Analysis of Growth and Prevalence of Malnutrition during Total Parenteral Nutrition Weaning: A Methodological Demonstration

Abstract

Background Total Parenteral Nutrition (TPN) is a life-saving intervention which provides nutrition to premature infants with immature gut functioning. Though essential for nutrition provision in the first days of life, TPN is not without risk. Therefore, it is important to introduce feedings into the gut and to wean off TPN when able. During this weaning phase, calorie and protein deficits have been observed to occur. Very few studies have investigated TPN weaning periods, and there are no studies on malnutrition associated with the TPN weaning period in premature infants. Methods This study employed a retrospective chart review, with medical records from a Level IV Midwest Neonatal Intensive Care Unit (NICU). Subjects were premature infants born between November 1, 2017 and June 30, 2018, weighing less than 1500 grams at birth, who received TPN for greater than two days during their hospital stay. Z-scores for weight, length, and head circumference were calculated and the change in weight z-score was used to assign malnutrition categories based on recommendations from the proposed methodology. Pearson’s Chi-Square for association and Kendall’s tau correlation tests were conducted to assign significance between differences and to understand relationships between variables. Results There was a significant positive correlation between TPN wean length and overall malnutrition, indicating that malnutrition incidence increased as TPN wean length increased. Analysis of change in weight z-score indicated a 50% prevalence of any form of malnutrition at two weeks of age. Upon further investigation, there was a significant difference in means of TPN wean length between each form of malnutrition (mild, moderate, and severe). Conclusion The results of this study support the emerging concept that the TPN weaning period is a phase when malnutrition can start to develop in premature infants. This study demonstrates how the proposed malnutrition criteria can be combined with TPN weaning data to add to an overall picture of growth during the NICU stay. Future research is warranted to confirm these findings with a larger sample and to establish TPN weaning protocol standards.