1055 All-In-One Versus Two-Compartment Parenteral Nutrition in Extremely Preterm Infants < 27 Weeks Gestation and < 1000 G Birthweight (ELBWI)

Abstract

Background and aims: Evidence suggests standardized total parenteral nutrition (TPN) confers benefits over individualized TPN in terms of availability, nutritional intake, cost-effectiveness and maybe patient safety (e.g. infections). However, it is unclear whether all-in-one or two-comparment (lipid separate) standardised preparations are more beneficial. This study aims to specifically address this question in a group of ELBWI.

Methods: A retrospective matched-pair cohort analysis was carried out of 25 ELBWI ≤ 27 weeks gestation, born at the Royal Sussex County Hospital, Brighton (UK), between January 2005 - December 2006 and January - December 2008. The early cohort received all-in-one TPN, while the later received two-component. They were matched for gestation, birth weight, admission duration, age at initiation and duration of TPN, and additional enteral feeds. Small for gestational age infants and infants with congenital anomalies were excluded. Clinical outcomes were daily weight gain, infectious and metabolic complications, and oxygen requirement at discharge. Daily cost of treatment was also compared.

Results: There was no statistically significant difference in daily growth, triglyceride and bilirubin levels, oxygen requirement at discharge or financial cost.

There was a statistically significant increase in episodes (5 [range 3-9] vs. 3 [range 1-6]; p = 0.016) and days of antibiotic treatment (33 [range 14-62] vs. 20 [range 5-51]; p = 0.017) in the all-in-one group.

Conclusion: All-in-one TPN seems to increase the risk of infection without conferring any clinical or economic benefits. Its use in ELBWI should probably be abandoned.

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