Introduction A standardised, concentrated neonatal parenteral nutrition (scNPN1) regimen can increase very preterm protein intake.1 Our aim was to compare macronutrient intake and metabolic tolerance using a modified regimen (scNPN2) designed to introduce protein within 4 h of birth.

Methods Local audit committee approval was obtained. 14-day fluid/drug infusion and biochemical data for infants <29 weeks were collected from NICU electronic patient data management systems using the previous methodology. This allowed evaluation of metabolic stability and actual daily parenteral/enteral macronutrient intake to be calculated and compared. Both regimens had identical formulations, intravenous glucose regimens and protocols for managing hyperglycaemia.

Results Infants (n=38): median (range) birthweight 935 g (440–1350) receiving scNPN2 were compared to previous study (n=38): birthweight 890 g (470–1330). No differences in actual daily glucose/carbohydrate, early lipid or enteral intake were identified. scNPN2 regimen increased mean early protein intake (p<0.001) mainly by starting PN soon after birth (p<0.001). This was associated with fewer insulin treated infants (p<0.02) and less insulin usage:

The pattern of glucose intolerance (both groups) showed peak insulin use between days 6–9. No violations of the hyperglycaemia treatment protocol were identified.

Conclusion The scNPN2 regimen improved early protein intake as intended. This was associated with a clinically important fall in insulin-treated hyperglycaemia requiring further study.