Administration of parenteral nutrition during therapeutic hypothermia: a population level observational study using routinely collected data held in the National Neonatal Research Database
Administration of parenteral nutrition during therapeutic hypothermia: a population level observational study using routinely collected data held in the National Neonatal Research Database
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.
epidemiology, neonatology, statistics
F608-F613
Gale, Chris
210b7c81-9a39-460a-9ab3-54fe92a69f8e
Jeyakumaran, Dusha
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Longford, Nicholas
2f3303da-6aa2-49e7-bb14-df151389aee2
Battersby, Cheryl
24ba455f-7f54-427c-8732-3007926ee5ce
Ojha, Shalini
adc62cc2-df92-446f-8ad2-4c0cf006d689
Oughham, Kayleigh
acc1f6f5-74eb-4815-83f3-891b0baf92b4
Dorling, Jon
e55dcb9a-a798-41a1-8753-9e9ff8aab630
20 October 2021
Gale, Chris
210b7c81-9a39-460a-9ab3-54fe92a69f8e
Jeyakumaran, Dusha
4af51f70-a8d5-42db-a5c9-5dfbf703a274
Longford, Nicholas
2f3303da-6aa2-49e7-bb14-df151389aee2
Battersby, Cheryl
24ba455f-7f54-427c-8732-3007926ee5ce
Ojha, Shalini
adc62cc2-df92-446f-8ad2-4c0cf006d689
Oughham, Kayleigh
acc1f6f5-74eb-4815-83f3-891b0baf92b4
Dorling, Jon
e55dcb9a-a798-41a1-8753-9e9ff8aab630
Gale, Chris, Jeyakumaran, Dusha, Longford, Nicholas, Battersby, Cheryl, Ojha, Shalini, Oughham, Kayleigh and Dorling, Jon
(2021)
Administration of parenteral nutrition during therapeutic hypothermia: a population level observational study using routinely collected data held in the National Neonatal Research Database.
Archives of Disease in Childhood: Fetal and Neonatal Edition, 106 (6), .
(doi:10.1136/archdischild-2020-321299).
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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Accepted/In Press date: 26 March 2021
e-pub ahead of print date: 5 May 2021
Published date: 20 October 2021
Additional Information:
Funding Information:
Competing interests CG reports grants from Medical Research Council and
the National Institute for Health Research during the conduct of the study; grants from National Institute for Health Research, Mason Medical Research Foundation, Rosetrees Foundation and from Canadian Institute for Health Research outside the submitted work. He reports a grant from Chiesi Pharmaceuticals outside of the submitted work for a research study and a personal fee from Chiesi Pharmaceuticals to support attendance at an educational meeting. CG is vice-chair of the NIHR Research for Patient Benefit London Regional Assessment Panel, and has sat on the panel since 2016. CG was an unremunerated member of the Neonatal Data Analysis Unit (NDAU) steering board which oversees the National Neonatal Research Database (NNRD) until August 2020. DJ reports no potential conflicts of interest. NL reports no potential conflicts of interest. CB reports personal fees from AbbVie Pharmaceuticals outside of the submitted work; the personal fee was to support attendance at an educational meeting. CB sits on the NIHR HTA Prioritisation Panel for Maternal, Child and Mental Health Care since November 2019. KO reports no potential conflicts of interest. SO reports grants from the National Institute for Health Research, Medical Research Council, Global Challenges Research Fund, and the Arts and Humanities Research Council outside of the work on this study. JD reports grants from NIHR, the Canadian Institute for Health Research, IWK Heath Centre, Research Nova Scotia, during the study and for the study; grants from NIHR, and grants from Nutrinia, outside the submitted work. The grant from Nutrinia in 2018 was for part of his salary to work as an expert advisor on a trial. He was a member of the NIHR HTA General Board (from 2017 to 2018) and the NIHR HTA Maternity, Newborn and Child Health Panel (from 2013 to 2018).
Keywords:
epidemiology, neonatology, statistics
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Local EPrints ID: 485020
URI: http://eprints.soton.ac.uk/id/eprint/485020
ISSN: 1359-2998
PURE UUID: 95264427-a867-4aa8-947d-45c11e99b331
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Date deposited: 28 Nov 2023 17:37
Last modified: 18 Mar 2024 04:16
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Author:
Chris Gale
Author:
Dusha Jeyakumaran
Author:
Nicholas Longford
Author:
Cheryl Battersby
Author:
Shalini Ojha
Author:
Kayleigh Oughham
Author:
Jon Dorling
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