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Abstract
Objective To evaluate the impact of a quality improvement project of the adoption of standard parenteral nutrition (SPN) in preterm infants.
Design Retrospective, multicentre, whole-population, non-concurrent control study using data from the UK National Neonatal Research Database between 1 January 2014 and 31 December 2020.
Setting Neonatal units in London UK organised by geographical network.
Patients Preterm infants <31 weeks’ gestation.
Interventions Introduction of two SPN formulations previously tested in randomised controlled trials (NEON and SCAMP). SCAMP delivers a higher target macronutrient intake.
Main outcome measures The primary outcome was survival to discharge from neonatal care without major morbidities. Secondary outcomes included the individual components of the primary outcome and a comparison of outcomes between the NEON and the SCAMP formulations.
Results Of 6538 eligible infants, 4693 were admitted to neonatal care before and 1845 after the adoption of SPN. Morbidity-free survival decreased by an average of 8.6% (95% CI 5.8% to 11.4%, p<0.0001) following adoption. The effect varied by type of formulation; the cohort that adopted NEON showed no difference in morbidity-free survival, whereas the cohort that adopted SCAMP showed a statistically significant decrease in morbidity-free survival. Overall survival decreased by an average of 2.0% (95% CI 0.01% to 4.0%, p=0.048).
Conclusions Research is urgently needed to identify the optimal composition of parenteral nutrition for preterm babies. This study also adds to the growing body of evidence that suggests that early and high intakes of macronutrients in preterm babies may be harmful.
- Gastroenterology
- Intensive Care Units, Neonatal
- Neonatology
Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information.
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Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information.
Footnotes
Twitter @DrJessBS, @NeenaModi1, @SabitaUthaya
Contributors SNU initiated the research question. JL prepared the data for analysis. MC conducted the analysis. JB-S wrote the first draft of the paper. All authors reviewed and contributed to subsequent drafts and approved the final version for submission. All authors confirm they had full access to all the data in the study and accept responsibility for publication. SU is the guarantor and takes responsibility for the overall content.
Funding This work represents independent research supported in part by the Imperial NIHR Biomedical Research Centre and NIHR award NIHR153935. The funders had no influence over study design, collection, analysis and interpretation of the data, in writing the report and in the decision to submit this article for publication.
Competing interests Members of this research group (SNU and NM) were investigators of the NEON trial. SNU was a committee member of the UK NICE guideline on neonatal parenteral nutrition and the QI implementation programme of SPN that is the subject of this paper.
Provenance and peer review Not commissioned; externally peer reviewed.
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