Neonatal Medicine, School of Public Health, Imperial College London, London, UK
Neonatal Medicine, School of Public Health, Imperial College London, London, UK.
Arch Dis Child Fetal Neonatal Ed. 2021 Nov;106(6):608-613. doi: 10.1136/archdischild-2020-321299. Epub 2021 May 5.
Parenteral nutrition is commonly administered during therapeutic hypothermia. Randomised trials in critically ill children indicate that parenteral nutrition may be harmful.
To examine the association between parenteral nutrition during therapeutic hypothermia and clinically important outcomes.
Retrospective, population-based cohort study using the National Neonatal Research Database; propensity scores were used to create matched groups for comparison.
National Health Service neonatal units in England, Scotland and Wales.
6030 term and near-term babies, born 1/1/2010 and 31/12/2017, who received therapeutic hypothermia; 2480 babies in the matched analysis.
We compared babies that received any parenteral nutrition during therapeutic hypothermia with babies that did not.
Primary outcome: blood culture confirmed late-onset infection; secondary outcomes: treatment for late onset infection, necrotising enterocolitis, survival, length of stay, measures of breast feeding, hypoglycaemia, central line days, time to full enteral feeds, discharge weight.
1475/6030 babies (25%) received parenteral nutrition. In comparative matched analyses, the rate of culture positive late onset infection was higher in babies that received parenteral nutrition (0.3% vs 0.9%; difference 0.6; 95% CI 0.1, 1.2; p=0.03), but treatment for presumed infection was not (difference 0.8%, 95% CI -2.1 to 3.6, p=0.61). Survival was higher in babies that received parenteral nutrition (93.1% vs 90.0%; rate difference 3.1, 95% CI 1.5, 4.7; p<0.001).
Receipt of parenteral nutrition during therapeutic hypothermia is associated with higher late-onset infection but lower mortality. This finding may be explained by residual confounding. Research should address the risks and benefits of parenteral nutrition in this population.
肠外营养在治疗性低温期间通常被给予。在危重症儿童的随机试验表明，肠外营养可能是有害的。
检查治疗性低温期间肠外营养与临床重要结局之间的关联。
使用国家新生儿研究数据库进行回顾性、基于人群的队列研究；使用倾向评分创建匹配组进行比较。
英格兰、苏格兰和威尔士的国民保健服务新生儿单位。
6030 名足月和近足月婴儿，出生于 2010 年 1 月 1 日至 2017 年 12 月 31 日，接受治疗性低温；6030 名婴儿中 2480 名进行了匹配分析。
我们比较了在治疗性低温期间接受任何肠外营养的婴儿与未接受肠外营养的婴儿。
主要结局：血培养证实的晚发性感染；次要结局：晚发性感染的治疗、坏死性小肠结肠炎、存活率、住院时间、母乳喂养措施、低血糖、中央静脉置管天数、完全肠内喂养时间、出院体重。
6030 名婴儿中有 1475 名（25%）接受了肠外营养。在比较性匹配分析中，接受肠外营养的婴儿血培养阳性晚发性感染的发生率较高（0.3%比 0.9%；差异 0.6，95%CI 0.1，1.2；p=0.03），但疑似感染的治疗并无差异（差异 0.8%，95%CI -2.1 至 3.6，p=0.61）。接受肠外营养的婴儿存活率较高（93.1%比 90.0%；率差 3.1，95%CI 1.5，4.7；p<0.001）。
在治疗性低温期间接受肠外营养与较高的晚发性感染相关，但死亡率较低。这一发现可能归因于残留的混杂因素。研究应解决这一人群中肠外营养的风险和益处。
