WIP 46 - Investigating Osmolality of Nutrition and Medications Received by Preterm Infants and Potential Risk of Receiving Diagnosis of Necrotizing Enterocolitis

Publication Number: WIP 46.7501

Michelle Y. Zhou, University of New Mexico School of Medicine, Albuquerque, NM, United States; Mónica C. Gierbolini Collazo, University of New Mexico School of Medicine, Albuquerque, NM, United States; Rachel Leung, University of New Mexico Children's Hospital, Albuquerque, NM, United States; Kayla Novick, University of New Mexico Children's Hospital, Albuquerque, NM, United States; Jessica M. Gross, University of New Mexico Health Sciences Center, Albuquerque, NM, United States; Jessie Maxwell, University of New Mexico School of Medicine, albuquerque, NM, United States; Hellen Ko, University of New Mexico School of Medicine, Albuquerque, NM, United States; Estephanie Rivero, University of New Mexico School of Medicine, Albuquerque, NM, United States

Background: The American Academy of Pediatrics (AAP) initially made recommendations in 1976 that the osmolality of enteral infant feeds should not exceed 450 mOsm/kg until there was further evidence on if hyperosmolar components contribute to the development of necrotizing enterocolitis (NEC) in preterm infants. There have not been updated guidelines since, and with commonly used medications within the neonatal intensive care unit (NICU) including high-osmolality medications like ergocalciferol (177,000 mOsm/kg) and multivitamin and iron drops (10,160 mOsm/kg), it is crucial to determine if osmolality of enteral components is associated with a diagnosis of NEC.

Objective: This project aims to examine for any existing relationship between the osmolality of enteral components (including feeds, fortification, and oral medications) received by preterm infants and a diagnosis of necrotizing enterocolitis.

Design/Methods: This is an ongoing retrospective chart review of all infants ≤ 35 0/7 weeks gestation with no known gastrointestinal abnormalities born at a single tertiary care hospital between January 1, 2020, and December 31, 2021. Local IRB approval was obtained. Data collected includes feed volumes and type (mL), fortification (kcal), and medication volumes (mL) within a 2-week period. Demographic information collected includes gestational age, delivery route, sex of infant, birth and discharge weights, and any drug exposure in utero. Additional clinical information obtained includes diagnosis of NEC (if present) and management, medical or surgical.

An institution-specific calculator was designed to calculate the average osmolality (mOsm/kg H₂O) of all enteric components received within the 2-week period. Statistical analysis will include chi-square tests and multivariate logistic regression to investigate if there is a significant association between osmolality of enteral components and risk of NEC. Of 324 eligible patients, 103 charts have been reviewed. Estimated timeline for completion of chart review is January 1st, 2025, with final analysis finished by March 1st, 2025.