761 - Decrease in the use of parenteral fluids in premature infants from 30 to 34 weeks of gestation at birth, 5 year experience

To administer nutrition/fluids, whenever possible, we used oral fluids by suction or otherwise by oral/nasogastric tube at volumes of 70-80 mL/Kg/day divided every 3 hours, starting in the first two hours of life, with 5 mL increments every 12-24 hours until 200 mL/K/day was achieved, always using his/her own mother's milk when available. 

For this work, we review all premature babies between 30-34 weeks of gestation in two time periods who were born at our hospital, the first from 01/01/2010 to 11/30/2017 and the second from 01/01/2018 to 08/15/2022. The number of cases with and without PF, the incidence of infection, the weight at admission and discharge, and the change in the weight Z score (calculated using Fenton 2013 growth chart) between birth and discharge were compared. Both the anthropometric and outcome variables were compared using the different statistical methods according to each variable. Infection was defined as positive blood or cerebrospinal fluid cultures and NEC was defined as Bell stage >I. 

 

Results: We found 920 cases with the described characteristics. (see tables 1 and 2) The groups before and after the intervention did not show significant differences in their general demographic characteristics. We observed a decrease use of PF in the second period, from 425(82.0%) before to 297(26.2%) after implementation, p < 0.0001 and fewer days of PF use (4.1 days/average before vs 1.3 after, p < 0.0001). Infections went from nine cases before to two cases after but it was not statistically significant. There were no complications due to less use of PF. NEC patients were not significant different among groups and all received PF from birth.

Conclusion(s):

This work confirms that the use of routine PF is not necessary in all cases and tolerance to oral feeds should be assessed in these premature infant groups between 30 and 34 weeks of gestation at birth, before deciding to use PF. There was appropriate growth, which suggests this protocol is adequate for good growth in this population and NEC was not increased and all cases happened while in PF. A larger sample size is required to detect differences in low incidence events such as infections and NEC.