Risks and benefits of prophylactic cyclic parenteral nutrition in surgical neonates. Nutr Clin Pract 2013 Dec;28(6):745-52
Date
10/11/2013Pubmed ID
24107391Pubmed Central ID
PMC5727895DOI
10.1177/0884533613502813Scopus ID
2-s2.0-84888604826 (requires institutional sign-in at Scopus site) 14 CitationsAbstract
BACKGROUND: Cyclic parenteral nutrition (PN) is used for both the treatment and prevention of parenteral nutrition-associated liver disease (PNALD). Early initiation of prophylactic cyclic PN may not be well tolerated in young neonates. Our objective was to test the hypothesis that prophylactic cyclic PN initiated prior to the onset of hyperbilirubinemia is associated with younger age at initiation, lower bilirubin levels, and similar rates of adverse events compared to therapeutic cyclic PN initiated after established cholestasis in surgical neonates.
METHODS: A retrospective review of infants with gastrointestinal disorders requiring surgical intervention who received cyclic PN 2006-2011 was performed.
RESULTS: Of the 43 infants eligible for analysis, 23 received prophylactic and 20 received therapeutic cyclic PN. Infants in both groups were comparable in demographics, surgical diagnoses, and illness severity. At initiation of cyclic PN, infants with prophylactic cyclic PN were significantly younger in chronologic (P = .003) and postmenstrual age (P = .029). Prophylactic cyclic PN was associated with a significantly lower incidence of hyperbilirubinemia (P = .001), lower maximum conjugated bilirubin (P < .0001), and lower last checked conjugated bilirubin (P = .032) compared to the therapeutic cyclic PN. The incidence of hypoglycemia, hyperglycemia, and hypertriglyceridemia was similar for the 2 groups.
CONCLUSIONS: There may be a potential benefit to initiating cyclic PN prior to the development of hyperbilirubinemia in surgical neonates. Early initiation of prophylactic cyclic PN does not appear to increase the risk for adverse events.
Author List
Nghiem-Rao TH, Cassidy LD, Polzin EM, Calkins CM, Arca MJ, Goday PSAuthors
Casey Matthew Calkins MD Professor in the Surgery department at Medical College of WisconsinLaura Cassidy PhD Associate Dean, Professor in the Institute for Health and Equity department at Medical College of Wisconsin
T Hang Nghiem-Rao MD Associate Professor in the Pediatrics department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
Age FactorsBilirubin
Cholestasis
Female
Gastrointestinal Diseases
Humans
Hyperbilirubinemia
Incidence
Infant, Newborn
Infant, Newborn, Diseases
Infant, Premature
Liver Diseases
Male
Parenteral Nutrition
Postoperative Complications
Retrospective Studies
Risk Assessment
Risk Factors
