Will the content of neonatal parenteral nutrition increase CLABSI rates?

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“Increasing the macronutrient content of a standardised concentrated neonatal PN regimen does not increase CVC complication rates.” Whitby et al (2014).

Reference:

Whitby, T., Morgan, C., McGowan, P. and Turner, M. (2014) PC.53 Concentrated parenteral nutrition solutions and central venous catheter complications in preterm infants. Archives of Disease in Childhood. Fetal and Neonatal Edition. 99(Suppl 1), p.A54.

Abstract:

BACKGROUND: The Standardised, Concentrated with Added Macronutrients Parenteral (SCAMP) nutrition regimen is a method of hyperalimentation shown to improve early head growth in very preterm infants.(1) It is possible that increasing the osmolality and lipid/glucose content of neonatal parenteral nutrition (PN) may reduce central venous catheter (CVC) life and/or increases late-onset sepsis (LOS; >72 h) sepsis rates.(2) We aimed to compare line life and LOS rates in VPI randomised to receive SCAMP or control PN.

METHODS: Control PN was started at birth and infants (<29 weeks, <1200 g) randomised (d2-5) to switch to SCAMP or remain on control PN. CVC, blood culture (BC) and C-reactive protein (CRP) data were collected d1-28.

RESULTS: Infants were randomised to SCAMP (n = 74) and control (n = 76) groups respectively. Survival curve analysis revealed no differences in line life between groups. The CVC-associated infection rates (per 1000 CVC days) were 18.5 (SCAMP) and 23.9 (control). There were no differences in CVC use/type or duration or in positive/negative BC with/without associated CRP rise in SCAMP versus control groups. fetalneonatal;99/Suppl_1/A54-b/T1T1T1 Abstract PC.53 Table 1 Comparison between SCAMP and control groups (28 day survivors) SCAMP n = 66 Control n = 69 SCAMP n = 66 Control n = 69 Blood cultures (BC) Number of cultures Number of infants p All 110 129 53 (80%) 61 (88%) 0.24 All negative 81 89 48 (73%) 53 (77%) 0.69 All positive 29 40 20 (30%) 29 (42%) 0.21 All CVC-related 23 30 17 (26%) 24 (35%) 0.27

CONCLUSION: Increasing the macronutrient content of a standardised concentrated neonatal PN regimen does not increase CVC complication rates.

REFERENCES: Morgan C, McGowan P, Herwitker S, et al. Pediatrics 2014;133:e620-8 Moltu SJ, Strømmen K, Blakstad EW, et al. Clin Nutr 2013;37:207-12.

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