Objective To assess the association between early initiation of parenteral nutrition (PN) and body growth in preterm infants with very low birth weight (VLBW). Design Causal inference analysis with confounders preselected by causal diagram based on the NeoNutriNet cohort containing data of infants born between 2011 and 2014 from 13 hospitals from 5 continents. Patients Neonates with birth weight ≤1500 g. Interventions PN initiated within the first day of life (early PN) versus within day 2–5 (delayed PN). Main outcome measures The primary outcome was body weight z-scores at postmenstrual age (PMA) 36 weeks or early discharge or death, whichever comes first (WT z-score END). Secondary outcomes included WT z-scores at week 1 and 4 of life (WT z-scores CA1 and CA4), corresponding growth velocities (GVs), mortality and incidence of necrotising enterocolitis (NEC), and duration and episodes of antibiotic treatment. Results In total, 2151 infants were included in this study and 2008 infants were in the primary outcome analysis. Significant associations of early PN were found with WT z-score END (adjusted mean difference, 0.14 (95% CI 0.05 to 0.23)), CA4 (β, 0.09 (0.04 to 0.14)) and CA1 (0.04 (0.01 to 0.08)), and GV PMA 36 weeks (1.02 (0.46 to 1.58)) and CA4 (1.03 (0.56 to 1.49), all p<0.001), but not with GV CA1 (p>0.05). No significant associations with mortality, incidence of NEC or antibiotic use was found (all p>0.05). Conclusions For VLBW infants, PN initiated within the first day of life is associated with improved in-hospital growth. Data are available on reasonable request.

中文翻译：

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早期肠外营养与极低出生体重婴儿的生长改善有关：一项回顾性研究

目的 评估早期开始肠外营养（PN）与极低出生体重（VLBW）早产儿身体生长之间的关系。基于 NeoNutriNet 队列（包含来自五大洲 13 家医院 2011 年至 2014 年出生的婴儿的数据），设计因果推理分析，并通过因果图预先选择混杂因素。患者 出生体重≤1500克的新生儿。PN 干预措施在出生后第一天（早期 PN）开始，而在第 2-5 天（延迟 PN）内开始。主要结局测量 主要结局是经后年龄 (PMA) 36 周时的体重 z 评分或提前出院或死亡，以先到者为准 (WT z 评分 END)。次要结局包括生命第 1 周和第 4 周的 WT z 评分（WT z 评分 CA1 和 CA4）、相应的生长速度 (GV)、死亡率和坏死性小肠结肠炎 (NEC) 的发生率以及抗生素治疗的持续时间和次数。结果 本研究总共纳入 2151 名婴儿，其中 2008 名婴儿进入主要结局分析。发现早期 PN 与 WT z 评分 END（调整后平均差，0.14（95% CI 0.05 至 0.23））、CA4（β，0.09（0.04 至 0.14））和 CA1（0.04（0.01 至 0.08））显着相关。 ，以及 GV PMA 36 周（1.02（0.46 至 1.58））和 CA4（1.03（0.56 至 1.49），所有 p<0.001），但 GV CA1 则不然（p>0.05）。未发现与死亡率、NEC 发生率或抗生素使用存在显着相关性（全部 p>0.05）。结论 对于 VLBW 婴儿，出生第一天开始的 PN 与改善院内生长有关。可根据合理要求提供数据。