Parenteral nutrition using corrected weight to the 10th percentile improves weight gain in preterm neonates: A randomized controlled trial

BACKGROUND: Parenteral nutrition (PN) plays a crucial role in providing nutritional support to premature and small for gestational age (SGA) neonates. In this randomized controlled study, we evaluated PN administration in preterm SGA neonates using the corrected weight estimated at the 10th percentile, as guided by a clinical decision support system (CDSS). METHODS: A total of 100 SGA neonates were randomly assigned to either the Control group (n = 50) or the Intervention group (n = 50). Both groups received PN support using a specialized CDSS. In the Control group, the CDSS calculated the PN regimen based on the actual birth weight, whereas in the Intervention group, calculations were based on the corrected weight corresponding to the 10th percentile. Growth indicators (i.e., body weight, length, and head circumference) were measured at baseline and at the time of exclusive enteral feeding initiation (endpoint). RESULTS: At baseline, no differences were observed between the two groups regarding gestational age, sex, birth weight, length, level of prematurity (all p's > 0.05). At the endpoint, the median weight gain was greater in the intervention group (+0.16 kg) than that of the control group (+0.09 kg), p = 0.034. The relative change in body weight was higher in the intervention group (+13.6 %) compared to the control group (+6.4 %), p = 0.047. CONCLUSIONS: Nutrient estimation based on the 10th percentile of weight with the assistance of CDSS, appears to be the most favorable combination for faster weight gain among SGA neonates. TRIAL REGISTRATION: ClinicalTrials.gov NCT07236957.