Early Versus Late Initiation of Postoperative TPN in Neonates: A Retrospective Study

ObjectivesTo compare short-term clinical outcomes according to the timing of postoperative total parenteral nutrition (TPN) initiation (early <7 days vs late [&ge;]7 days) in surgical neonates. Design, Setting, and PatientsThis single-center retrospective cohort study included neonates admitted to the NICU of Nagoya University Hospital between June 2011 and November 2023. Eligible patients underwent surgery within 30 days of birth and received postoperative TPN. Patients were classified into two groups according to the timing of TPN initiation after surgery: the early TPN group (<7 days; n = 235) and the late TPN group ([&ge;]7 days; n = 55). Main Outcome MeasuresInfection rate requiring antibiotics. ResultsBaseline characteristics were comparable between the groups. No significant difference was observed in the proportion of patients requiring antibiotics within one month after TPN initiation (early TPN group 33.6% vs late TPN group 40.0%, OR =0.76, 95% CI: 0.40-1.46, p = 0.63). Compared with the late TPN group, the early TPN group had a significantly shorter duration of intubation (5.0 days [IQR: 2-18] vs 11 days [IQR: 2.9-34], p < 0.01). The incidence of hypoglycemia was significantly lower in the early TPN group (39.9% vs 61.8%, OR = 0.40, 95% CI: 0.21-0.77, p < 0.01). ConclusionIn neonates requiring surgery, delayed initiation of TPN conferred no clinical advantage and was associated with longer intubation and a higher risk of hypoglycemia. Prospective randomized controlled trials are warranted to validate these findings. O_TEXTBOX* What is already known on this topic -Early supplementation with adequate nutrition is useful for the development and growth of newborns. However, a previous study suggested that it is better to wait one week before starting TPN in critically ill newborns. There are no reports on whether delaying TPN for one week is beneficial in newborns who are unable to advance enteral nutrition. * What this study adds -In newborns who underwent surgery, early initiation of TPN did not increase the infection rate. Moreover, several short-term outcomes were improved in the group that received early TPN. * How this study might affect research, practice or policy -This study suggests that early initiation of TPN may provide benefits for postoperative neonates who are at high risk of insufficient enteral intake. These findings highlight the need for prospective randomized controlled trials to further evaluate the role of early TPN initiation in this specific population. C_TEXTBOX