A comparitive study of low dose (1gm/Kg/Day) vs high dose (3gm/kg/day) protein parenteral nutrition therapy on nutrition accretion and outcomes in very low birth weight preterm neonates- a randomized controlled trial

Introduction: Parenteral Nutrition (PN) therapy plays a vital role in the management of hospitalized very low birth weight (VLBW) preterm infants who are unable to feed adequately. However, the optimal dosage of the nutrient infusate which enables accretion with best tolerance   remains controversial. Hence this study was undertaken. Aim: To compare the efficacy of low(1gm/kg/day) vs high dose (3gm/kg/day) proteins in PN therapy in pre-term VLBW neonates on nutrition accretion as evidenced by time to regain birth weight, respiratory support duration & hospitalization period  and tolerance as evidenced by side-effects encountered. Materials and Methods: This RCT study enrolled hospitalized pre-term VLBW neonates who were not predicted to achieve full enteral nutrition in 5days. Aminoacids were started on day1 in PN fluids after randomization and were increased in increments of 0.5gm/kg/day to a maximum of 4gms/kg/day. Primary outcomes were time to regain birth weight and days of oxygen dependency. Secondary outcomes were days on PN, hospitalization duration & days of Invasive/non-invasive ventilation. Complications encountered viz ROP/IVH/PDA/NNEC were recorded. Data obtained was analysed statistically. Results: The two study groups were comparable for birth weight, gestational age, gender and delivery mode. In low dose vs high dose protein groups time to regain birth weight (13.82vs 12.91days), hospital stay (19.29vs18.69days), oxygen dependency duration (6.81vs6.82 days) were comparable (p>0.05) as were secondary outcomes i.e hospitalisation duration (19.29 vs18.69 days), TPN duration (7.64vs7.41days) and ventilation duration (invasive-1.71vs1.09days & non-invasive-5.04vs5.91days). Complications observed were similar except for increased incidence of IVH in low dose protein group. Conclusions: The study suggests that low dose protein infusate is as effective as high dose proteins in PN therapy of preterm neonates. Keywords: Preterm neonates, Parenteral n