4.1 Hyperalimentation and blood glucose control in very preterm infants: a randomised controlled parenteral nutrition study: Abstract 4.1 Table 1

ObjectiveHyperglycaemia is common in very preterm infants and is associated with adverse outcomes. Preventing hyperglycaemia without increasing the risk of hypoglycaemia is difficult. Real time tracking with continuous glucose monitors (CGM) may improve glucose control. We assessed the feasibility and safety of CGM to target glucose control in preterm infants, to inform a randomised controlled trial (RCT).DesignWe performed a single centre study in very preterm infants during the first week of life. Accuracy was assessed by comparison of CGM with blood glucose levels (n=20 infants). In a separate pilot study of efficacy (n=20), real-time CGM combined with a paper guideline to target glucose control (2.6–10 mmol/L) was compared with standard neonatal care (masked CGM). Questionnaires were used to assess staff acceptability.ResultsNo concerns were raised about infection or skin integrity at sensor site. The sensor performed well compared with point-of-care blood glucose measurements, mean bias of −0.27 (95% CI −0.35 to −0.19). Per cent time in target range (sensor glucose 2.6–10 mmol/L) was greater with CGM than POC (77% vs 59%, respectively) and per cent time sensor glucose >10 mmol/L was less with CGM than POC (24% vs 40%, respectively). The CGM also detected clinically unsuspected episodes of hypoglycaemia. Staff reported that the use of the CGM positively improved clinical care.ConclusionsThis study suggests that CGM has sufficient accuracy and utility in preterm infants to warrant formal testing in a RCT.

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O-088 Hyperalimentation And Electrolyte Requirements In Very Preterm Infants: The Randomised Controlled Scamp Nutrition Study: Abstract O-088 Table 1

Archives of Disease in Childhood ◽

10.1136/archdischild-2014-307384.156 ◽

2014 ◽

Vol 99 (Suppl 2) ◽

pp. A58.2-A58

Author(s):

J Green ◽

P McGowan ◽

C Morgan

Keyword(s):

Preterm Infants ◽

Very Preterm Infants ◽

Very Preterm ◽

Nutrition Study ◽

Randomised Controlled

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Early versus later initiation of parenteral nutrition for very preterm infants: a propensity score-matched observational study

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/archdischild-2021-322383 ◽

2021 ◽

pp. fetalneonatal-2021-322383

Author(s):

Sabita Uthaya ◽

Nicholas Longford ◽

Cheryl Battersby ◽

Kayleigh Oughham ◽

Julia Lanoue ◽

...

Keyword(s):

Parenteral Nutrition ◽

Preterm Infants ◽

Late Onset ◽

Controlled Trial ◽

Absolute Difference ◽

Research Database ◽

Very Preterm Infants ◽

Very Preterm ◽

Randomised Controlled ◽

The Impact

ObjectiveTo evaluate the impact of timing of initiation of parenteral nutrition (PN) after birth in very preterm infants.DesignPropensity-matched analysis of data from the UK National Neonatal Research Database.Patients65 033 babies <31 weeks gestation admitted to neonatal units in England and Wales between 2008 and 2019.InterventionsPN 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 measuresThe main outcome measure was morbidity-free survival to discharge. The secondary outcomes were survival to discharge, growth and other core neonatal outcomes.FindingsNo 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.ConclusionsResidual confounding and survival bias cannot be excluded and justify the need for a randomised controlled trial powered to detect differences in important functional outcomes.

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