral nutrition group) completed the study protocol. Thirteen patients were excluded from the final analysis because of transfer to a children's hospital for various reasons (Figure; available at www.jpeds.com).
Gestational age (22-30 weeks), birth weight (420-1250 g), sex, Apgar score, and CRIB II score were similar in the
Discussion
In this study, early prophylactic cycling of parenteral nutrition (20 hours on and 4 hours off) did not reduce the incidence of PNAC in VLBW infants. The biochemical markers of hepatic dysfunction, including direct bilirubin, transaminase, and GGT levels, were not different between the cycle and continuous parenteral nutrition groups. Our findings show that postnatal factors, such as time to full feedings and prolonged exposure to parenteral nutrition, are independent risk factors for PNAC.
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Cited by (30)
Nutrition in Short Bowel Syndrome
2023, Principles of NeonatologyNutritional Management of Short Bowel Syndrome
2022, Clinics in PerinatologyESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Lipids
2018, Clinical NutritionCitation Excerpt :This is especially the case with lower gestational ages or at higher infusion rates. Besides, interruption of PN in neonates could result in higher infection rate, possibly due to increased line handling [91,92]. A retrospective analysis of PN cycling in both preterm and term neonates with gastrointestinal disorders requiring surgical intervention showed that prophylactic daily discontinuous PN infusion could not prevent a rise in conjugated bilirubin concentrations [93].
ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Organisational aspects
2018, Clinical NutritionLipids in the intensive care unit: Recommendations from the ESPEN Expert Group
2018, Clinical NutritionCitation Excerpt :Besides prematurity and prolonged TPN use, other risk factors for IFALD include lack of enteral nutrition, multiple operative procedures, sepsis or inflammation, and possibly also nutrient deficiencies or toxicities associated with other components in lipid PN [140,141]. Preventative/treatment measures for IFALD may include cycling PN, feed advancement, prevention and aggressive treatment of sepsis, lipid reduction to ≤1 g/kg/d, altering the lipid being used in PN (see below), elimination of hepatotoxic medications, reduction of bacterial overgrowth, use of the bile acid ursodiol, reduction of transfusions and minimizing surgical procedures if possible [137,142–151], although the evidence in favor of some of these is weak [152]. Whilst IFALD/cholestasis may be reversed with elimination/reduction of lipids, cholestasis may be progressive whilst on PN.
The authors declare no conflicts of interest.