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A safe and efficacious preventive strategy in the high-risk surgical neonate: cycled total parenteral nutrition

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Abstract

Introduction

Hepatic dysfunction in patients reliant on total parenteral nutrition (TPN) may benefit from cycled TPN. A concern for neonatal hypoglycemia has limited the use of cycled TPN in neonates less than 1 week of age. We sought to determine both the safety and efficacy of cycled TPN in surgical neonates less than 1 week of age.

Methods

A retrospective chart review was conducted on surgical neonates placed on prophylactic and therapeutic cycled TPN from January 2013 to March 2016. Specific emphasis was placed on identifying incidence of direct hyperbilirubinemia and hypoglycemic episodes.

Results

Fourteen neonates were placed on cycled TPN; 8 were prophylactically cycled and 6 were therapeutically cycled. Median gestational age was 36 weeks (34, 37). Sixty-four percent (n = 9) had gastroschisis. There was no difference between the prophylactic and therapeutic groups in incidence of hyperbilirubinemia > 2 mg/dL (3 (37%) vs 5 (83%), p = 0.08) or the length of time to development of hyperbilirubinemia [24 days (4, 26) vs 27 days (25, 67), p = 0.17]. Time on cycling was similar though patients who were prophylactically cycled had a shorter overall time on TPN. Three (21%) infants had documented hypoglycemia, but only one infant became clinically symptomatic.

Conclusion

Prophylactic TPN cycling is a safe and efficacious nutritional management strategy in surgical neonates less than 1 week of age with low rates of hypoglycemia and a shorter total course of TPN; however, hepatic dysfunction did not appear to be improved compared to therapeutic cycling.

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Abbreviations

GIR:

Glucose infusion rate

TPN:

Total parenteral nutrition

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Funding

No funding was received to conduct this study.

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Authors and Affiliations

  1. Department of Surgery, Children’s Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64108, USA

    Joseph A. Sujka, Katrina L. Weaver, Joel D. Lim, Deborah J. Biondo, David Juang, Pablo Aguayo & Richard J. Hendrickson

  2. Johns Hopkins All Children’s Hospital, Saint Petersburg, USA

    Katherine W. Gonzalez

Authors
  1. Joseph A. Sujka
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  2. Katrina L. Weaver
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  3. Joel D. Lim
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  4. Katherine W. Gonzalez
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  5. Deborah J. Biondo
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  6. David Juang
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  7. Pablo Aguayo
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  8. Richard J. Hendrickson
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Contributions

JS: Contributed to conception or design, drafted the manuscript, critically revised the manuscript, gave final approval, agrees to be accountable for all aspects of work ensuring integrity and accuracy. KW: Contributed to conception or design, contributed to acquisition of data, drafted the manuscript, critically revised the manuscript, gave final approval, agrees to be accountable for all aspects of work ensuring integrity and accuracy. JDL: Contributed to conception or design, drafted the manuscript, critically revised the manuscript, gave final approval, agrees to be accountable for all aspects of work ensuring integrity and accuracy. DJB: Contributed to conception or design, drafted the manuscript, critically revised the manuscript, gave final approval, agrees to be accountable for all aspects of work ensuring integrity and accuracy. DJ: Contributed to conception or design, drafted the manuscript, critically revised the manuscript, gave final approval, agrees to be accountable for all aspects of work ensuring integrity and accuracy. PA: Contributed to conception or design, drafted the manuscript, critically revised the manuscript, gave final approval, agrees to be accountable for all aspects of work ensuring integrity and accuracy. RJH: Contributed to conception or design, drafted the manuscript, critically revised the manuscript, gave final approval, agrees to be accountable for all aspects of work ensuring integrity and accuracy.

Corresponding author

Correspondence to Richard J. Hendrickson.

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Conflict of interest

The authors have no conflict of interest to disclose.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was waived by our IRB due to the fact that the data collected for this study was retrospective and de-identified.

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Sujka, J.A., Weaver, K.L., Lim, J.D. et al. A safe and efficacious preventive strategy in the high-risk surgical neonate: cycled total parenteral nutrition. Pediatr Surg Int 34, 1177–1181 (2018). https://doi.org/10.1007/s00383-018-4351-0

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  • DOI: https://doi.org/10.1007/s00383-018-4351-0

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