Early parenteral nutrition for preterm infants: perhaps more complicated than it first appears

Since its first neonatal application in an infant with small bowel atresia in 1968,1 parenteral nutrition (PN) has become a key tool in the management of preterm infants, and has likely contributed to the improvements in survival seen over the past few decades. Over the years, it has been established as a safe practice and been the subject of several consensus guidelines regarding its use, which advocate starting it early as a replacement for the placental nutrition that preterm infants have been denied. A group of researchers from Imperial College present two observational studies using data from the National Neonatal Research Database, which question the idea that early PN is beneficial, comparing the outcomes of those given early PN straight after birth, with those who received it later. The first by Webbe et al 2 focuses on moderately preterm infants born between 30 and 33 weeks’ gestation, while the second by Uthaya et al 3 looks at very preterm infants born at <31 weeks’ gestation. In the moderate preterm infants, early PN was defined as PN given prior to day 7 of life, while in the very preterm infants it was the first 2 days of life. Both studies found that there was an increased rate of neonatal morbidities such as bronchopulmonary dysplasia, late-onset sepsis and a need for major surgery, there was also increased survival in those given early PN when compared with those who started it late. However, at the same time, there was improved survival in infants who received early PN. Studies …