Effect of Different Approaches to Intravenous Nutrition on the Pattern of Weight Gain in Very Low Birth Weight Preterm Neonates: A Randomized Clinical Trial

Document Type : Original Article


1 Clinical Research Development Unit, Hajar Hospital, Shahrekord University of Medical Sciences, Shahrekord, Iran

2 Department of Pediatrics, Clinical Research Development Unit, Hajar Hospital, Shahrekord University of Medical Sciences, Shahrekord, Iran

3 Modeling in Health Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran

4 Tehran University of Medical Sciences, Tehran, Iran

5 Shahid Beheshti University of Medical Sciences, Tehran, Iran


Background: Low birth weight neonates have low energy reserves; thus, postpartum feeding is required to meet their ongoing nutritional requirements. Total parenteral nutrition (TPN) provides critical nutrients for the metabolism and development of neonates; however, few studies have investigated the effect of TPN on the early growth patterns of neonates. The present study examined the effects of TPN on preterm neonate anthropometric characteristics using two commonly used TPN calorie introduction techniques.
Methods: This randomized clinical trial studied preterm neonates with birth weights of less than 1500 g. Calories were initiated at a rate of 3 g/kg for lipids and 3.5 g/kg for amino acids in the intervention group. In the control group, the amino acid solution was begun at 1 g/kg/day and the lipid solution at 0.5 g/kg/day, and both were increased daily by 1 g/kg to a maximum of 3.5 and 3 g/kg/day for amino acids and lipids, respectively. In this group, all neonates reached full calorie intake at 3 to 5 days of age. The trend of change in the anthropometric parameters was evaluated and compared.
Results: Although both groups showed an increase in neonatal weight, length and head circumference, no statistically significant difference was observed between them. Both groups had similar lengths of hospital stay.
Conclusion: Based on the findings of the present study, TPN feeding done using two approaches to amino acid and lipid administration had no significant influence on hospital stay, TPN duration, or growth indices in preterm neonates weighing less than 1500 g.


  1. Kumar RK, Singhal A, Vaidya U, Banerjee S, Anwar F, Rao S. Optimizing nutrition in preterm low birth weight infants—consensus summary. Front Nutr. 2017; 4:20.
  2. ElHassan NO, Kaiser JR. Parenteral nutrition in the neonatal intensive care unit. Neo Reviews. 2011; 12(3):130-40.
  3. De Curtis M, Rigo J. The nutrition of preterm infants. Early Hum Dev. 2012; 88:5-7.
  4. Hay Jr HW. Aggressive nutrition of the preterm infant. Curr Pediatr Rep. 2013;1(4):229-39.
  5. Sluncheva B. Strategies for nutrition of the preterm infant with low and very low birth weight. Akush Ginekol. 2010; 49(2):33-9.
  6. Riskin A, Hartman C, Shamir R. Parenteral nutrition in very low birth weight preterm infants. Isr Med Assoc J. 2015; 17(5):310-5.
  7. Ben XM. Nutritional management of newborn infants: practical guidelines. WJG. 2008; 14(40):6133.
  8. Fusch C, Bauer K, Böhles H, Jochum F, Koletzko B, Krawinkel M, et al. Neonatology/paediatrics–Guidelines on parenteral nutrition, Chapter 13. GMS German Medical Science; 2009.
  9. Dutta S, Singh B, Chessell L, Wilson J, Janes M, McDonald K, et al. Guidelines for feeding very low birth weight infants. Nutrients. 2015; 7(1):423-42.
  10. Belfort MB, Rifas-Shiman SL, Sullivan T, Collins CT, McPhee AJ, Ryan P, et al. Infant growth before and after term: effects on neurodevelopment in preterm infants. Pediatrics. 2011; 128(4):899-906.
  11. Purkayastha J, Soundaram V, Lewis LE, Bhat YR. Postnatal growth and short-term complications in very low birth weight neonates receiving total parenteral nutrition. Indian J Child Health. 2016; 3(1):44-8.
  12. Repa A, Lochmann R, Unterasinger L, Weber M, Berger A, Haiden N. Aggressive nutrition in extremely low birth weight infants: impact on parenteral nutrition associated cholestasis and growth. PeerJ. 2016; 4:e2483.
  13. Sivamurthy S, Ahlers-Schmidt CR, Williams KS, Shaw J, Delmore P, Bloom BT. Impact of increased amino acid intake on very low birth weight infants. Kans J Med. 2011; 4(2):31-6.
  14. Clark RH, Chace DH, Spitzer AR, PAASG. Effects of two different doses of amino acid supplementation on growth and blood amino acid levels in premature neonates admitted to the neonatal intensive care unit: a randomized, controlled trial. Pediatrics. 2007;120(6):1286-96.
  15. Leenders EK, de Waard M, van Goudoever JB. Low-versus high-dose and early versus late parenteral amino-acid administration in very-low-birth-weight infants: a systematic review and meta-analysis. Neonatology. 2018; 113(3):187-205.
  16. Blanco CL, Gong AK, Schoolfield J, Green BK, Daniels W, Liechty EA, et al. Impact of early and high amino acid supplementation on ELBW infants at 2 years. J Pediatr Gastroenterol Nutr. 2012; 54(5):601-7.
  17. Bulbul A, Okan F, Bulbul L, Nuhoglu A. Effect of low versus high early parenteral nutrition on plasma amino acid profiles in very low birth-weight infants. J Matern-Fetal Neonatal Med. 2012; 25(6):770-6.
  18. Terrin G, Boscarino G, Gasparini C, Di Chiara M, Faccioli F, Onestà E, et al. Energy-enhanced parenteral nutrition and neurodevelopment of preterm newborns: A cohort study. Nutrition. 2021; 89:111219.