Clinical evaluation of a novel preterm standardised parenteral nutrition system for targeted macronutrient delivery

BACKGROUND: System-based approaches to operationalise international nutrition recommendations for preterm infants do not exist. We developed the PremSmart (Preterm Standardised Multimodal and Responsive Transitional) nutrition system, comprising standardised parenteral nutrition (SPN) formulations and an enteral feed volume-based protocol using in silico modelling of macronutrient data to address this gap. This study evaluated the system's effectiveness in delivering macronutrient intakes within target ranges. METHODS: Prospectively collected macronutrient intake data from 49 infants ( < 34 wk gestation and ≤1500 g; n = 14 < 28 wk) who received the PremSmart system were compared with modelled intakes and predefined target ranges across two nutrition epochs: day of life 1-4 to evaluate incremental macronutrient advancement, and the transition phase, analysed across advancing enteral feed volumes (10 mL/kg/day increments). RESULTS: The system delivered amino acid, glucose and lipid intakes within target ranges across both nutrition epochs in