Podcast
Questions and Answers
What was the range of initial AA doses studied in the clinical trials?
What was the range of initial AA doses studied in the clinical trials?
Which measurement tool was most commonly used in trials to evaluate neurodevelopment?
Which measurement tool was most commonly used in trials to evaluate neurodevelopment?
What is the recommended daily advancement of ILE to improve growth outcomes?
What is the recommended daily advancement of ILE to improve growth outcomes?
What is the primary concern regarding ILE composition?
What is the primary concern regarding ILE composition?
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What was the maximum target dose range studied for AA?
What was the maximum target dose range studied for AA?
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What was the outcome of the single trial that showed an association between higher AA doses and lower BSID scores?
What was the outcome of the single trial that showed an association between higher AA doses and lower BSID scores?
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What is the quality of evidence for the recommendation on ILE dose?
What is the quality of evidence for the recommendation on ILE dose?
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What is the strength of recommendation for parenteral AA dosing?
What is the strength of recommendation for parenteral AA dosing?
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What is the highest maximum dose of ILE studied in the clinical trials?
What is the highest maximum dose of ILE studied in the clinical trials?
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What was the outcome of the single study that showed an association between higher starting ILE dose and postnatal weight loss?
What was the outcome of the single study that showed an association between higher starting ILE dose and postnatal weight loss?
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What is the main objective of parenteral nutrition in preterm infants?
What is the main objective of parenteral nutrition in preterm infants?
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How many questions about parenteral nutrition did the interdisciplinary committee aim to answer?
How many questions about parenteral nutrition did the interdisciplinary committee aim to answer?
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What was the time frame for the citations reviewed by the committee?
What was the time frame for the citations reviewed by the committee?
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What was the primary outcome of interest in the clinical trials evaluated by the committee?
What was the primary outcome of interest in the clinical trials evaluated by the committee?
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What was the finding regarding multicomponent oil ILE compared to ILE containing 100% soybean oil?
What was the finding regarding multicomponent oil ILE compared to ILE containing 100% soybean oil?
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What was the quality of evidence for most questions evaluated by the committee?
What was the quality of evidence for most questions evaluated by the committee?
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What is the recommended next step to improve future guidelines on PN in preterm infants?
What is the recommended next step to improve future guidelines on PN in preterm infants?
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Which of the following groups of preterm infants were excluded from the study?
Which of the following groups of preterm infants were excluded from the study?
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What is the primary rationale for recommending prompt initiation of PN in preterm infants?
What is the primary rationale for recommending prompt initiation of PN in preterm infants?
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What is the recommended maximum initial dose of parenteral AA in preterm infants?
What is the recommended maximum initial dose of parenteral AA in preterm infants?
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What is the main concern regarding higher doses of parenteral AA in preterm infants?
What is the main concern regarding higher doses of parenteral AA in preterm infants?
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What is the recommended minimum target dose of parenteral AA in preterm infants?
What is the recommended minimum target dose of parenteral AA in preterm infants?
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What is the primary reason for not recommending AA doses exceeding 3.5 g/kg/day?
What is the primary reason for not recommending AA doses exceeding 3.5 g/kg/day?
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According to the recommendation, what is the goal of providing parenteral AA in preterm infants?
According to the recommendation, what is the goal of providing parenteral AA in preterm infants?
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What is the quality of evidence for the recommendation on the timing of PN initiation in preterm infants?
What is the quality of evidence for the recommendation on the timing of PN initiation in preterm infants?
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What is the strength of recommendation for the prompt initiation of PN in preterm infants?
What is the strength of recommendation for the prompt initiation of PN in preterm infants?
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What is the primary concern regarding the delay in PN initiation in preterm infants?
What is the primary concern regarding the delay in PN initiation in preterm infants?
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Why is it recommended to initiate PN promptly after birth in preterm infants?
Why is it recommended to initiate PN promptly after birth in preterm infants?
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Study Notes
Parenteral Nutrition in Preterm Infants
- Parenteral nutrition (PN) is prescribed for preterm infants until nutrition needs are met via the enteral route, but there are unanswered questions regarding PN best practices in this population.
- An interdisciplinary committee was assembled to answer 12 questions concerning the provision of PN to preterm infants, using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) process.
Timing of PN Initiation
- The committee recommends prompt initiation of PN after birth as soon as appropriate vascular access is obtained, despite the very low quality of evidence.
- The rationale for this recommendation is based on the endogenous capacity to metabolize parenteral nutrients and the rapid accrual of protein and total energy deficits after birth in preterm infants.
Parenteral Amino Acid (AA) Doses
- The committee recommends against an initial dose of >3 g/kg/day of parenteral AA, due to the increased rate of sepsis in infants who were prescribed an initiating AA dose of 3.5 g/kg/day.
- The committee recommends providing parenteral AA at a minimum of 3 g/kg/day and not exceeding 3.5 g/kg/day, considering growth outcomes as well as neurodevelopmental outcomes associated with AA dose.
Parenteral AA Doses and Neurodevelopmental Outcomes
- The committee recommends providing parenteral AA doses at a minimum of 3 g/kg/day without increasing beyond 3.5 g/kg/day, due to the limited evidence distinguishing any benefit in neurodevelopmental outcomes.
- There is a suggestion that exceeding 3.5 g/kg/day may not be without harm, based on the risk difference (RD) of cerebral palsy and the directional consistency between study outcomes in favor of lower AA doses.
Lipid Injectable Emulsion (ILE) Composition and Doses
- The committee recommends daily advancement of ILE to a dose of 3 g/kg/day if using SO-ILE or multicomponent ILE, to improve growth outcomes.
- The committee strongly emphasizes the need for attention to ILE composition when making decisions on ILE dose to ensure the provision of sufficient fatty acids for the prevention of essential fatty acid deficiency (EFAD).
Multicomponent Oil ILE and Retinopathy of Prematurity (ROP)
- A multicomponent oil ILE was associated with a reduction in stage 3 or higher retinopathy of prematurity (ROP) compared to an ILE containing 100% soybean oil.
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Description
This quiz assesses knowledge of amino acid doses and their impact on neurodevelopment in clinical trials. Questions cover dose ranges, measurement tools, and growth outcomes.
