FNCE 2023
Session 357. Providing MNT for the Pediatric Type 1 Diabetes Population: What Does the Evidence Show?
Monday, October 9, 8:30 AM - 9:30 AM
See session information ♦ See EAL review results

Preterm Infant (VLBW) Enteral Nutrition

VLBW: Non-Protein Energy (2020)

Intervention
In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of non-protein energy via enteral nutrition on mortality?
- Conclusion
  Fortification of already fortified human milk with human milk cream did not affect risk of mortality compared to fortified human milk alone after approximately nine weeks in very low birthweight (VLBW) preterm infants, but evidence was limited.
- Grade: III
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of non-protein energy via enteral nutrition on mortality?
- Search Plan and Results: VLBW: Non-Protein Energy (2019)
In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of non-protein energy via enteral nutrition on sepsis?
- Conclusion
  Fortification of already fortified human milk with human milk cream did not affect risk of sepsis, compared to fortified human milk alone after approximately nine weeks in very low birth weight (VLBW) preterm infants, but evidence was limited.
- Grade: III
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of non-protein energy via enteral nutrition on sepsis?
- Search Plan and Results: VLBW: Non-Protein Energy (2019)
In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of non-protein energy via enteral nutrition on necrotising enterocolitis??
- Conclusion
  Fortification of already fortified human milk with human milk cream did not affect incidence of necrotizing enterocolitis (NEC) compared to fortified human milk alone after approximately 9 weeks in very low birthweight (VLBW) preterm infants, but evidence was limited.
- Grade: III
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of non-protein energy via enteral nutrition on necrotising enterocolitis?
- Search Plan and Results: VLBW: Non-Protein Energy (2019)
In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of non-protein energy via enteral nutrition on weight gain?
- Conclusion
  Increasing non-protein energy in infant formula for up to 35 weeks did not affect weight gain. However, when breast milk was supplemented with non-protein energy in the form of human-based fat or cream for one to two months, weight gain increased by a MD of 1.05g per kg per day; 95% CI, 0.12 to 1.97, compared to the groups consuming human milk alone in very low birthweight (VLBW) preterm infants.
- Grade: III
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of non-protein energy via enteral nutrition on weight gain?
- Search Plan and Results: VLBW: Non-Protein Energy (2019)
In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of non-protein energy via enteral nutrition on length gain?
- Conclusion
  Non-protein-energy supplementation for up to nine weeks did not affect length (SMD, 0.81cm per week; 95% CI, 0.03 to 0.19) in very low birthweight (VLBW) preterm infants, compared to usual care, regardless of feeding type or source of the non-protein energy.
- Grade: III
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of non-protein energy via enteral nutrition on length gain?
- Search Plan and Results: VLBW: Non-Protein Energy (2019)
In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of non-protein energy via enteral nutrition on head circumference gain?
- Conclusion
  Non-protein energy supplementation for up to nine weeks did not affect head circumference (MD, 0.05cm per week; 95% CI, 0.03 to 0.13) in very low birthweight (VLBW) preterm infants, compared to usual care, regardless of feeding type or source of the non-protein energy.
- Grade: III
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of non-protein energy via enteral nutrition on head circumference gain?
- Search Plan and Results: VLBW: Non-Protein Energy (2019)
In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of non-protein energy via enteral nutrition on skinfold measurements?
- Conclusion
  Two RCTs suggest that adding non-protein energy to formula may increase subscapular, suprailiac and leg skinfold thickness measurements when consumed for two to three weeks in very low birthweight (VLBW) preterm infants. However, evidence was limited.
- Grade: III
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of non-protein energy via enteral nutrition on skinfold measurements?
- Search Plan and Results: VLBW: Non-Protein Energy (2019)
In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of non-protein energy via enteral nutrition on body fat percentage?
- Conclusion
  One small study suggests that non-protein energy supplementation may increase body fat percentage in very low birthweight (VLBW) preterm infants, but evidence was very limited.
- Grade: III
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of non-protein energy via enteral nutrition on body fat percentage?
  - Detail
  - Quality Rating Summary
    For a summary of the Quality Rating results, click here.
  - Worksheets
    
    van Goudoever J, Sulkers E, Lafeber H, Sauer P. Short-term growth and substrate use in very-low-birth-weight infants fed formulas with different energy contents. The American Journal of Clinical Nutrition 2000; 71:816-21
- Search Plan and Results: VLBW: Non-Protein Energy (2019)
In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of non-protein energy via enteral nutrition on development, gastrointestinal function, bone mineral content or adverse effects?
- Conclusion
  No research was identified to evaluate the effect of non-protein energy on development, gastrointestinal function, bone mineral content or adverse effects.
- Grade: V
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Search Plan and Results: VLBW: Non-Protein Energy (2019)
In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of non-protein energy via enteral nutrition on protein utilization?
- Conclusion
  Very limited evidence suggests that the addition of 1.3g medium chain triglycerides (MCT) oil per day to preterm formula for 11 days does not affect nitrogen retention (SMD, 2mg per kg per day; 95% CI, 27.81 to 31.81) in very low birthweight (VLBW) preterm infants.
- Grade: III
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of non-protein energy via enteral nutrition on protein utilization?
- Search Plan and Results: VLBW: Non-Protein Energy (2019)