4. Discussion
deaths, hypokalaemia, metabolic complications, Hyperglycaemia, cranial ultrasound abnormalities, hyperglycaemia, preterm morbidities, hypercalcaemia
HYPOPHOSPHATEMIA, HYPERGLYCAEMIA, SECONDARY, REFEEDING SYNDROME, HYPERGLYCAEMIA, HYPERCALCAEMIA
The study demonstrates that there were higher motor, cognitive, language, and combined Bayley III scores at 30 months when comparing SCAMP and control infants. However, none of these findings were statistically significant, and a larger study with power to assess neurodevelopmental outcomes is required. The importance of linking early anthropometric data, particularly head growth, and later neurocognitive outcomes has been previously highlighted [This study design ensured parenteral protein and energy intakes were incrementally introduced from birth so that the intervention did not achieve higher protein and energy intakes until day 4;There are potentially greater effects of the intervention in the 24–26-week stratum;Hypophosphatemia and hypokalaemia were avoided during hyperalimentation via higher supplementation rates in the SCAMP population;The higher glucose intake in the SCAMP infants did not result in significantly higher rates of hyperglycaemia or insulin use when compared to the controls.There are recent NPN RCTs that have compared standard and high parenteral protein (amino acid) intakes and reported neurodevelopment as a secondary outcome. Blanco [It is possible that high-dose AA administration without a sufficient energy intake at birth or during the first week of life may lead to high plasma AA levels, excessive AA oxidation, or other metabolic complications harmful to growth [Increasing parenteral energy intake has potential consequences. Increasing glucose intake as part of increasing overall energy intake has the potential to increase the risk of hyperglycaemia. Hyperglycaemia is associated with an increased risk of many preterm morbidities, including major cranial ultrasound abnormalities and neurodisability [Improving growth by increasing parenteral amino acid intake not only requires adequate energy intakes but also requires additional electrolytes (primarily potassium) and minerals (particularly phosphate). These increased requirements have been well described and are sometimes referred to as refeeding syndrome: a triad of hypokalaemia, hypophosphatemia, and hypercalcaemia [Comparing nutritional interventions and outcomes is difficult when there is such variation in parenteral/enteral interventions, methodologies for growth/developmental assessment, and other laboratory measures [The main weaknesses of this study are that neurodevelopmental outcome was a planned secondary outcome and that we only had the power to assess early head growth. There are also missing data resulting from deaths and loss to follow-up. There is consistent evidence in the literature that the cognitive, language, and motor composites of the Bayley III scales underestimate the proportion of children with developmental delay when using the conventional cut off score of 70 [