Early Aggressive Total Parenteral Nutrition to Premature Infants in Neonatal Intensive Care Unit

Abstract

Introduction: Iatrogenic intrauterine growth restriction in NICU has been a prevailing problem in these days when smaller babies are being salvaged. Early aggressive TPN is defined when total of 4g/kg/day of amino acid is administrated via standardized TPN to neonates over first week of life. Our main objective of the study is to evaluate the efficacy, safety and tolerability of early aggressive standardized TPN to infants. We also explore the impact of early and high dose of amino acid with hypophosphatemia in extreme low birth weight (ELBW) infants, growth velocity in infants with TPN therapy and TPN cost when the hang time is extended from 24 hours to 48 hours. Methods: This is a prospective study on premature infants in NICU, Sarawak General Hospital for 6 months. Demographics and anthropometric data of eligible infants were collected. Biochemical test, growth velocity and cost of TPN therapy were analysed. Results: There are 69 eligible infants recruited. Serum electrolytes of all infants were found to be within normal range throughout TPN therapy except serum phosphate concentration. We found that incidence of hypophosphatemia is high with high amino acid supply in ELBW infants. There is a negative correlation (-0.26) between serum urea concentration and birth weight. Targeted growth velocity is achieved with standardized TPN and ELBW premature infants were found to have highest weight growth velocity. By extending TPN hang time to 48 hours, TPN related cost is associated with minimizing and resulted in yearly savings of RM 62556.60, exclusive of labour cost and nursing cost. Conclusion: Early aggressive PN therapy is safe and it achieved goal of postnatal growth velocity and body composition in premature infants. This study also demonstrated that the current practice of extending hang time is financially beneficial to hospital.

Keywords

• Preterm infants, low birth weight infants, aggressive PN therapy, electrolytes, serum phosphate concentration, urea, growth velocity, hang time, TPN related cost

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