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Variability in Parenteral Nutrition Use in US Children's Hospitals

Robert John Pettit1, Liese C C Pruitt1, Stephanie Iantorno1

  • 1Division of Pediatric Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA.

JPEN. Journal of Parenteral and Enteral Nutrition
|September 8, 2020
PubMed

Insights

Parenteral nutrition (PN) use varies significantly among US children's hospitals. High-use hospitals initiate PN earlier, but this doesn't affect treatment duration or hospital stay, highlighting opportunities for quality improvement.

Area of Science:

  • Pediatric hospital medicine
  • Clinical nutrition
  • Healthcare quality improvement

Background:

  • Parenteral nutrition (PN) is crucial for pediatric inpatients, but its utilization patterns across US children's hospitals are not well-documented.
  • Understanding variability in PN use is essential for identifying best practices and potential areas for improvement.

Purpose of the Study:

  • To determine the variability in parenteral nutrition (PN) use among US children's hospitals.
  • To investigate the association between hospital-level PN use rates and the timing of PN initiation, duration, and overall length of stay.

Main Methods:

  • A retrospective cohort study analyzed 82,142 pediatric inpatients receiving PN across US children's hospitals.
  • Hospitals were categorized into low, medium, and high tertiles based on their PN use rates (per 1000 inpatient encounters).
  • Multivariable regression models assessed the relationship between hospital PN use and PN initiation time, duration, and length of stay, adjusting for patient factors.

Main Results:

  • Significant variability in PN use was observed, with rates ranging from 5.9 to 76.7 per 1000 encounters.
  • Patients at high-PN-use hospitals experienced significantly earlier initiation of PN compared to those at low-use hospitals (IRR 0.78; P < .001).
  • No significant associations were found between hospital PN use levels and PN duration or length of hospital stay.

Conclusions:

  • Substantial variation in parenteral nutrition (PN) utilization exists across US children's hospitals.
  • While high-PN-use hospitals initiate PN earlier, this does not correlate with longer PN duration or hospital stays.
  • The observed variability in PN use presents a key opportunity for quality improvement initiatives focused on evidence-based guidelines.
Abstract

Keywords:
outcomes/research qualityparenteral nutritionpediatrics

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