RT Journal Article
SR Electronic
T1 Early versus later initiation of parenteral nutrition for very preterm infants: a propensity score-matched observational study
JF Archives of Disease in Childhood - Fetal and Neonatal Edition
JO Arch Dis Child Fetal Neonatal Ed
FD BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health
SP fetalneonatal-2021-322383
DO 10.1136/archdischild-2021-322383
A1 Sabita Uthaya
A1 Nicholas Longford
A1 Cheryl Battersby
A1 Kayleigh Oughham
A1 Julia Lanoue
A1 Neena Modi
YR 2021
UL http://fn.bmj.com/content/early/2021/11/17/archdischild-2021-322383.abstract
AB Objective To evaluate the impact of timing of initiation of parenteral nutrition (PN) after birth in very preterm infants.Design Propensity-matched analysis of data from the UK National Neonatal Research Database.Patients 65 033 babies <31 weeks gestation admitted to neonatal units in England and Wales between 2008 and 2019.Interventions PN initiated in the first 2 days (early) versus after the second postnatal day (late). Babies who died in the first 2 days without receiving PN were analysed as ‘late’.Main outcome measures The main outcome measure was morbidity-free survival to discharge. The secondary outcomes were survival to discharge, growth and other core neonatal outcomes.Findings No difference was found in the primary outcome (absolute rate difference (ARD) between early and late 0.50%, 95% CI −0.45 to 1.45, p=0.29). The early group had higher rates of survival to discharge (ARD 3.3%, 95% CI 2.7 to 3.8, p<0.001), late-onset sepsis (ARD 0.84%, 95% CI 0.48 to 1.2, p<0.001), bronchopulmonary dysplasia (ARD 1.24%, 95% CI 0.30 to 2.17, p=0.01), treated retinopathy of prematurity (ARD 0.50%, 95% CI 0.17 to 0.84, p<0.001), surgical procedures (ARD 0.80%, 95% CI 0.20 to 1.40, p=0.01) and greater drop in weight z-score between birth and discharge (absolute difference 0.019, 95% CI 0.003 to 0.035, p=0.02). Of 4.9% of babies who died in the first 2 days, 3.4% were in the late group and not exposed to PN.Conclusions Residual confounding and survival bias cannot be excluded and justify the need for a randomised controlled trial powered to detect differences in important functional outcomes.Data are available upon reasonable request.