Authors (including presenting author) :
PYJ Wong(1), KM Law(1), YS Leung(1), TM Ng(1), MW Chu(1), Betty Butt(2), KL Siu(2), Jenny Lam(3)
Affiliation :
(1) Department of Pharmacy, Queen Elizabeth Hospital, Hong Kong, (2) Department of Paediatrics, Queen Elizabeth Hospital, Hong Kong, (3) Department of Pharmacology and Pharmacy, University of Hong Kong
Introduction :
Very low birth weight (VLBW) infants experience an abrupt cessation of placental nutrition and caloric support. Insufficient nutrients restrict physical and brain growth, which pose premature neonates at a high risk of nutritional and developmental deficits. Without timely nutritional interventions, they often suffer from permanent detrimental complications or even mortality. Conventionally, dextrose was used as the sole source of energy on the first day of life. Amino acids and lipids were gradually introduced from the day onwards, after 24 hours of life. However, recent researchers found the early use of total parenteral nutrition (TPN) improved neonatal growth outcomes. The availability of starter TPN in Neonatal Intensive Care Unit (NICU) of Queen Elizabeth Hospital (QEH) since February 2015 provides an earlier access to TPN.
Objectives :
Our study seeks to compare growth outcomes with early use of TPN versus its conventional use, particularly the time to regain birth weight. Growth rates and prevalence of complications were also assessed.
Methodology :
This retrospective review included VLBW neonates admitted to QEH NICU within a two-year period (February 2014 to January 2015 and February 2016 to January 2017) who received TPN either within or after 24 hours of life. Primary outcome is the time to regain birth weight. Other outcomes include rate of weight gain, head circumference growth, days of hospitalization and days on TPN. Prevalence of neonatal complications were also identified. Demographics and growth outcomes were compared and tested for significant differences between means (p< 0.05). Confounders were controlled using regression when evaluating the relationship between early TPN use and its growth outcomes.
Result & Outcome :
Hospitalization records of 78 neonates were reviewed. The early use of TPN allowed neonates to regain their birth weight quicker than the conventional group (8 days vs 12 days). The total days on TPN was significantly reduced with early TPN (20 days vs 30 days). Weight gain (6.17g/kg/day vs 3.86g/kg/day) and head circumference growth (0.10cm/week vs 0.06cm/week) were both seen significantly increased with early TPN. With regards to prevalence of complications, early TPN allowed a statistically significant reduction in metabolic bone disease (9.5% vs 30.3%), chronic lung disease (23.8% vs 48.5%), as well as mortality (0% vs 8.8%). Neonatal growth is on an improving trend with the use of starter TPN when compared to its conventional use. This study provided a local perspective on the effect of early TPN in VLBW neonates. It reinforced the current practice and is the way forward for further review and protocol development.
