692 - The Clinical Significance of Nutrition in Neonatal ECMO

Publication Number: 692.6601

Amanda J. Zayek, Baylor College of Medicine, Houston, TX, United States; Sharada H. Gowda, Baylor College of Medicine, Houston, TX, United States; Joseph Hagan, Baylor College of Medicine, Houston, TX, United States; Pablo Lohmann, Baylor College of Medicine, Houston, TX, United States; Amy Hair, Baylor College of Medicine, Houston, TX, United States; Joseph A. Garcia-Prats, Baylor College of Medicine, Houston, TX, United States; Caraciolo Fernandes, Baylor College of Medicine, Houston, TX, United States

Background: Neonates who require extracorporeal membrane oxygenation (ECMO) have a high risk of morbidity and mortality, often increased by fluid overload. Managing organ dysfunction and fluid restriction are paramount, and often take precedence over nutrition. We previously found ultrafiltration (UF) alone does not impact nutritional provision in neonates on ECMO. However, there are no studies investigating the association of net balance with nutritional provision in neonates on ECMO, or the relationship between nutritional provision in neonates on ECMO and long-term anthropometric data.

Objective: We sought to investigate the relationship between net fluid balance and delivery of nutrition, and the association of nutritional delivery in neonates on ECMO with anthropometric measures prior to discharge.

Design/Methods: We reviewed the medical records of neonates with GA ≥ 34 weeks and BW ≥ 2 kg at a quaternary care NICU. Data collected included TPN data on ECMO, fluid balance on ECMO, medications, and anthropometric data. Pearson’s correlation and linear regression analysis were used to explore the associations of net balance on ECMO with amino acid/ calorie administration, and to investigate the associations of amino acid/ calorie administration with change in z-score. Logistic regression and receiver operating characteristic curve analysis were used to examine the associations of amino acid/calorie administration with growth failure.

Results: Ninety-five patients were included in the net balance analysis. Fifty-one patients were included in the long-term anthropometric data analysis. A negative net balance on ECMO was associated with increased amino acid (p=0.046, Figure 1) and calorie provision (p=0.013, Figure 2). UF and diuretic use were not independently associated with a negative balance on ECMO.
Median growth velocity of the cohort was 24.0 (interquartile range: 21.4 – 26.0) g/day. Increased amino acid provision was not associated with a positive change in Z-score for weight (Figure 3). Increased calorie provision was associated with a positive change in Z-score for weight (p=0.006, Figure 4). Amino acid provision was not associated with predicting growth failure (p=0.180, Figure 5). Calorie provision < 67.5 kcal/kg/day was associated with predicting growth failure (p=0.006, Figure 6).

Conclusion(s): In this study, we found a negative fluid balance on ECMO is associated with increased amino acid and calorie administration on ECMO. Increased calorie, but not protein, administration is associated with positive changes in weight z-score. Decreased calorie provision is associated with predicting growth failure.

ECMO Analysis- Inclusion and Exclusion Criteria


Association between Nutritional Provision and Anthropometric Measures


ECMO Analysis- Inclusion and Exclusion Criteria


Association between Nutritional Provision and Anthropometric Measures