Protein Restriction In Parenteral Nutrition For Critically Ill Neonates During The Acute Phase: A Preliminary Study

Critical illness in neonates can be caused by various causes, including sepsis, majorsurgery, or other injuries with tissue damage (trauma, hypoxic‐ischemia, severecardio‐respiratory disorders, or acute conditions requiring intensive care). Metabolicchanges that occur are aimed at survival, but when these processes are disrupted, it canlead to multiorgan dysfunction and even death. The timing of the initiation ofnutritional support can significantly influence the nutritional and clinical outcomes ofcritically ill infants and children. The Pediatric Early versus Late Parenteral Nutritionin Intensive Care Unit (PEPaNIC) study showed higher morbidity rates in critically illinfants and children who received supplemental parenteral nutrition early compared withsubjects who had it delayed for 1 week. These short‐term outcomes included shorter PICUstays and earlier weaning from mechanical ventilation. ESPGHAN‐CoN does not recommend ashift towards withholding parenteral nutrition support for 7 days as part of routinenutritional care. Instead, the current position paper suggests a cautious approach toinitiating parenteral nutrition support in critically ill term newborns after 48‐72 hourson an individual basis, and suggests that parenteral nutrition support can be delayeduntil day 8 for term infants with normal nutritional status and a low risk of nutritionaldeterioration.The principles of altered nutritional requirements and metabolic changes in criticallyill neonates are poorly understood due to limited research. Studies in adults andchildren indicate significant metabolic changes, including reduced nutrient absorptionand an inability to utilize administered nutrients. Protein is mobilized to meet specificamino acid requirements as precursors for gluconeogenesis and acute‐phase reactantsynthesis in the liver. Energy mobilization through protein and fat catabolism can occurfor up to several days, resulting in growth arrest.The debate regarding nutritional support in critically ill neonates is ongoing.Therefore, further research is needed to contribute to this knowledge.