Use of parenteral nutrition in the first postnatal week in England and Wales: an observational study using real-world data

Abstract

BackgroundParenteral nutrition (PN) is used to provide supplemental support to neonates while enteral feeding is being established. PN is a high-cost intervention with beneficial and harmful effects. Internationally, there is substantial variation in how PN is used, and there are limited contemporary data describing use across Great Britain.ObjectiveTo describe PN use in the first postnatal week in infants born and admitted to neonatal care in England, Scotland and Wales.MethodData describing neonates admitted to National Health Service neonatal units between 1 January 2012 and 31 December 2017, extracted from routinely recorded data held the National Neonatal Research Database (NNRD); the denominator was live births, from Office for National Statistics.ResultsOver the study period 62 145 neonates were given PN in the first postnatal week (1.4% of all live births); use was higher in more preterm neonates (76% of livebirths at <28 weeks, 0.2% of term livebirths) and in neonates with lower birth weight. 15% (9181/62145) of neonates given PN in the first postnatal week were born at term. There was geographic variation in PN administration: the proportion of live births given PN within neonatal regional networks ranged from 1.0% (95% CIs 1.0 to 1.0) to 2.8% (95% CI 2.7 to 2.9).Conclusions and relevanceSignificant variation exists in neonatal PN use; it is unlikely this reflects optimal use of an expensive intervention. Research is needed to identify which babies will benefit most and which are at risk of harm from early PN.Trial registration numberClinicalTrials.gov: NCT03767634; registration date: 6 December 2018.

Association of Standardized Parenteral Nutrition with Early Neonatal Growth of Moderately Preterm Infants: A Population-Based Cohort Study

“…Some MP infants require PN to avert or treat hypoglycemia or to provide sufficient nutritional intake when enteral feeding is delayed or impossible. In the literature, the rate of PN requirements widely varies from 5% to 90% depending on GA and clinical practices, and the duration is generally short [8,[20][21][22]. Moreover, PN generally provides AA and lipid intake at the lower limits of current recommendations, partly because of the use of peripheral venous lines with limited concentrated solutions.…”

Early parenteral nutrition is associated with improved growth in very low birth weight infants: a retrospective study

“…Current guidelines recommend early initiation of PN for infants with very low birth weight (VLBW),3 4 but in clinical practice, PN is often not initiated until day 2 or later. The effect of early PN initiation within the first days after preterm birth is unclear 5 6…”