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Outcomes in relation to early parenteral nutrition use in preterm neonates born between 30 and 33 weeks' gestation: a
James William Harrison Webbe1, Nicholas Longford2, Cheryl Battersby2
1Neonatal Medicine, Imperial College London, London, UK j.webbe@imperial.ac.uk.
Insights
Early parenteral nutrition in preterm neonates (30-32 weeks gestation) improved survival but increased risks of necrotizing enterocolitis, bronchopulmonary dysplasia, and sepsis. Further randomized trials are needed to resolve clinical equipoise.
Area of Science:
- Neonatal Medicine
- Pediatric Nutrition
- Clinical Epidemiology
Background:
- Parenteral nutrition (PN) is used in neonates, but its early use in preterm infants (30-32 weeks gestation) lacks robust evidence regarding risks and benefits.
- Existing data in critically ill children suggest potential harms of early PN outweigh benefits, highlighting a need for similar data in neonates.
Purpose of the Study:
- To evaluate the association between early parenteral nutrition (first 7 postnatal days) and survival and morbidities in preterm neonates born between 30 and 32 weeks gestation.
- To compare outcomes of neonates receiving early PN versus those not receiving PN.
Main Methods:
- Retrospective cohort study utilizing national, population-level clinical data from NHS neonatal units in England and Wales.
- Propensity score matching was employed, considering 35 maternal, infant, and organizational factors to minimize bias and confounding.
- The study included preterm neonates born between 30 and 32 weeks gestation.
Main Results:
- A total of 16,292 neonates were analyzed after propensity score matching.
- Neonates receiving early PN showed higher survival rates (absolute increase 0.91%) compared to those not receiving PN.
- However, early PN was associated with increased rates of necrotizing enterocolitis (4.6%), bronchopulmonary dysplasia (3.9%), late-onset sepsis (1.5%), and need for surgical procedures (0.92%).
Conclusions:
- In preterm neonates (30-32 weeks gestation), early PN administration in the first week of life is linked to improved survival but also higher rates of significant neonatal morbidities.
- The findings suggest a complex risk-benefit profile for early PN in this population.
- Prospective randomized trials are recommended to definitively resolve clinical equipoise regarding the use of early parenteral nutrition in this specific preterm infant group.
Objective:
To evaluate whether in preterm neonates parenteral nutrition use in the first 7 postnatal days, compared with no parenteral nutrition use, is associated with differences in survival and other important morbidities. Randomised trials in critically ill older children show that harms, such as nosocomial infection, outweigh benefits of early parenteral nutrition administration; there is a paucity of similar data in neonates.
Design:
Retrospective cohort study using propensity matching including 35 maternal, infant and organisational factors to minimise bias and confounding.
Setting:
National, population-level clinical data obtained for all National Health Service neonatal units in England and Wales.
Patients:
Preterm neonates born between 30+0 and 32+6 weeks+days.
Interventions:
The exposure was parenteral nutrition administered in the first 7 days of postnatal life; the comparator was no parenteral nutrition.
Main Outcome Measures:
The primary outcome was survival to discharge from neonatal care. Secondary outcomes comprised the neonatal core outcome set.
Results:
16 292 neonates were compared in propensity score matched analyses. Compared with matched neonates not given parenteral nutrition in the first postnatal week, neonates who received parenteral nutrition had higher survival at discharge (absolute rate increase 0.91%; 95% CI 0.53% to 1.30%), but higher rates of necrotising enterocolitis (absolute rate increase 4.6%), bronchopulmonary dysplasia (absolute rate increase 3.9%), late-onset sepsis (absolute rate increase 1.5%) and need for surgical procedures (absolute rate increase 0.92%).
Conclusions:
In neonates born between 30+0 and 32+6 weeks' gestation, those given parenteral nutrition in the first postnatal week had a higher rate of survival but higher rates of important neonatal morbidities. Clinician equipoise in this area should be resolved by prospective randomised trials.
Trial Registration Number:
NCT03767634.
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