Body composition after implementation of an enhanced parenteral nutrition protocol in the neonatal intensive care unit: a randomised pilot trial

Figures & data

Figure 1. Nutrition protocol for Intervention and Standard Nutrition groups.

Figure 2. CONSORT diagram for study.

Table 1. Descriptive characteristics of preterm infants (n = 55)^a.

Variable	Intervention Group (n = 26)	Standard Group (n = 29)
Gestational Age at Birth (weeks)	27.1 ± 2.18	28.0 ± 1.99
Birth Weight (g)	919 ± 243	1051 ± 241
Birth Weight z-score	−0.16 ± 0.83	−0.04 ± 0.83
SGA at Birth^b	4 (15%)	2 (7%)
Birth Length (cm)	34.6 ± 3.24	35.8 ± 3.14
Birth Length z-score	−0.11 ± 0.98	−0.11 ± 0.93
Birth OFC (cm)	23.7 ± 2.80	25.0 ± 3.82
Birth OFC z-score	−0.52 ± 1.84	−0.33 ± 2.04
Sex (male)	15 (52%)	13 (50%)
Race
White	15 (65%)	21 (78%)
Asian	3 (13%)	3 (11%)
Black	5 (22%)	2 (7%)
Other	0	1 (4%)
Ethnicity
Hispanic/Latino	2 (9%)	2 (9%)
Not Hispanic/Latino	17 (77%)	25 (89%)
Not reported	3 (14%)	1 (4%)
Length of Stay (days)	81.5 (47)	81 (44)
Discharge Body Composition^c
PMA at Discharge Measurement (weeks)	39.4 ± 4.09	39.1 ± 3.89
Percent Body Fat (%)	17.7 (10.5)	17.3 (7.80)
Percent Body Fat z-score	1.74 (2.74)	1.96 (2.27)
Fat Mass (kg)	0.52 (0.47)	0.60 (0.33)
Fat Mass z-score	1.09 (2.13)	1.80 (2.14)
Fat-Free Mass (kg)	2.46 (0.69)	2.51 (0.54)
Fat-Free Mass z-score	−0.72 (2.30)	−0.90 (1.63)

^a Continuous variables expressed as mean ± standard deviation, median (interquartile range), and categorical variables as n (percentage).

^b SGA defined as <10%tile weight for gestational age at birth.

^c Body composition z-scores calculated using postconceptional charts from Norris et al. (Norris et al. 2019)(Norris et al. 2019)(Norris et al. 2019)(Norris et al. 2019)(Norris et al. 2019).

OFC, head circumference; PMA, postmenstrual age; SGA, small for gestational age.

Table 2. Nutritional intake by study group (n = 55).

Variable	Intervention Group (n = 26)	Standard Group (n = 29)
First week of life nutrition^a	Data Value^b	Data Value^b	p-value^c
Total calorie intake (kcal/kg)	105.3 (19.4)	97.0 (17.5)	0.03
Total protein intake (g/kg)	4.12 (0.34)	4.19 (0.52)	0.59
Calories from parenteral nutrition (kcal/kg)	83.6 (13.7)	67.7 (17.7)	<.0001
Protein from parenteral nutrition (g/kg)	3.78 (0.36)	3.54 (0.74)	0.04
Calories from enteral nutrition (kcal/kg)	16.9 (34.8)	30.6 (37.8)	0.25
Protein from enteral nutrition (g/kg)	0.35 (0.62)	0.71 (1.04)	0.27
Length of stay nutrition	Data Value^b	Data Value^b
Total Calorie intake (kcal/kg)	118.6 (7.46)	117.2 (7.11)	0.13
Total Protein intake (g/kg)	4.08 (0.18)	4.15 (0.17)	0.62
Calories from parenteral nutrition (kcal/kg)	17.1 (9.84)	10.6 (11.0)	0.04
Protein from parenteral nutrition (g/kg)	0.69 (0.40)	0.51 (0.34)	0.12
Parenteral nutrition duration (days)	32.6 (33)	18.0 (42)	0.39
Calories from enteral nutrition (kcal/kg)	104.4 (15.7)	109.5 (9.95)	0.42
Protein from enteral nutrition (g/kg)	3.47 (0.45)	3.64 (0.43)	0.14
Calorie deficit	43.9 (558.6)	−88.1 (537.4)	0.20
Protein deficit	8.17 (11.8)	12.3 (14.5)	0.52

^a Calculated as DOL 2–8.

^b Data are median (Interquartile Range).

^c Differences between groups evaluated using Wilcoxon tests.

