Outcomes following early parenteral nutrition use in preterm neonates: protocol for an observational study

IntroductionPreterm babies are among the highest users of parenteral nutrition (PN) of any patient group, but there is wide variation in commencement, duration, and composition of PN and uncertainty around which groups will benefit from early introduction. Recent studies in critically unwell adults and children suggest that harms, specifically increased rates of nosocomial infection, outweigh the benefits of early administration of PN. In this study, we will describe early PN use in neonatal units in England, Wales and Scotland. We will also evaluate if this is associated with differences in important neonatal outcomes in neonates born between 30+0and 32+6weeks+daysgestation.Methods and analysisWe will use routinely collected data from all neonatal units in England, Wales and Scotland, available in the National Neonatal Research Database (NNRD). We will describe clinical practice in relation to any use of PN during the first 7 postnatal days among neonates admitted to neonatal care between 1 January 2012 and 31 December 2017. We will compare outcomes in neonates born between 30+0and 32+6weeks+daysgestation who did or did not receive PN in the first week after birth using a propensity score-matched approach. The primary outcome will be survival to discharge home. Secondary outcomes will include components of the neonatal core outcome set: outcomes identified as important by former patients, parents, clinicians and researchers.Ethics and disseminationWe have obtained UK National Research Ethics Committee approval for this study (Ref: 18/NI/0214). The results of this study will be presented at academic conferences; the UK charity Bliss will aid dissemination to former patients and parents.Trial registration numberNCT03767634

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Outcomes in relation to early parenteral nutrition use in preterm neonates born between 30 and 33 weeks’ gestation: a propensity score matched observational study

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/archdischild-2021-321643 ◽

2021 ◽

pp. fetalneonatal-2021-321643 ◽

Cited By ~ 1

Author(s):

James William Harrison Webbe ◽

Nicholas Longford ◽

Cheryl Battersby ◽

Kayleigh Oughham ◽

Sabita N Uthaya ◽

...

Keyword(s):

Propensity Score ◽

Parenteral Nutrition ◽

Rate Increase ◽

Late Onset ◽

Preterm Neonates ◽

Postnatal Life ◽

Similar Data ◽

Absolute Rate ◽

Randomised Trials ◽

Early Parenteral Nutrition

ObjectiveTo evaluate whether in preterm neonates parenteral nutrition use in the first 7 postnatal days, compared with no parenteral nutrition use, is associated with differences in survival and other important morbidities. Randomised trials in critically ill older children show that harms, such as nosocomial infection, outweigh benefits of early parenteral nutrition administration; there is a paucity of similar data in neonates.DesignRetrospective cohort study using propensity matching including 35 maternal, infant and organisational factors to minimise bias and confounding.SettingNational, population-level clinical data obtained for all National Health Service neonatal units in England and Wales.PatientsPreterm neonates born between 30+0 and 32+6 weeks+days.InterventionsThe exposure was parenteral nutrition administered in the first 7 days of postnatal life; the comparator was no parenteral nutrition.Main outcome measuresThe primary outcome was survival to discharge from neonatal care. Secondary outcomes comprised the neonatal core outcome set.Results16 292 neonates were compared in propensity score matched analyses. Compared with matched neonates not given parenteral nutrition in the first postnatal week, neonates who received parenteral nutrition had higher survival at discharge (absolute rate increase 0.91%; 95% CI 0.53% to 1.30%), but higher rates of necrotising enterocolitis (absolute rate increase 4.6%), bronchopulmonary dysplasia (absolute rate increase 3.9%), late-onset sepsis (absolute rate increase 1.5%) and need for surgical procedures (absolute rate increase 0.92%).ConclusionsIn neonates born between 30+0 and 32+6 weeks’ gestation, those given parenteral nutrition in the first postnatal week had a higher rate of survival but higher rates of important neonatal morbidities. Clinician equipoise in this area should be resolved by prospective randomised trials.Trial registration numberNCT03767634.

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Stability of the Glutathione Supplementation into Parenteral Nutrition to Protect Very Preterm Babies from Oxidative Stress

10.20944/preprints202103.0751.v1 ◽

2021 ◽

Author(s):

Clémence Guiraut ◽

Nadine El Raichani ◽

Guillaume Morin ◽

Ibrahim Mohamed ◽

Jean-Claude Lavoie

Keyword(s):

