259 - Administration and optimal timing of parenteral nutrition in critically ill late preterm and term neonates

Poster Number: 259
Publication Number: 259.131

Katrina Savioli, Walter Reed National Military Medical Center, Washington, DC, United States; Carl E. Hunt, Uniformed Services University of the Health Sciences F. Edward Hebert School of Medicine, Chevy Chase, MD, United States; Reese H. Clark, MEDNAX, Myrtle Beach, SC, United States; Anwar Ahmed, Usuhs, Bethesda, MD, United States; Cara H. Olsen, Uniformed Services University of the Health Sciences, Bethesda, MD, United States; Nicole R. Dobson, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States

Background: Optimizing nutrition for infants in the Neonatal Intensive Care Unit (NICU) promotes optimum growth and neurodevelopment, and early parenteral nutrition (PN) is considered an important part of nutritional support. However, a trial in patients within the Pediatric Intensive Care Unit (PICU) found early administration of PN in critically ill term neonates had adverse consequences, including longer length of stay.

Objective: To determine if initiation and timing of administration of PN in critically ill late preterm and term neonates affects NICU length of stay.

Design/Methods: This is a retrospective cohort study of late preterm and term infants ≥35 weeks gestation admitted to a Mednax-affiliated NICU from 2009-2019, using the Pediatrix Clinical Data Warehouse. Propensity score matching was used to control for neonatal demographics, delivery characteristics, and severity of illness. The primary outcome was NICU length of stay. Early initiation of PN was defined as initiation on the day of birth, and late initiation of PN was defined as initiation greater than the median of 1 day after birth.

Results: The total cohort included 475 708 neonates, of which 126 337 (27%) received PN. Propensity score matching yielded 38 872 matched neonates; 19 436 neonates received PN and had a longer median length of stay (8 versus 6 days, p < 0.0001) than neonates who did not receive PN. In the propensity matched analysis of timing of initiation of PN (3 968 matched neonates), neonates who received late PN (>1 day after birth, n=1 984) had a longer median length of stay (8 versus 7 days, p < 0.0001) than neonates who received early PN. Negative binomial regression showed a progressively increasing rate of hospital days with later initiation of PN (Table 1). Analysis of secondary outcomes after matching for PN versus no PN groups resulted in higher rate of vent days (RR 1.17; 95% CI 1.03-1.32; p=0.02), higher rate of high frequency vent days (RR 3.00; 95% CI 1.11-8.10; p=0.03), and higher odds of late onset sepsis (odds ratio 5.34; 95% CI 2.62-10.89; p < 0.0001) (Table 2). There were no differences in mortality between the PN and no PN groups (Table 3). There were no differences in morbidity or mortality between the late and early PN groups (Tables 2 and 3).Conclusion(s): Administration of PN in late preterm and term neonates admitted to the NICU is associated with longer duration of stay. In contrast to data from the PICU, neonates receiving early PN in the NICU is associated with a shorter duration of stay.
KSavioli CVCV savioli nov 2021 update.pdf
Table 2: Associations between clinical outcomes and PN versus no PN and late versus early PNTable 2.jpeg*Results represented by odds ratio