1. Introduction
VLBW, Hyperglycemia
HYPERGLYCEMIA, VERY LOW BIRTH WEIGHT INFANT
Hyperglycemia (HG) is an independent risk factor of mortality and morbidity in very low birth weight newborns (VLBW). Achievement of high nutritional intakes in the first days of life (DoL) by parenteral nutrition (PN) increases the risk of HG. We aim to assess if a delayed achievement of the PN macronutrient target dose could reduce the occurrence of HG in VLBW. We enrolled 353 VLBW neonates in a randomized controlled clinical trial comparing two PN protocols that differed in the timing of energy and amino acid target dose achievement: (1) early target dose achievement (energy within 4–5 DoL; amino acids within 3–4 DoL) vs. (2) late target dose achievement (energy within 10–12 DoL; amino acids within 5–7 DoL). The primary outcome was the occurrence of HG during the first week of life. An additional endpoint was long-term body growth. We observed a significant difference in the rate of HG between the two groups (30.7% vs. 12.2%, Despite improvement in neonatal care, post-natal growth restriction (EUGR) associated with undernourishment remain a challenge for neonatologists. Thus, adequate nutritional support immediately after birth is essential for preterm newborns to limit EUGR. Over the last decade, an early enhanced nutrition strategy has been adopted routinely in NICU in order to ensure a neonatal growth as close as possible to that of a fetus of the same gestational age (GA). In particular, current guidelines recommend preterm newborns to receive high doses of amino acids (i.e., 1.5–3.5 g/kg/d) and energy (i.e., 90–120 kcal/kg/d) [However, the efficacy of this nutritional approach in terms of growth herein remains controversial [However, guidelines recommend administration of PN ensuring that it is advisable continuing to treat a child with PN being wary that it might become harmful for the child [We hypothesized that delaying the time needed to achieve the macronutrient target of supplemental PN beyond the critical window period (first week of life), even maintaining the same target value recommended, may reduce the occurrence of metabolic side effects in very low birth weight infants (VLBW). The effects of this kind of nutritional strategy on growth in VLBW infants still needs to be established. To test this hypothesis, we designed a controlled clinical trial aiming to investigate the efficacy and safety of two PN strategies, which were different for the time of target achievement: (1) Group 1: early target achievement of PN; (2) Group 2: delayed target achievement of PN. 