Oxidative Stress ◽

Parenteral Nutrition ◽

Bronchopulmonary Dysplasia ◽

Preterm Neonates ◽

Maximum Loss ◽

Very Preterm ◽

Premature Babies ◽

Therapeutic Benefits ◽

Preterm Babies ◽

Glutathione Deficiency

Most very premature newborns (< 32 weeks of gestation) receive parenteral nutrition (PN) that is inherently contaminated with peroxides. Oxidative stress induced by PN is associated with bronchopulmonary dysplasia, a main pathological complication in these babies who have weak antioxidant capacity to detoxify peroxides because of their glutathione deficiency. In animals, glutathione supplementation of PN prevented oxidative stress and alveolar loss (the main characteristic of bronchopulmonary dysplasia). Of its two forms - disulfide (GSSG) and free thiol (GSH) - GSSG was used because of its better stability in PN. However, a 30% loss of GSSG in PN is observed. The potentially high therapeutic benefits of GSSG supplementation on the health of very premature babies makes the study of its stability highly important. Thus, GSSG was incubated in combination with the following components of PN: dextrose, multivitamins, Primene, Travasol, as well as with cysteine, cystine and peroxides for 24h. Total glutathione in these solutions was measured 0-24h after the addition of GSSG. The combination of cysteine and multivitamins caused the maximum loss of glutathione. Removing the cysteine prevented the degradation of glutathione. GSSG reacts with cysteine to form cysteine-glutathione disulfide, another suitable glutathione substrate for preterm neonates.

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Diagnosis of Carnitine Deficiency in Extremely Preterm Neonates Related to Parenteral Nutrition: Two Step Newborn Screening Approach

International Journal of Neonatal Screening ◽

10.3390/ijns5030029 ◽

2019 ◽

Vol 5 (3) ◽

pp. 29

Author(s):

Mamatha Ramaswamy ◽

Victor Anthony Skrinska ◽

Rola Fayez Mitri ◽

Ghassan Abdoh

Keyword(s):

Parenteral Nutrition ◽

Newborn Screening ◽

Premature Infants ◽

Retrospective Cohort ◽

Optimal Growth ◽

Carnitine Deficiency ◽

Preterm Neonates ◽

Extremely Preterm ◽

Significant Difference ◽

Preterm Babies

Currently, there is no evidence in the literature to support the routine supplementation of all parenterally fed premature infants with l-carnitine. In our study, we found that about 8.56% of extremely preterm neonates are diagnosed with carnitine deficiency secondary to malnutrition, either due to reduced stores at birth or related to total parenteral nutrition (TPN). Our two step approach of performing newborn screening (NBS) again at 32 weeks gestational age (GA) equivalent helps to diagnose 81.4% more preterm babies with carnitine deficiency—who would otherwise be missed—and supplement them with l-carnitine for optimal growth. We performed a retrospective cohort study to diagnose carnitine deficiency related to malnutrition in two groups: those presenting at birth and those presenting later in life. We found that there was a statistically significant difference in the median GA and birth weight (BW) between the two groups, but there was no difference in the free carnitine levels.

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Outcomes in Relation to Early Parenteral Nutrition Use in Preterm Neonates Born between 30 and 33 Weeks Gestation: A Propensity Score Matched Observational Study

SSRN Electronic Journal ◽

10.2139/ssrn.3726171 ◽

2020 ◽

Author(s):

James Webbe ◽

Nicholas Longford ◽

Cheryl Battersby ◽

Kayleigh Ougham ◽

Sabita Uthaya ◽

...

Keyword(s):

Propensity Score ◽

Observational Study ◽

Parenteral Nutrition ◽

Preterm Neonates ◽

Early Parenteral Nutrition

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Contrasting Broad- and Clinically- defined Polygenic Indicators of Depression and Depression-related Phenotypes in Adults and Children

10.31234/osf.io/pn9vb ◽

2020 ◽

Author(s):

John E. McGeary ◽

Chelsie Benca-Bachman ◽

Victoria Risner ◽

Christopher G Beevers ◽

Brandon Gibb ◽

...

Keyword(s):

Suicidal Ideation ◽

Cognitive Reappraisal ◽

Twin Studies ◽

European Ancestry ◽

Summary Statistics ◽

Depression Severity ◽

Uk Biobank ◽

Polygenic Scores ◽

Adults And Children ◽

The Uk

Twin studies indicate that 30-40% of the disease liability for depression can be attributed to genetic differences. Here, we assess the explanatory ability of polygenic scores (PGS) based on broad- (PGSBD) and clinical- (PGSMDD) depression summary statistics from the UK Biobank using independent cohorts of adults (N=210; 100% European Ancestry) and children (N=728; 70% European Ancestry) who have been extensively phenotyped for depression and related neurocognitive phenotypes. PGS associations with depression severity and diagnosis were generally modest, and larger in adults than children. Polygenic prediction of depression-related phenotypes was mixed and varied by PGS. Higher PGSBD, in adults, was associated with a higher likelihood of having suicidal ideation, increased brooding and anhedonia, and lower levels of cognitive reappraisal; PGSMDD was positively associated with brooding and negatively related to cognitive reappraisal. Overall, PGS based on both broad and clinical depression phenotypes have modest utility in adult and child samples of depression.