^d Calculated as the last age in days at which infant received PN.

Calorie deficit = total calories – (120 kcal/kg*length of stay); a negative value indicates total calorie intake was less than goal of 120 kcal/kg/day.

Protein deficit = total protein – (4 g/kg*length of stay); a negative value indicates total protein intake was less than goal of 4 g/kg/day.

Table 3. Association of nutrition group and body composition over length of stay (n = 55).

Nutrition Group	Fat-free Mass (kg)		Fat-free Mass (z-scores)
	β ± SE	p-value	β ± SE	p-value
Intervention	−0.02 ± 0.14	0.90	−0.26 ± 0.33	0.44
Standard	Ref.	---	Ref.	---
	Fat Mass (kg)		Fat Mass (z-scores)
	β ± SE	p-value	β ± SE	p-value
Intervention	0.04 ± 0.09	0.68	0.23 ± 0.45	0.61
Standard	Ref.	---	Ref.	---
	Percent Body Fat (%)		Percent Body Fat (z-scores)
	β ± SE	p-value	β ± SE	p-value
Intervention	1.10 ± 1.80	0.55	0.24 ± 0.46	0.60
Standard	Ref.	---	Ref.	---

Table 4. Association of nutrition group and body composition over length of stay (n = 55) adjusted for SGA status and birthweight.

Nutrition Group	Fat-free Mass (kg)		Fat-free Mass (z-scores)
	β ± SE	p-value	β ± SE	p-value
Intervention	−0.08 ± 0.14	0.57	−0.08 ± 0.21	0.70
Standard	Ref.	---	Ref.	---
	Fat Mass (kg)		Fat Mass (z-scores)
	β ± SE	p-value	β ± SE	p-value
Intervention	−0.03 ± 0.08	0.68	0.37 ± 0.44	0.41
Standard	Ref.	---	Ref.	---
	Percent Body Fat (%)		Percent Body Fat (z-scores)
	β ± SE	p-value	β ± SE	p-value
Intervention	−0.44 ± 1.65	0.79	0.005 ± 0.44	0.99
Standard	Ref.	---	Ref.	---

Table 5. Association of nutrition group and anthropometric measurements over length of stay (n = 55).

Nutrition Group	Weight (kg)		Weight (z-scores)^a
	β ± SE	p-value	β ± SE	p-value
Intervention	0.03 ± 0.21	0.88	−0.12 ± 0.25	0.62
Standard	Ref.	---	Ref.	---
	Length (cm)		Length (z-scores)^a
	β ± SE	p-value	β ± SE	p-value
Intervention	0.03 ± 0.86	0.97	−0.19 ± 0.26	0.47
Standard	Ref.	---	Ref.	---
	OFC (cm)		OFC (z-scores)
	β ± SE	p-value	β ± SE	p-value
Intervention	−0.50 ± 0.57	0.40	−0.45 ± 0.23	0.052
Standard

^a Fenton growth charts used to calculate weight and length z-scores; n = 53 for z-scores.

Table 6. Association of nutrition group and anthropometric measurements over length of stay (adjusted for SGA status and birthweight) (n = 55).

Nutrition Group	Weight (kg)		Weight (z-scores)^a
	β ± SE	p-value	β ± SE	p-value
Intervention	−0.10 ± 0.20	0.63	−0.01 ± 0.17	0.96
Standard	Ref.	---	Ref.	---
	Length (cm)		Length (z-scores)^a
	β ± SE	p-value	β ± SE	p-value
Intervention	0.23 ± 0.88	0.80	−0.10 ± 0.23	0.66
Standard	Ref.	---	Ref.	---
	OFC (cm)		OFC (z-scores)
	β ± SE	P-value	β ± SE	P-value
Intervention	−0.44 ± 0.58	0.45	−0.38 ± 0.21	0.07
Standard

^a Fenton growth charts used to calculate weight and length z-scores; n = 53 for z-scores

Weights: Adjusted for SGA status and birthweight (kg); weight z-score adjusted for SGA status and birthweight z-score

Length and OFC: adjusted for SGA status

Norris T, Ramel SE, Catalano P, Caoimh C. n, Roggero P, Murray D, Fields DA, Demerath EW, Johnson W. 2019. New charts for the assessment of body composition, according to air-displacement plethysmography, at birth and across the first 6 mo of life. Am J Clin Nutr. 109(5):1353–1360. [accessed 2023 Jan 5] doi: 10.1093/AJCN/NQY377.

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Data availability statement

Deidentified data used in this manuscript are available upon request.