2.4. Nutritional Protocol
bradycardia, Human milk, emesis, apnea, abdominal distension, ileus
HEMODYNAMIC INSTABILITY, ILEUS
In both groups, PN was initiated within 24 h after admission into the NICU. The macronutrient dose varied according to group assignment (Neonatologists in charge prescribed PN on a daily basis to preterm neonates based upon each clinical condition, laboratory results and weight by using a specific software. The requirement of macro- and micronutrients administered through PN was calculated by deducting the amount of enteral nutrition from the total energy requirement. The PN was administered via central vascular access. The overall fluid intake administered by combined EN and PN started with 70–90 mL/kg/day and increased by 10–20 mL/kg/day until the achievement of 150–180 mL/kg/day. The enteral feeding scheme was the same for the 2 study groups. Minimal enteral feeding was commenced within 48 h after birth at 10–20 mL/kg/day. The amount was increased by 20–30 mL/kg/day if enteral nutrition (EN) was tolerated. We withheld enteral feeding in case of severe abdominal distension, emesis, ileus with visible intestinal loops, blood in the stools, apnea, bradycardia, inadequate perfusion and hemodynamic instability. Human milk (HM) of own mother without fortifications was given fresh as soon as possible after birth if available. The preterm formula (PF) was administered to the infants when HM was not available or sufficient. Preterm HM was assumed to contain 65 Kcal/100 mL (1.5 g of protein/100 mL, 3.5 g of fat/100 mL and 6.9 g of carbohydrate/100 mL). Macronutrient contents of formula (Pre-Nidina Nestlè 1, Milan, Italy) and of PN were calculated based on the published manufacturer’s labels and included proteins (TrophAmine1 6% Braun Medical Inc., Irvine, CA, USA), lipids (Smoflipd 1, Fresenius Kabi, Lake Zurich, IL, USA) and carbohydrates (Dextrose injection 10%, Fresenius Kabi, USA) expressed in g/kg/day.