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Outcomes in relation to early parenteral nutrition use in preterm neonates born between 30 and 33 weeks’ gestation: a propensity score matched observational study
  1. James William Harrison Webbe,
  2. Nicholas Longford,
  3. Cheryl Battersby,
  4. Kayleigh Oughham,
  5. Sabita N Uthaya,
  6. Neena Modi,
  7. Chris Gale
  1. Neonatal Medicine, Imperial College London, London, UK
  1. Correspondence to Dr James William Harrison Webbe, Section of Neonatal Medicine, Imperial College London, London, SW10 9NH, UK; j.webbe{at}imperial.ac.uk

Abstract

Objective To evaluate whether in preterm neonates parenteral nutrition use in the first 7 postnatal days, compared with no parenteral nutrition use, is associated with differences in survival and other important morbidities. Randomised trials in critically ill older children show that harms, such as nosocomial infection, outweigh benefits of early parenteral nutrition administration; there is a paucity of similar data in neonates.

Design Retrospective cohort study using propensity matching including 35 maternal, infant and organisational factors to minimise bias and confounding.

Setting National, population-level clinical data obtained for all National Health Service neonatal units in England and Wales.

Patients Preterm neonates born between 30+0 and 32+6 weeks+days.

Interventions The exposure was parenteral nutrition administered in the first 7 days of postnatal life; the comparator was no parenteral nutrition.

Main outcome measures The primary outcome was survival to discharge from neonatal care. Secondary outcomes comprised the neonatal core outcome set.

Results 16 292 neonates were compared in propensity score matched analyses. Compared with matched neonates not given parenteral nutrition in the first postnatal week, neonates who received parenteral nutrition had higher survival at discharge (absolute rate increase 0.91%; 95% CI 0.53% to 1.30%), but higher rates of necrotising enterocolitis (absolute rate increase 4.6%), bronchopulmonary dysplasia (absolute rate increase 3.9%), late-onset sepsis (absolute rate increase 1.5%) and need for surgical procedures (absolute rate increase 0.92%).

Conclusions In neonates born between 30+0 and 32+6 weeks’ gestation, those given parenteral nutrition in the first postnatal week had a higher rate of survival but higher rates of important neonatal morbidities. Clinician equipoise in this area should be resolved by prospective randomised trials.

Trial registration number NCT03767634.

  • neonatology
  • statistics

Data availability statement

Data are available upon reasonable request. The NNRD is a national Data Asset discoverable through the Health Data Research UK Alliance Innovation Gateway (https://www.healthdatagateway.org/) and is available for use by external investigators. Data from this study is available from the Neonatal Data Analysis Unit upon reasonable request.

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Data availability statement

Data are available upon reasonable request. The NNRD is a national Data Asset discoverable through the Health Data Research UK Alliance Innovation Gateway (https://www.healthdatagateway.org/) and is available for use by external investigators. Data from this study is available from the Neonatal Data Analysis Unit upon reasonable request.

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Footnotes

  • Twitter @DrCBattersby, @NeenaModi1, @DrCGale

  • Contributors JWHW, NM and CG conceived this project. JWHW, NL, SNU and CG planned the statistical analyses. Data were extracted from the NNRD by KO and checked by CB. Data analysis was undertaken by JWHW and NL. The first draft of the manuscript was written by JWHW and revised by CG. NL, CB, KO, SNU and NM edited and reviewed the manuscript. It was approved by JWHW, NL, CB, KO, SNU, NM and CG.

  • Funding The NNRD is funded and maintained from awards to NM. These include costs for data transfer, storage, cleaning, merging, administration and regulatory approvals. The extraction of study data from the NNRD and analysis for this study was funded through a Mason Medical Research Fellowship awarded to JWHW. CG was funded by the UK Medical Research Council (MRC) through a Clinician Scientist Fellowship award.

  • Disclaimer The MRC and Mason Medical Research Foundation were not involved in the design of the study, collection, analysis, and interpretation of data or in writing the manuscript.

  • Competing interests JWHW has received support from Chiesi Pharmaceuticals to attend an educational conference and has received a research grant from Mason Medical Research Foundation. SNU has received funding from the National Institute of Health Research, the Department of Health and Prolacta Life Sciences. SNU has been on the Advisory Board of Fresenius Kabi and received honoraria and travel expenses for speaking at study days organised by Fresenius Kabi. SNU is a member of the National Institute for Health and Care Excellence Parenteral Nutrition Guideline Development Committee. NM is the Chief Investigator for the National Neonatal Research Database and Director of the Neonatal Data Analysis Unit at Imperial College London. In the last 5 years, NM has served on the Board of Trustees of the Royal College of Paediatrics and Child Health, David Harvey Trust, Medical Women’s Federation and Medact; and is a member of the Nestle Scientific Advisory Board. NM has received research grants from the British Heart Foundation, Medical Research Council, National Institute of Health Research, Westminster Research Fund, Collaboration for Leadership in Applied Health and Care Northwest London, Healthcare Quality Improvement Partnership, Bliss, Prolacta Life Sciences, Chiesi, Shire and HCA International; travel and accommodation expenses from Nutricia, Prolacta, Nestle and Chiesi; honoraria from Ferring Pharmaceuticals and Alexion Pharmaceuticals for contributions to expert advisory boards, and Chiesi for contributing to a lecture programme. CG is part of an international team developing reporting guidance (a CONSORT extension) for clinical trials using cohorts and routinely collected health data. He has received support from Chiesi Pharmaceuticals to attend an educational conference; in the past 5 years he has been an investigator on received research grants from Medical Research Council, National Institute of Health Research, Canadian Institute of Health Research, Department of Health in England, Mason Medical Research Foundation, Westminster Medical School Research Trust and Chiesi Pharmaceuticals, and has been an unremunerated member of the Neonatal Data Analysis Unit Board, which oversees the NNRD.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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