Administration of parenteral nutrition during therapeutic hypothermia: A population level observational study using routinely collected data held in the National Neonatal Research Database

Abstract

Background Parenteral nutrition is commonly administered during therapeutic hypothermia. Randomised trials in critically ill children indicate that parenteral nutrition may be harmful. Objective To examine the association between parenteral nutrition during therapeutic hypothermia and clinically important outcomes. Design Retrospective, population-based cohort study using the National Neonatal Research Database; propensity scores were used to create matched groups for comparison. Setting National Health Service neonatal units in England, Scotland and Wales. Participants 6030 term and near-term babies, born 1/1/2010 and 31/12/2017, who received therapeutic hypothermia; 2480 babies in the matched analysis. Exposure We compared babies that received any parenteral nutrition during therapeutic hypothermia with babies that did not. Main outcome measures 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. Results 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). Conclusions 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.