Abstract
OBJECTIVE: To reach nutrition goals for neonatal patients, institutions often exceed the American Society for Parenteral and Enteral Nutrition recommended maximum of 900 mOsm/L for peripheral parenteral nutrition (PPN). Evidence is limited regarding the safety of PPN osmolarities above this maximum, specifically in neonatal patients. The purpose of this study was to determine if PPN with osmolarities ≥ 1000 mOsm/L is associated with an increased rate of line-related complications. METHODS: This retrospective study included infants admitted to the Penn State Health Children's Hospital NICU from January 1, 2013, through July 31, 2018, who were receiving PPN, to assess if solutions with osmolarities ≥ 1000 mOsm/L versus < 1000 mOsm/L are associated with increased rates of line-related complications. RESULTS: A total of 200 patients were included in the study, and 618 individual PPN days were analyzed. Baseline patient characteristics were similar between groups. The PPN osmolarities ranged from 610 to 1267 mOsm/L. Overall, the incidence of line-related complications for PPN < 1000 (n = 342 PPN days) and ≥ 1000 mOsm/L (n = 276 PPN days) was 28.9% and 29.0%, respectively (OR 1.00 [95% CI 0.72-1.40, p = 0.99]). Irrespective of PPN osmolarity, infants weighing > 1.5 kg had significantly greater odds of experiencing line complications compared with patients < 1 kg, but showed no difference compared with patients weighing 1 to 1.5 kg. CONCLUSIONS AND RECOMMENDATIONS: There were no significant differences in the incidence of line-related complications in NICU patients receiving PPN with osmolarities 1000 to 1250 versus < 1000 mOsm/L.