The supply of sodium, rather than fluid volume, is the major factor determining P-Na concentrations and the risks of hyper- and hyponatremia.

Background Evidence showing the beneficial effects of enhanced parenteral nutrition (PN) to very low‐birth‐weight (VLBW, <1500 g) infants is accumulating. However, PN composition and its impact on growth outcomes are questioned. This study aimed to investigate the associations between administration of a concentrated PN regime and intakes of energy and macronutrients as well as postnatal growth in VLBW infants. Methods We compared 2 cohorts of VLBW infants born before (n = 74) and after (n = 44) a concentrated PN regime was introduced into clinical use. Daily nutrition and fluid intake during the first 28 postnatal days and all available growth measurements during hospitalization were retrospectively collected from clinical charts. Results Infants who received concentrated PN compared with original PN had higher parenteral intakes of energy (56 vs 45 kcal/kg/d, P < 0.001), protein (2.6 vs 2.2 g/kg/d, P = 0.008), and fat (1.5 vs 0.7 g/kg/d, P < 0.001) during the first postnatal week. Changes in standard deviation scores for weight and length from birth to postnatal day 28 were more positive in the concentrated PN group (mean [95% CI]; weight change: –0.77 [–1.02 to –0.52] vs –1.29 [–1.33 to –1.05], P = 0.005; length change: –1.01 [–1.36 to –0.65] vs –1.60 [–1.95 to –1.25], P = 0.025). There were no significant differences in fluid intake and infant morbidity between the groups. Conclusion Our results suggest that concentrated PN is useful and seems to be safe for improving early nutrition and growth in VLBW infants.

Objectives: This study aimed to investigate the effects of a higher intake of electrolytes from parenteral nutrition (PN) on plasma electrolyte concentrations in very low birth weight (VLBW, <1500 g) infants. Methods: This was a single-center cohort study including all VLBW infants born before (n = 81) and after (n = 53) the implementation of a concentrated PN regimen. Daily nutritional intakes and plasma concentrations of sodium, chloride, potassium, phosphate, and calcium were collected from clinical charts. Results: During the first postnatal week, electrolyte intakes were higher in infants who received concentrated PN compared with infants who received original PN. Infants who received concentrated PN had a lower incidence of hypokalemia (<3.5 mmol/L; 30% vs 76%, P < 0.001) and severe hypophosphatemia (<1.0 mmol/L; 2.2% vs 17%, P = 0.02). While the relatively high prevalence of severe hypophosphatemia in infants who received original PN can be explained by a phosphorus intake below the recommendation, the potassium intake during the first 3 postnatal days (mean ± SD: 0.7 ± 0.2 mmol/kg/d) was within the recommendation. The prevalence of early hypernatremia was not affected by the different sodium intake in the 2 groups. Conclusions: In VLBW infants, a sodium-containing PN solution (about 2.7 mmol/100 mL) does not cause hypernatremia during the first days of life. Furthermore, providing at least 1 mmol potassium/kg/d during the first 3 postnatal days might be necessary to prevent early hypokalemia.

examination (OSCE) StationA and Station B were assessed after the training. Results NR knowledge score improved from 12.43 ± 3.50 to 15.86 ± 1.60 after HBB training, with statisticallysignificant difference (t=7.42, p < 0.001). NR confidence score improvedfrom 2.15 ± 1.01 to 3.38 ± 0.80, with statistically significantdifference (t=7.72, p < 0.001). 72.2% of 73 trainees masteredthe whole 7 items on BMVS after training, and 16.7% mastered 6 items of theskill. 92.3% of trainees passed the OSCE A assessment, 83.9% passed the OSCE Bassessment, and 77.4% passed both assessments. Conclusions Healthcare providers participating the HBB trainingcan significantly improve their NR knowledge and confidence. More simulationtrainings are needed for healthcare providers to master the practical bag andmask ventilation skills, and deal with complex clinical cases correctly. O-044 ObjectivesPopulation data for Necrotising Enterocolitis (NEC) are sparse. We determined the incidence, short-term outcomes and antecedent feed exposures of severe NEC in preterm infants in England. Methods The study comprised infants 23 +0 to 31 +6 weeks gestation born in 2012 and admitted to 129 (80%) neonatal units in England. Infants with severe NEC (defined as requirement for surgery, histology, or post-mortem) were identified from the National Neonatal Research Database (www.imperial.ac.uk/ ndau). Results Of 6468 infants, 167 (2.6%) had severe NEC; incidence (95% confidence interval) for 23 to 25 +6 , 26 to 28 +6 , 29 to 31 +6 weeks gestation infants was 8% (6.4, 10), 3.5% (2.7, 4.4) and 0.8% (0.6, 1.0) respectively. Relative Risk reduced with each additional gestational week (0.70 (0.66, 0.74); Poisson regression, p < 0.001). Of infants requiring surgery, 60% received surgery and survived, 30% received surgery and died, and 10% did not receive surgery; all died. Figure 1 illustrates :12 (8-25) (log-rank test, p = 0.02). Antecedent feeding exposures were 8% never fed; 41% exclusively maternal milk; 13% maternal and donor milk; 35% human milk and formula; 3% exclusively formula. Fortifier was used in 12%. Conclusions Severe NEC remains a devastating disease affecting preterm infants in the first postnatal month. Novel findings are that 1 in 10 affected infants die having been considered too unwell for surgery, and over half were exclusively fed human milk prior to onset. O-046 EFFECTS OF EARLY SODIUM AND FLUID INTAKES ON SODIUM LEVELS AND WEIGHT CHANGE IN EXTREMELY PRETERM INFANTSC Späth, E Stoltz Sjöström, M Domellöf. Department of Clinical Sciences Pediatrics, Umeå University, Umeå, Sweden 10. 1136/archdischild-2014-307384.113 Background Hypernatremia is common in extremely preterm infants but it is unclear to what extent it is affected by sodium (Na) and fluid intakes. It is assumed that infants normally lose 5-10% of birth weight during the first postnatal days. Aim To explore associations between early intakes of Na and fluids and biochemical levels of Na as well as weight change during early postnatal life. Method We investigated a populat...

Extremely preterm (EPT) infants frequently experience intraventricular haemorrhage (IVH) mainly occurring within the first 72 h after birth. 1,2 The incidence of IVH is inversely related to gestational age (GA) and birth weight (BW), and very immature preterm infants are more likely to experience the higher grades of IVH occurring earlier after birth. [2][3][4] While mild IVH (grades 1 and 2) has been shown to increase the risk of neurodevelopmental impairment to a lesser extent, severe IVH (grade 3 or peri-ventricular haemorrhagic infarction [PVHI]) is a major risk factor for subsequent neurodevelopmental disability. 5 Besides immaturity, several risk factors have been