Association between late parenteral nutrition initiation and length of hospital stay in late preterm and term infants: A retrospective cohort study

Background

We aimed to determine the association between timing of parenteral nutrition initiation and length of hospital stay in late preterm and term infants.

Methods

This retrospective cohort study includes infants ≥35 weeks gestation admitted to a Pediatrix Medical Group neonatal intensive care unit in 2009–2019. Propensity score matching was used to control for demographics, delivery characteristics, and severity of illness. The primary outcome was length of hospital stay. Secondary outcomes were duration of mechanical ventilation, late-onset sepsis, and mortality. Early parenteral nutrition was defined as initiation on the day of birth and late as initiation after.

Results

The total cohort has 475,708 infants; of 259,495 eligible infants, 97,577 (37.6%) received parenteral nutrition. After propensity score matching, outcomes were analyzed for 13,712 infants. Infants receiving late parenteral nutrition (n = 6856) have no difference in length of hospital stay compared with early. Analysis of secondary outcomes reveals no differences between groups. Negative binomial regression shows decreased length of hospital stay when parenteral nutrition is initiated on days of life 1–3 compared with day of birth or days 4–10.

Conclusion

Initiating parenteral nutrition on day 1 or later vs day of birth is not associated with increased length of hospital stay in late preterm and term infants. Exploratory analysis suggests that initiation of parenteral nutrition on days 1–3 instead of day of birth or days 4–10 is associated with decreased hospital stay. Prospective clinical trials are needed to better understand optimal timing of parenteral nutrition in this population.