Bridging the Gap: Real-World Parenteral Nutrition Practices versus ESPGHAN 2018 Recommendations in Very Low Birth Weight Infants.

Background

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Aims

Early parenteral nutrition (PN) is a critical determinant of growth and neurodevelopment in very low birth weight (VLBW) infants. Despite existing evidence, a documented gap remains between international guideline recommendations for PN and actual clinical practice. We aimed to analyse early PN prescription (days 2 and 3 of life) in preterm infants with birth weight ≤1.5 kg, using data from a national compounding centre supplying neonatal units in Argentina, and to assess adequacy against ESPGHAN 2018 recommendations and differences between weight groups (≤1 kg vs. >1 kg).

Methods

This observational, descriptive and analytical study was based on a secondary analysis of a centralised database from a national pharmaceutical compounding centre. The study included 371 unique VLBW infants, each contributing a day-2 and a day-3 prescription. Fluid volume, amino acids and lipids (g/kg/day), glucose (mg/kg/min), sodium and potassium were analysed and classified against ESPGHAN 2018 recommendations. Between-group comparisons were performed separately for each day.

Results

Amino acid provision was homogeneous across weight groups (median 3.0 g/kg/day on both days; p>0.05) and fell within the ESPGHAN range (2.5-3.5 g/kg/day) in 76% of day-3 prescriptions but correlated with prescribed fluid volume (Spearman rho 0.47-0.54; p<0.001). Glucose infusion rates fell within the ESPGHAN recommended initial range (4-8 mg/kg/min) in 92% of day-2 and 84% of day-3 prescriptions (median 7.0 and 7.8 mg/kg/min, respectively), and none exceeded the 12 mg/kg/min maximum. Lipid provision remained below the 3.0 g/kg/day target in 72% of day-3 prescriptions, although the proportion reaching target rose from day 2 to day 3, consistent with gradual advancement. The ≤1 kg group received higher fluid volumes and the >1 kg group higher glucose infusion rates (p<0.01), both differences of small effect size (|r|≈0.2).

Conclusion

Early PN prescriptions in VLBW infants showed lipid provision below ESPGHAN 2018 targets during gradual advancement, with glucose infusion rates largely within the recommended initial range, alongside weight-independent amino acid provision that correlated with fluid volume. These patterns are consistent with prescribing conditioned by infused volume rather than individualised weight-based targets and highlight opportunities to improve guideline adherence.