Sustaining ELBW infants

Article Outline

• Copyright

Poindexter et al address important issues in the provision of parenteral nutrition to extremely low birth weight infants. Infants ∼26 weeks gestation and ∼800 grams birth weight who received “early” or “late” administration of hyperalimentation were compared. The “late” group followed conventional management at the time in the participating centers. The study was part of a larger study on provision of glutamine supplementation early in life on mortality and late-onset sepsis. Those outcomes did not differ. This secondary analysis is important because it allows comparison of the safety and the effect(s) of early hyperalimentation on somatic growth and neurodevelopmental outcome. The “early” group received hyperalimentation sooner and reached almost 3 gm/kg/day of parenteral amino acids by 4 days of age whereas the “late” group took twice as long to reach this level of “protein” intake. The infants in the “early” group had better indices of somatic growth at 36 weeks corrected age. However, these differences were not demonstrable by 18 months. There were no differences in standardized measures of neuromotor development. Nonetheless, these results are important for demonstrating that the provision of higher amounts of amino acids in hyperalimentation solutions earlier in life than conventionally practiced is safe and may afford significant benefits. Like many studies, this one raises more questions than it answers. Can higher doses of amino acids be given even earlier in life? If so, will growth effects be even more evident? Are there neurocognitive effects/benefits in other regimens, even though not demonstrated in these studies? With the improved survival of these smaller and at risk infants in nearly all units across the nation, these emerge as important questions to address in future investigations.