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Faculty Opinions recommendation of Early parenteral nutrition in critically ill patients with short-term relative contraindications to early enteral nutrition: a randomized controlled trial.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718011916.793479251 ◽

2013 ◽

Author(s):

Bruce Bistrian

Keyword(s):

Randomized Controlled Trial ◽

Enteral Nutrition ◽

Parenteral Nutrition ◽

Critically Ill ◽

Critically Ill Patients ◽

Controlled Trial ◽

Early Enteral Nutrition ◽

Short Term ◽

Randomized Controlled ◽

Early Parenteral Nutrition

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Exploring activity levels in physical education lessons in the UK: a cross-sectional examination of activity types and fitness levels

BMJ Open Sport & Exercise Medicine ◽

10.1136/bmjsem-2020-000924 ◽

2021 ◽

Vol 7 (1) ◽

pp. e000924

Author(s):

Nick Beale ◽

Emma Eldridge ◽

Anne Delextrat ◽

Patrick Esser ◽

Oliver Bushnell ◽

...

Keyword(s):

Physical Activity ◽

Physical Education ◽

Multilevel Models ◽

Activity Levels ◽

Cross Sectional ◽

Registration Number ◽

Global Norms ◽

Cross Sectional Design ◽

The Uk ◽

Fitness Levels

ObjectivesTo establish pupil fitness levels, and the relationship to global norms and physical education (PE) enjoyment. To measure and describe physical activity (PA) levels during secondary school PE lessons, in the context of recommended levels, and how levels vary with activity and lesson type.MethodsA cross-sectional design; 10 697 pupils aged 12.5 (SD 0.30) years; pupils who completed a multistage fitness test and wore accelerometers to measure PA during PE lessons. Multilevel models estimated fitness and PE activity levels, accounting for school and class-level clustering.ResultsCardiorespiratory fitness was higher in boys than girls (ß=−0.48; 95% CI −0.56 to −0.39, p<0.001), within absolute terms 51% of boys and 54% of girls above the 50th percentile of global norms. On average, pupils spent 23.8% of PE lessons in moderate-to-vigorous PA (MVPA), and 7.1% in vigorous PA (VPA). Fitness-focused lessons recorded most VPA in co-educational (ß=1.09; 95% CI 0.43 to 1.74) and boys-only lessons (ß=0.32; 95% CI −0.21 to 0.85). In girls-only lessons, track athletics recorded most VPA (ß=0.13; 95% CI −0.50 to 0.75) and net/wall/racket games (ß=0.97; 95% CI 0.12 to 1.82) the most MVPA. For all lesson types, field athletics was least active (ß=−0.85; 95% CI −1.33 to −0.36). There was a relationship of enjoyment of PE to fitness (ß=1.03; 95% CI 0.83 to 1.23), and this relationship did not vary with sex (ß=−0.14 to 0.23; 95% CI −0.16 to 0.60).ConclusionsPE lessons were inactive compared with current guidelines. We propose that if we are to continue to develop a range of sporting skills in schools at the same time as increasing levels of fitness and PA, there is a need to introduce additional sessions of PE activity focused on increasing physical activity.Trial registration numberNCT03286725.

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The effect of early versus late lipid infusion in parenteral nutrition on the biochemical and cortical auditory evoked potential parameters in preterm neonates

Egyptian Pediatric Association Gazette ◽

10.1186/s43054-019-0006-6 ◽

2019 ◽

Vol 67 (1) ◽

Author(s):

Rania Mohamed Abdou ◽

Hoda Mahmoud Ibrahim Weheiba

Keyword(s):

Weight Gain ◽

Parenteral Nutrition ◽

Biochemical Parameters ◽

Evoked Potential ◽

Demographic Data ◽

Auditory Evoked Potential ◽

Preterm Neonates ◽

Lipid Infusion ◽

Significant Difference ◽

Cortical Auditory Evoked Potential

Abstract Background As brain activity depends greatly on the functions provided by lipid membranes, dietary fat in early life can affect the developing nervous system. Despite the adoption of an early more aggressive parenteral nutrition approach with amino acid infusions still reluctance to the early use of intravenous lipids in neonates. Aim To compare the effect of delayed versus early introduction of intravenous lipid in preterm on the biochemical parameters and on brain development by the cortical auditory evoked potential (CAEP) latency and amplitude. Methods This is a comparative study included 49 neonates admitted at the ain shams university NICUs. Participants were divided into two groups: 26 in group of early lipid infusion and 23 in late lipid infusion, Demographic data, and biochemical parameters were documented during the 1st 2 weeks of life. The CAEP was performed at age of 6 months. The latency and amplitude of P1 were recorded and compared between both groups. Results In the present work we found that group of early lipid infusion had reach their full oral intake earlier with shorter duration of parenteral nutrition and length of stay. They had better weight gain and significantly better glucose level control than group of late lipid infusion. There was no significant difference in the other chemical parameters between both groups expect for the higher incidence of cholestasis in the group of late lipid infusion. At 6 months of age, the group of early lipid infusion had significantly shorter latency and amplitude of P1 than the group of late lipid infusion. Conclusion Early effective nutrition positively affect feeding tolerance and weight gain and maturation of higher brain centers brain.

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