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Use of parenteral nutrition in the first postnatal week in England and Wales: an observational study using real-world
James Webbe1, Cheryl Battersby1, Nicholas Longford1
1Neonatal Medicine, Imperial College London, London, UK.
Insights
Parenteral nutrition (PN) use in UK neonates varies significantly, particularly for preterm infants. Further research is needed to optimize this high-cost intervention and minimize potential harm.
Area of Science:
- Neonatal Medicine
- Clinical Nutrition
- Healthcare Utilization
Background:
- Parenteral nutrition (PN) supports neonates when enteral feeding is insufficient.
- PN is a costly intervention with both benefits and risks.
- Current data on PN use in Great Britain is limited.
Purpose of the Study:
- To describe the utilization of parenteral nutrition (PN) in neonates during their first postnatal week.
- To analyze PN use in infants born and admitted to neonatal care across England, Scotland, and Wales.
Main Methods:
- Data extracted from the National Neonatal Research Database (NNRD) for neonates admitted between January 2012 and December 2017.
- Utilized routinely recorded data from NHS neonatal units.
- Denominator sourced from Office for National Statistics live birth data.
Main Results:
- Over 62,000 neonates received PN in the first week (1.4% of live births).
- PN use was higher in preterm infants (<28 weeks) and those with lower birth weight.
- Significant geographic variation in PN administration was observed across neonatal networks.
Conclusions:
- Substantial variation in neonatal PN use suggests potential suboptimal application of this expensive treatment.
- Further research is essential to identify neonates who benefit most from early PN.
- Investigating risks associated with early PN in specific infant populations is crucial.
Background:
Parenteral nutrition (PN) is used to provide supplemental support to neonates while enteral feeding is being established. PN is a high-cost intervention with beneficial and harmful effects. Internationally, there is substantial variation in how PN is used, and there are limited contemporary data describing use across Great Britain.
Objective:
To describe PN use in the first postnatal week in infants born and admitted to neonatal care in England, Scotland and Wales.
Method:
Data describing neonates admitted to National Health Service neonatal units between 1 January 2012 and 31 December 2017, extracted from routinely recorded data held the National Neonatal Research Database (NNRD); the denominator was live births, from Office for National Statistics.
Results:
Over the study period 62 145 neonates were given PN in the first postnatal week (1.4% of all live births); use was higher in more preterm neonates (76% of livebirths at <28 weeks, 0.2% of term livebirths) and in neonates with lower birth weight. 15% (9181/62145) of neonates given PN in the first postnatal week were born at term. There was geographic variation in PN administration: the proportion of live births given PN within neonatal regional networks ranged from 1.0% (95% CIs 1.0 to 1.0) to 2.8% (95% CI 2.7 to 2.9).
Conclusions And Relevance:
Significant variation exists in neonatal PN use; it is unlikely this reflects optimal use of an expensive intervention. Research is needed to identify which babies will benefit most and which are at risk of harm from early PN.
Trial Registration Number:
ClinicalTrials.gov: NCT03767634; registration date: 6 December 2018.
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