Administration of parenteral nutrition during therapeutic hypothermia: a population level observational study using routinely collected data held in the National Neonatal Research Database

Arch Dis Child Fetal Neonatal Ed. 2021 Nov;106(6):608-613. doi: 10.1136/archdischild-2020-321299. Epub 2021 May 5.

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.

Keywords: epidemiology; neonatology; statistics.

Publication types

  • Observational Study

MeSH terms

  • Combined Modality Therapy / methods
  • Enterocolitis, Necrotizing / epidemiology*
  • Female
  • Gestational Age
  • Humans
  • Hypothermia, Induced* / adverse effects
  • Hypothermia, Induced* / methods
  • Hypothermia, Induced* / statistics & numerical data
  • Infant, Newborn
  • Infant, Premature* / blood
  • Infant, Premature* / physiology
  • Length of Stay / statistics & numerical data
  • Male
  • Outcome and Process Assessment, Health Care
  • Parenteral Nutrition* / adverse effects
  • Parenteral Nutrition* / methods
  • Parenteral Nutrition* / statistics & numerical data
  • Retrospective Studies
  • Routinely Collected Health Data
  • Sepsis / epidemiology*
  • Survival Analysis
  • United Kingdom / epidemiology