AI Article Synopsis
- Parenteral nutrition is often used during therapeutic hypothermia for critically ill infants, but studies suggest it could be harmful.
- A retrospective study analyzed data from over 6,000 babies treated with therapeutic hypothermia, comparing those who received parenteral nutrition to those who did not.
- Results showed that while parenteral nutrition was linked to a higher rate of late-onset infections, it also correlated with increased survival rates, highlighting the need for further research to understand these conflicting outcomes.
Article Abstract
Background: Parenteral nutrition is commonly administered during therapeutic hypothermia. Randomised trials in critically ill children indicate that parenteral nutrition may be harmful.
Objective: To examine the association between parenteral nutrition during therapeutic hypothermia and clinically important outcomes.
Design: Retrospective, population-based cohort study using the National Neonatal Research Database; propensity scores were used to create matched groups for comparison.
Setting: National Health Service neonatal units in England, Scotland and Wales.
Participants: 6030 term and near-term babies, born 1/1/2010 and 31/12/2017, who received therapeutic hypothermia; 2480 babies in the matched analysis.
Exposure: We compared babies that received any parenteral nutrition during therapeutic hypothermia with babies that did not.
Main Outcome Measures: Primary outcome: blood culture confirmed late-onset infection; secondary outcomes: treatment for late onset infection, necrotising enterocolitis, survival, length of stay, measures of breast feeding, hypoglycaemia, central line days, time to full enteral feeds, discharge weight.
Results: 1475/6030 babies (25%) received parenteral nutrition. In comparative matched analyses, the rate of culture positive late onset infection was higher in babies that received parenteral nutrition (0.3% vs 0.9%; difference 0.6; 95% CI 0.1, 1.2; p=0.03), but treatment for presumed infection was not (difference 0.8%, 95% CI -2.1 to 3.6, p=0.61). Survival was higher in babies that received parenteral nutrition (93.1% vs 90.0%; rate difference 3.1, 95% CI 1.5, 4.7; p<0.001).
Conclusions: Receipt of parenteral nutrition during therapeutic hypothermia is associated with higher late-onset infection but lower mortality. This finding may be explained by residual confounding. Research should address the risks and benefits of parenteral nutrition in this population.
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|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8543212 | PMC |
| http://dx.doi.org/10.1136/archdischild-2020-321299 | DOI Listing |
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