title: Brief parenteral nutrition accelerates weight gain, head growth even in healthy VLBWs.
abstract: BACKGROUND
  Whether parenteral nutrition benefits growth of very low birth weight (VLBW) preterm infants in the setting of rapid enteral feeding advancement is unclear. Our aim was to examine this issue using data from Japan, where enteral feeding typically advances at a rapid rate.
  
  
  METHODS
  We studied 4005 hospitalized VLBW, very preterm (23-32 weeks' gestation) infants who reached full enteral feeding (100 ml/kg/day) by day 14, from 75 institutions in the Neonatal Research Network Japan (2003-2007). Main outcomes were weight gain, head growth, and extra-uterine growth restriction (EUGR, measurement <10(th) percentile for postmenstrual age) at discharge.
  
  
  RESULTS
  40% of infants received parenteral nutrition. Adjusting for maternal, infant, and institutional characteristics, infants who received parenteral nutrition had greater weight gain [0.09 standard deviation (SD), 95% CI: 0.02, 0.16] and head growth (0.16 SD, 95% CI: 0.05, 0.28); lower odds of EUGR by head circumference (OR 0.66, 95% CI: 0.49, 0.88). No statistically significant difference was seen in the proportion of infants with EUGR at discharge. SGA infants and infants who took more than a week until full feeding had larger estimates.
  
  
  CONCLUSIONS
  Even in infants who are able to establish enteral nutrition within 2 weeks, deprivation of parenteral nutrition in the first weeks of life could lead to under nutrition, but infants who reached full feeding within one week benefit least. It is important to predict which infants are likely or not likely to advance on enteral feedings within a week and balance enteral and parenteral nutrition for these infants.
authors.affiliation: Department of Health Policy, National Center for Child Health and Development, Setagayaku, Tokyo, Japan ; Department of Pediatrics, University of Tokyo, Bunkyoku, Tokyo, Japan.
authors.forename: Naho
authors.initials: N
authors.lastname: Morisaki
authors.affiliation: Division of Newborn Medicine, Boston Children's Hospital, Boston, Massachussetts, United States of America ; Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: Mandy B
authors.initials: MB
authors.lastname: Belfort
authors.affiliation: Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America ; Society, Health, and Human Development, Harvard School of Public Health, Boston, Massachusetts, United States of America.
authors.forename: Marie C
authors.initials: MC
authors.lastname: McCormick
authors.affiliation: Department of Health Policy, National Center for Child Health and Development, Setagayaku, Tokyo, Japan.
authors.forename: Rintaro
authors.initials: R
authors.lastname: Mori
authors.affiliation: Department of Health Policy, National Center for Child Health and Development, Setagayaku, Tokyo, Japan ; Department of Data Science, The Institute of Statistical Mathematics, Tachikawa Tokyo, Japan.
authors.forename: Hisashi
authors.initials: H
authors.lastname: Noma
authors.affiliation: Department of Neonatology, Maternal and Perinatal Center, Tokyo Women's Medical University, Shinjukuku, Tokyo, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kusuda
authors.affiliation: Department of Neonatology, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Osaka, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Fujimura
mesh_terms: D000328:Adult; D005260:Female; D006257:Head / Q000254:growth & development*; D006262:Health; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight / Q000254:growth & development*; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D010288:Parenteral Nutrition; D013997:Time Factors; D015430:Weight Gain