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Table of Contents
Vol. 98, No. 1, 2010
Issue release date: June 2010
Neonatology 2010;98:84–90

Standardized Parenteral Nutrition in Preterm Infants: Early Impact on Fluid and Electrolyte Balance

Iacobelli S. · Bonsante F. · Vintéjoux A. · Gouyon J.-B.
Neonatal Intensive Care Unit, Department of Paediatrics, University of Dijon, Dijon, France

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Background: Parenteral nutrition is commonly given to premature infants. It has previously been suggested that standardized parenteral nutrition (SPN) may offer nutritional advantages compared to individualized parenteral nutrition (IPN). However, whether the same level of biochemical control is assured with SPN and with IPN remains uncertain. Objectives: To compare fluid and electrolyte balance in preterm infants receiving IPN versus SPN in the first week of life. Methods: 107 infants born at <33 weeks gestation were prospectively evaluated. Serum and urinary creatinine and electrolyte concentration, urine volume, body weight, fluid, electrolyte and energy intakes were recorded daily. Results: 40 infants received IPN and 67 SPN. Infants in IPN had significantly more water and less sodium intake than those receiving SPN. Energy and amino acid intakes were significantly lower in IPN than in SPN groups. Incidence of hypernatremia and hyponatremia was similar in both groups. Nonoliguric hyperkalemia (NOHK) was significantly more frequent in IPN than in SPN (20.0 vs. 2.9%) and mean serum K+ peak over the first 3 days was higher in IPN than in SPN (5.63 ± 1.05 vs. 4.91 ± 0.78 mmol/l). Weight loss (% of birth weight) at day 7 was significantly higher in IPN than in SPN (7.7 ± 5.8 vs. 4.2 ± 6.5) without differences in urine output/input fluid intake ratio and glomerular renal function between the two groups. Conclusions: There were no significant differences in water and sodium balance in preterm infants who received IPN versus SPN. The risk of NOHK was higher in IPN. Also, SPN significantly increased amino acid and caloric intakes, and it reduced early weight loss.

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  1. Denne SC, Poindexter BB: Evidence supporting early nutritional support with parenteral amino acid infusion. Semin Perinatol 2007;31:56–60.
  2. Beecroft C, Martin H, Puntis JWL: How often do parenteral nutrition prescriptions for the newborn need to be individualized? Clin Nutr 1999;18:83–85.
  3. Riskin A, Shiff Y, Raanan S: Parenteral nutrition in neonatology – to standardize or individualize? Isr Med Assoc J 2006;8:641–645.
  4. Lorenz JM: Assessing fluid and electrolyte status in the newborn. National Academy of Clinical Biochemistry. Clin Chem 1997;43:205–210.
  5. Baumgart S, Costarino AT: Water and electrolyte metabolism of the micropremie. Clin Perinatol 2000;27:131–144.
  6. Hartnoll G, Bétrémieux P, Modi N: Randomised controlled trial of postnatal sodium supplementation on body composition in 25 to 30 week gestational age infants. Arch Dis Child Fetal Neonatal Ed 2000;82:F24–F28.
  7. Yeung MY, Smyth JP, Maheshwari R, Shah S: Evaluation of standardized versus individualized total parenteral nutrition regime for neonates less than 33 weeks gestation. J Pediatr Child Health 2003;39:613–617.
  8. Lenclen R, Crauste-Manciet S, Narcy P, Boukhouna S, Geffray A, Guerrault MN, Bordet F, Brossard D: Assessment of implementation of standardized parenteral formulation for early nutritional support of very preterm infants. Eur J Pediatr 2006;165:512–518.
  9. Lorenz JM, Kleinman LI, Ahmed G, Markarian K: Phases of fluid and electrolytes homeostasis in the extremely low birth weight infant. Pediatrics 1995;96:484–489.
  10. Koletzko B, Goulet O, Hunt J, Krohn K, Shamir R: 1. Guidelines on Paediatric Parenteral Nutrition of the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and the European Society for Clinical Nutrition and Metabolism (ESPEN), Supported by the European Society of Paediatric Research (ESPR). J Pediatr Gastroenterol Nutr 2005;41(suppl 2):S1–S87.

    External Resources

  11. Rigo J, De Curtis M: Parenteral nutrition in premature infants; in Guandalini S (ed): Textbook of Pediatric Gastroenterology and Nutrition. London, Taylor & Francis, 2004, vol 37, pp 619–637.
  12. Gouyon JB, Sonveau N, d’Athis P, Chaillot B: Accuracy of urine output measurement with regular disposable nappies. Pediatr Nephrol 1994;8:88–90.
  13. National Center for Health Statistic: CDC growth charts. (accessed November 2008).
  14. Choker G, Gouyon JB: Diagnosis of acute renal failure in very preterm infants. Biol Neonate 2004;86:212–216.
  15. Stefano JL, Norman ME: Nitrogen balance in extremely low birth weight infants with nonoliguric hyperkalemia. J Pediatr 1993;123:632–635.
  16. Eleni-dit-Trolli S, Kermorvant-Duchemin E, Huon C, Mokthari M, Husseini K, Brunet ML, Dupont C, Lapillonne A: Early individualised parenteral nutrition for preterm infants. Arch Dis Child Fetal Neonatal Ed 2009;94:F152–F153.
  17. Dice JE, Burckart GJ, Woo JT, Helm RA: Standardized versus pharmacist-monitored individualized parenteral nutrition in low-birth-weight infants. Am J Hosp Pharm 1981;38:1487–1489.
  18. Bauer K, Bovermann G, Roithmaier A, Götz M, Pröiss A, Versmold HT: Body composition, nutrition, and fluid balance during the first two weeks of life in preterm neonates weighing less than 1500 grams. J Pediatr 1991;118:615–620.
  19. Wilson DC, Cairns P, Halliday HL, Reid M, McClure G, Dodge JA: Randomised controlled trial of an aggressive nutritional regimen in sick very low birthweight infants. Arch Dis Child Fetal Neonatal Ed 1997;77:F4–F11.
  20. Kotsopoulos K, Benadiba-Torch A, Cuddy A, Shah PS: Safety and efficacy of early amino acids in preterm <28 weeks gestation: prospective observational comparison. J Perinatol 2006;26:749–754.
  21. Pieltain C, Habibi F, Rigo J: Early nutrition, postnatal growth retardation and outcome of VLBW infants. Arch Pediatr 2007;14:S11–S15.
  22. Heimler R, Doumas BT, Jendrzejczak BM, Nemath PB, Hofman RG, Nelin LD: Relationship between nutrition, weight change, and fluid compartments in preterm infants during the first week of life. J Pediatr 1993;122:110–114.

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