628 - Early Versus Delayed Initiation of Postoperative TPN in Neonates Undergoing Surgery: A Retrospective Study

Publication Number: 628.4802

Nao Takami, Nagoya University Hospital, Nagoya, Aichi, Japan; ryosuke Miura, Nagoya university, Nagoya, Aichi, Japan; Yukako Muramatsu, Nagoya University Hospital, Nagoya, Aichi, Japan; Masahiro Kato, Nagoya University, Nagoya, Aichi, Japan; Kazuto Ueda, Nagoya University, Nagoya, Aichi, Japan; Takashi Maeda, Nagoya university Hospital, Nagoya, Aichi, Japan; Ryuichi Tanaka, Nagoya University Hospital, Nisshin-shi, Aichi, Japan; Toshihiko Suzuki, Nagoya University Hospital, Nagoya, Aichi, Japan; Yoshiaki Sato, Nagoya University Hospital, Nagoya, Aichi, Japan

Background: Newborns are highly susceptible to malnutrition, and preventing protein catabolism in critically ill neonates is crucial for their nutritional status, electrolyte balance, and neurodevelopment. Many neonates requiring early surgical intervention cannot receive adequate enteral nutrition, necessitating total parenteral nutrition (TPN). A prior study indicated that delaying TPN initiation post-surgery for one week might promote earlier ICU discharge and reduce infection risk. Until 2019, our NICU initiated TPN soon after surgery, but following this report, we shifted to starting TPN from postoperative day seven or later.

Objective: We evaluated whether delayed TPN initiation benefits neonates undergoing early surgical intervention in terms of mortality, infection rates, and hospital stay length.

Design/Methods: This single-center, retrospective study included neonates admitted to the NICU at Nagoya University Hospital from June 2011 to November 2023, who required surgery within their first month and postoperative TPN. Patients were divided into an early TPN group (TPN started within seven days post-surgery; before 2019) and a delayed TPN group (TPN started after seven days; from 2019 onward). Outcomes assessed included mortality, infection rates requiring antibiotics within one month of TPN initiation, and NICU stay length. Statistical analyses were conducted using chi-square tests for categorical variables and Mann-Whitney U tests for continuous variables.

Results: Among 331 neonates who underwent early surgery and received postoperative TPN, 186 (56%) were male, with a median gestational age of 37 weeks and 3 days, and a median birth weight of 2,550 grams. Most surgeries were gastrointestinal, with diaphragmatic hernia being the most common. TPN was initiated within seven days in 273 cases and after seven days in 58 cases. Mortality was reported in 4 cases, with no significant difference between the groups (p = 0.87). Of the 114 cases with infections within one month of TPN initiation, there was no significant difference between the early (32%, 89 cases) and delayed (43%, 25 cases) TPN groups (p = 0.54). The median NICU stay was significantly longer in the delayed TPN group (67.5 days) compared to the early TPN group (49.0 days, p = 0.046).

Conclusion(s): Delayed initiation of TPN in neonates requiring surgery may not confer benefits and is associated with a longer hospital stay. Prospective randomized trials are needed for further validation.