Mahallei Majid, Gorbani Lida, Hoseini Mohammad Bagher, Shaseb Elnaz, Mehramuz Bahareh, Rezazadeh Khatereh
Pediatric Health Research Center, Zahra Mardani Azari Children Training, Research & Treatment Center, Tabriz University of Medical Sciences, Tabriz, Iran.
Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran.
BMC Pediatr. 2025 May 19;25(1):399. doi: 10.1186/s12887-025-05735-0.
To improve the nutritional management of premature infants in neonatal intensive care units (NICUs), we developed and implemented a standardized parenteral nutrition (PN) protocol aimed at optimizing early macronutrient delivery. This study evaluated the impact of the new protocol on growth parameters and clinical outcomes in preterm neonates.
This prospective, non-randomized interventional cohort study included two groups of preterm infants born before 32 weeks of gestation or with birth weights under 1250 g. The PRE group received individualized PN formulations based on clinician discretion, while the POST group received PN guided by a newly introduced, stepwise algorithmic protocol aiming to optimize early protein and energy intake. Anthropometric data, daily energy and macronutrient intakes during the first 14 days, and weight at day 28 were collected. Clinical outcomes-including the incidence of sepsis, necrotizing enterocolitis (NEC), intraventricular hemorrhage (IVH) retinopathy of prematurity (ROP) and hospitalization duration-were compared between groups.
A total of 139 infants were enrolled (69 PRE, 70 POST). While weight gain in the first 14 days was similar, the POST group showed significantly greater weight and weight velocity by day 28. These improvements paralleled higher mean daily energy and protein intakes during the early postnatal period. The incidence of bacterial sepsis was significantly reduced in the POST cohort, possibly reflecting better nutritional status and improved PN preparation practices. Although other complications did not differ significantly, fewer infants in the POST group required prolonged hospitalization (> 90 days).
Implementation of a standardized PN protocol improved early nutritional intake and was associated with better growth and reduced infection rates in premature infants. These findings support the use of structured PN strategies to enhance early neonatal outcomes in NICU settings.
The Iranian Registry of Clinical Trials (http//www.irct.ir) with the identification No. IRCT20240519061838N2. Registered 24 November 2024.
为改善新生儿重症监护病房（NICU）中早产儿的营养管理，我们制定并实施了一项标准化肠外营养（PN）方案，旨在优化早期常量营养素的供给。本研究评估了新方案对早产儿生长参数和临床结局的影响。
这项前瞻性、非随机干预队列研究纳入了两组妊娠32周前出生或出生体重低于1250克的早产儿。PRE组根据临床医生的判断接受个体化PN配方，而POST组接受基于新引入的逐步算法方案指导的PN，该方案旨在优化早期蛋白质和能量摄入。收集人体测量数据、出生后前14天的每日能量和常量营养素摄入量以及第28天的体重。比较两组之间的临床结局，包括败血症、坏死性小肠结肠炎（NEC）、脑室内出血（IVH）、早产儿视网膜病变（ROP）的发生率以及住院时间。
共纳入139例婴儿（69例PRE组，70例POST组）。虽然前14天的体重增加相似，但POST组在第28天时体重和体重增长速度明显更高。这些改善与出生后早期更高的平均每日能量和蛋白质摄入量平行。POST队列中细菌败血症的发生率显著降低，这可能反映了更好的营养状况和改进的PN配制方法。虽然其他并发症没有显著差异，但POST组中需要延长住院时间（>90天）的婴儿较少。
实施标准化PN方案可改善早期营养摄入，并与早产儿更好的生长和降低感染率相关。这些发现支持使用结构化PN策略来改善NICU环境中新生儿的早期结局。
伊朗临床试验注册中心（http//www.irct.ir），标识符为IRCT20240519061838N2。于2024年11月24日注册。
