Will the content of neonatal parenteral nutrition increase CLABSI rates?


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


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.


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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