Outcomes in relation to early parenteral nutrition use in preterm neonates born between 30 and 33 weeks gestation: a propensity score matched observational study
File(s)
Accepted version
Author(s)
Type
Journal Article
Abstract
Objective
To evaluate whether in preterm neonates parenteral nutrition use in the first seven
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 seven 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.
To evaluate whether in preterm neonates parenteral nutrition use in the first seven
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 seven 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.
Date Issued
2022-02-17
Date Acceptance
2021-08-06
Citation
Archives of Disease in Childhood: Fetal and Neonatal Edition, 2022, 107, pp.131-136
ISSN
1359-2998
Publisher
BMJ Publishing Group
Start Page
131
End Page
136
Journal / Book Title
Archives of Disease in Childhood: Fetal and Neonatal Edition
Volume
107
Copyright Statement
This paper is embargoed until publication.
Sponsor
Mason Medical Research Foundation
Subjects
Parenteral nutrition
Survival
NNRD
propensity score
Neonatology
Notes
Source info: THELANCETCHILDADOL-D-20-01414
Publication Status
Published
Date Publish Online
2021-09-21