Abstract：
Parenteral nutrition (PN) is prescribed for preterm infants until nutrition needs are met via the enteral route, but unanswered questions remain regarding PN best practices in this population.
An interdisciplinary committee was assembled to answer 12 questions concerning the provision of PN to preterm infants. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) process was used. Questions addressed parenteral macronutrient doses, lipid injectable emulsion (ILE) composition, and clinically relevant outcomes, including PNALD, early childhood growth, and neurodevelopment. Preterm infants with congenital gastrointestinal disorders or infants already diagnosed with necrotizing enterocolitis or PN-associated liver disease (PNALD) at study entry were excluded.
The committee reviewed 2460 citations published between 2001 and 2023 and evaluated 57 clinical trials. For most questions, quality of evidence was very low. Most analyses yielded no significant differences between comparison groups. 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. For all other questions, expert opinion was provided.
Most clinical outcomes were not significantly different between comparison groups when evaluating timing of PN initiation, amino acid dose, and ILE composition. Future clinical trials should standardize outcome definitions to permit statistical conflation of data, thereby permitting more evidence based recommendations in future guidelines. This guideline has been approved by the ASPEN 2022-2023 Board of Directors.
An interdisciplinary committee was assembled to answer 12 questions concerning the provision of PN to preterm infants. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) process was used. Questions addressed parenteral macronutrient doses, lipid injectable emulsion (ILE) composition, and clinically relevant outcomes, including PNALD, early childhood growth, and neurodevelopment. Preterm infants with congenital gastrointestinal disorders or infants already diagnosed with necrotizing enterocolitis or PN-associated liver disease (PNALD) at study entry were excluded.
The committee reviewed 2460 citations published between 2001 and 2023 and evaluated 57 clinical trials. For most questions, quality of evidence was very low. Most analyses yielded no significant differences between comparison groups. 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. For all other questions, expert opinion was provided.
Most clinical outcomes were not significantly different between comparison groups when evaluating timing of PN initiation, amino acid dose, and ILE composition. Future clinical trials should standardize outcome definitions to permit statistical conflation of data, thereby permitting more evidence based recommendations in future guidelines. This guideline has been approved by the ASPEN 2022-2023 Board of Directors.
摘要：
背景：对早产儿规定肠胃外营养（PN），直到通过肠内途径满足营养需求为止，但在这一人群中，关于PN最佳实践的问题仍未解决。
方法：成立了一个跨学科委员会，以回答有关为早产儿提供PN的12个问题。建议的分级，评估,发展,并使用评估（等级）过程。关于肠胃外常量营养素剂量的问题，脂质注射乳剂（ILE）组合物，和临床相关结果，包括PNALD,儿童早期成长，和神经发育。排除患有先天性胃肠道疾病的早产儿或在研究进入时已经诊断为坏死性小肠结肠炎或PN相关肝病（PNALD）的婴儿。
结果：委员会审查了2001年至2023年之间发表的2460篇引文，并评估了57项临床试验。对于大多数问题，证据质量很低。大多数分析在对照组之间没有显着差异。与含有100％大豆油的ILE相比，多组分油ILE与3期或更高级早产儿视网膜病变（ROP）的减少有关。对于所有其他问题，提供了专家意见。
结论：在评估PN启动时机时，对照组之间的大多数临床结局没有显着差异，氨基酸剂量，和ILE组成。未来的临床试验应该标准化结果定义，以允许数据的统计合并，从而在未来的指南中允许更多基于证据的建议。该指南已获得ASPEN2022-2023年董事会的批准。
方法：成立了一个跨学科委员会，以回答有关为早产儿提供PN的12个问题。建议的分级，评估,发展,并使用评估（等级）过程。关于肠胃外常量营养素剂量的问题，脂质注射乳剂（ILE）组合物，和临床相关结果，包括PNALD,儿童早期成长，和神经发育。排除患有先天性胃肠道疾病的早产儿或在研究进入时已经诊断为坏死性小肠结肠炎或PN相关肝病（PNALD）的婴儿。
结果：委员会审查了2001年至2023年之间发表的2460篇引文，并评估了57项临床试验。对于大多数问题，证据质量很低。大多数分析在对照组之间没有显着差异。与含有100％大豆油的ILE相比，多组分油ILE与3期或更高级早产儿视网膜病变（ROP）的减少有关。对于所有其他问题，提供了专家意见。
结论：在评估PN启动时机时，对照组之间的大多数临床结局没有显着差异，氨基酸剂量，和ILE组成。未来的临床试验应该标准化结果定义，以允许数据的统计合并，从而在未来的指南中允许更多基于证据的建议。该指南已获得ASPEN2022-2023年董事会的批准。
