# Systematic Review on Individualized Versus Standardized Parental Nutrition in Preterm Infants
## 3 Results  
PRISMA flow diagram is given in Figure 1. Altogether 498 potential hits were found in PubMed and Cochrane database. After removal of duplicates 463 potential papers were assessed by title and/or abstract. Fifteen potential papers were assessed for eligibility and 12 were excluded. Three new studies [17; 18; 19] (Table 5) were identified. Together with the six studies already included in the previous ESPGHAN review [20; 21; 22; 23; 24; 25] (see Table S2) now nine clinical trials were included in the present review. The innovation of two of the previous studies was individualization of PN by pharmacists (IPN with pharmaceutical individualization) in contrast to standardized PN approaches monitored and organized by neonatologists [20; 24]. More recent observational trials studied individualization by neonatologists (IPN) in contrast to standard PN bags (SPN). All new identified trials were nonrandomized observational trials using historical controls and therefore provide a low level of evidence (LoE 2-) only. * The study by [PERSON] et al. was designed as a retrospective cohort study comparing IPN (2011) to partially SPN (2012) and completely SPN (2014) consequently [17]. The partial SPN group was not included in the present review. * The study by [PERSON] et al. was designed as a retrospective cohort study comparing IPN (2005-2007) to two-in-one SPN (2008-2009), a second two-in-one SPN (2010-2011), and finally a triple-chamber-SPN (2012-2013) consequently [19]. For analysis of sepsis \begin{table}
\begin{tabular}{c c c c c c} \hline \hline
**Study** & **Population** & **Intervention** & **Comparison** & **Outcomes** & **Comments** \\ \hline [PERSON] [18] 2019 & \multirow{4}{*}{N = 198} & SPN & IPN & Protein intake & \multirow{4}{*}{SPN infants from a} \\  & & Standard SPN of & Standard IPN of & Gain in weight & & RCT in SPN [26] vs. \\  & Mean BW 905 g & RCT 2 & RCT 1 & & & historic control \\  & Mean GA 26 wks & High target SPN of & High target IPN of & No of infants with & infants from a RCT \\  & & RCT 2 & RCT 1 & & & in IPN [27] \\ \hline \multirow{6}{*}{Evering [17]} & \multirow{6}{*}{N = 198} & SPN (\(n\) = 104) & \multirow{6}{*}{IPN (\(n\) = 94)} & \multirow{6}{*}{Weight gain/loss} & \multirow{6}{*}{A group of 101} \\  & & NEOmix— & & & & \\ \cline{1-1}  & & contained per & & Variable amounts & \\ \cline{1-1}  & & & of energy, protein, & & \\ \cline{1-1}  & & Mean GA: & 66 kcal with, & & & \\ \cline{1-1}  & Netherlands & 205 days (SD 26.5) & 2.6 g protein, 2.0 g & & & \\ \cline{1-1}  & & triglycerides, 8.9 g & & & \\ \cline{1-1}  & & gluc, and fixed & & & \\ \cline{1-1}  & & other nutrients & & & \\ \hline Immeli [19] 2020 & N = 953 VLBW & \multirow{2}{*}{SPN: Numeta} & IPN: days 1–2 & Energy intake & \multirow{2}{*}{Retrospective} \\ \cline{1-1}  & infants & & in-hospital SPN & & & 2005–2013 \\ \cline{1-1}  & & 28\(A\) wks 106 g & G13E & afterwards IPN & & & IPN vs. 2 in 1 vs. \\ \hline \hline \end{tabular}
\end{table} 
Table 5: New identified studies. All new studies are nonrandomized trials using historical controls (LoE 2-). (Standardized parenteral nutrition (SPN), individualized parenteral nutrition (IPN)). and NEC incidence the SPN groups were merged. For analysis of first week protein intake the triple-chamber SPN group only was used. * The retrospective observational trial by [PERSON] et al. compares the data of two RCTs performed in the same department from 2004-2006 and 2009-2012 [18]. The first study was a RCT of normal vs. high nutrient IPN, the second a RCT of SPN vs. high nutrient SPN. The forest plots provide two comparisons based on this data. Standard SPN vs. standard IPN ([PERSON] 2019 part A) and high nutrients SPN vs. high nutrients IPN ([PERSON] 2019 part B). Forrest plots of meta-analyzed outcomes are given in Figures 2-5. More recent trials suggest that SPN may easily increase early protein intake (Figure 2). It is important to appreciate the heterogeneity of the reported protein intake data. The length of the reported protein intake periods varied.