title: Early parenteral nutrition and growth outcomes in preterm infants: a systematic review and meta-analysis.
abstract: BACKGROUND
  The achievement of adequate nutritional intakes in preterm infants is challenging and may explain the poor growth often seen in this group. The use of early parenteral nutrition (PN) is one potential strategy to address this problem, although the benefits and harms are unknown.
  
  
  OBJECTIVE
  We determined whether earlier administration of PN benefits growth outcomes in preterm infants.
  
  
  METHODS
  We conducted a systematic review of randomized controlled trials (RCTs) and observational studies.
  
  
  RESULTS
  Eight RCTs and 13 observational studies met the inclusion criteria (n = 553 and 1796 infants). The meta-analysis was limited by disparate growth-outcome measures. An assessment of bias was difficult because of inadequate reporting. Results are given as mean differences (95% CIs). Early PN reduced the time to regain birth weight by 2.2 d (1.1, 3.2 d) for RCTs and 3.2 d (2.0, 4.4 d) in observational studies. The maximum percentage weight loss with early PN was lower by 3.1 percentage points (1.7, 4.5 percentage points) for RCTs and by 3.5 percentage points (2.6, 4.3 percentage points) for observational studies. Early PN improved weight at discharge or 36 wk postmenstrual age by 14.9 g (5.3, 24.5 g) (observational studies only), but no benefit was shown for length or head circumference. There was no evidence that early PN significantly affects risk of mortality, necrotizing enterocolitis, sepsis, chronic lung disease, intraventricular hemorrhage, or cholestasis.
  
  
  CONCLUSIONS
  The results of this review, although subject to some limitations, show that early PN provides a benefit for some short-term growth outcomes. No evidence that early PN increases morbidity or mortality was found. Neonatal research would benefit from the development of a set of core growth outcome measures.
authors: National Institute for Health Research Foundation Trust, Southampton, United Kingdom. h.e.moyses@soton.ac.uk
authors: Helen E
authors: HE
authors: Moyses
authors: Mark J
authors: MJ
authors: Johnson
authors: Alison A
authors: AA
authors: Leaf
authors: Victoria R
authors: VR
authors: Cornelius
mesh_terms: D001724:Birth Weight; D006128:Growth; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D010288:Parenteral Nutrition; D010351:Patient Discharge; D047928:Premature Birth; D015431:Weight Loss