PARENTERAL NUTRITION IN NEWBORNS TREATED IN PEDIATRIC INTENSIVE CARE UNIT (PICU), DEPARTMENT OF PEDIATRICS, UNIVERSITY HOSPITAL OF SPLIT FROM 2010 TO 2019

Ciljevi istraživanja: Ciljevi istraživanja bili su ispitati koliko je novorođenčadi liječene u Zavodu za intenzivnu pedijatriju Klinike za dječje bolesti KBC-a Split u razdoblju od 1. siječnja 2010. do 31. prosinca 2019. primalo parenteralnu prehranu i koliko je novorođenčadi koja je primala parenteralnu prehranu razvilo najtežu komplikaciju, kateter sepsu, te koji su bili najčešći uzročnici iste. Ispitanici i metode: U istraživanje je uključeno 178 novorođenčadi obaju spolova koji su primali parenteralnu prehranu. Novorođenčad je podijeljena u dvije skupine, u odnosu na vrstu parenteralne prehrane: one koji su primali potpunu parenteralnu prehranu i one koji su primali djelomičnu parenteralnu prehranu. Analizirali smo njihove demografske i antropometrijske karakteristike, porodnu anamnezu, pridružene dijagnoze, dijagnostičke i terapijske postupke te ishod liječenja (duljina hospitalizacije, preživljenje). Izvor podataka je bila medicinska dokumentacija. Rezultati: Od 451 novorođenčeta primljenog u Zavod za intenzivnu pedijatriju 178 (39,5%) novorođenčadi primalo je parenteralnu prehranu. PPP primalo je 133 (74,7%) djece od njih 178, dok je njih 153 (86,0%) primalo DPP, kombinaciju PP i EP. Najčešća indikacija za PP bila je prematuritet, kod 74 (41,6%) slučajeva, a zatim stanje poslije operacije gastrointestinalnog trakta kod njih 37 (20,8%). Periferni venski put imalo je 79 (44,4%) djece, a središnji 99 (55,6%). SVK je najčešće bio postavljen u umbilikalnu, potom potključnu pa u bedrenu venu. Najmanje je bilo PICC-a. Od ukupnog broja djece koja su primala parenteralnu prehranu 21 (11,8%) dijete razvilo je kateter sepsu, a pneumotoraks 3 (1,7%) djece. Najčešći bakterijski uzročnici kateter sepse bili su MRSE (26,9%), a potom koagulaza negativni Staphylococcus species (15,4 %) i Klebsiella pneumoniae ESBL+ (11,5%). Od gljivičnih uzročnika najčešća je bila Candida albicans (75%). Preživjelo je 148 (83,1%) novorođenčadi, a umrlo njih 30 (16,9%). Zaključci: Dokazali smo da je manji udio hospitalizirane novorođenčadi primao parenteralnu prehranu, također, da je manji udio njih razvio kateter sepsu te da su najčešći uzročnici kateter sepse u našem istraživanju u skladu s dostupnom medicinskom literaturom.Objectives: The objectives of the study were to determine the number of newborns treated in PICU, Department of Pediatrics, University Hospital of Split during the period of ten years (from January 1st 2010 to December 31st 2019) who received parenteral nutrition and to determine how many of them developed the most severe complication, catheter-related bloodstream infection (CRBSI), and the most frequent causative pathogens. Subjects and methods: The study included 178 newborns of both sexes who received parenteral nutrition. Newborns were divided into two groups, according to the type of parenteral nutrition they were receiving: those who were receiving total parenteral nutrition (TPN) and those who were receiving partial parenteral nutrition (PPN). We analyzed their demographic and anthropometric characteristics, perinatal anamnesis, associated diagnoses, diagnostic and therapeutic procedures they undergone, and treatment outcomes (duration of hospitalization, survival). The source of data was medical documentation. Results: Out of the 451 newborns admitted to the PICU, 178 (39.5%) of them received parenteral nutrition. 133 (74.7%) children received TPN, 153 (86.0%) received PPN, combination of parenteral (PN) and enteral nutrition (EN). The most common indication for PN was prematurity, in 74 (41.6%) cases, followed by surgical disorders of the gastrointestinal tract in 37 (20.8%). 79 (44.4%) children had peripheral and 99 (55.6%) had a central venous catheter (CVC). CVC was mostly inserted via the umbilical vein, then subclavian and femoral vein. Just a few were peripherally inserted central catheters. Out of the total number of children receiving parenteral nutrition, 21 (11.8%) children developed CRBSI. Pneumothorax occurred in 3 (1.7%) children. CRBSI was caused by MRSE in 26.9% of cases, followed by coagulase-negative Staphylococcus species (15.4%) and Klebsiella pneumoniae ESBL+ (11.5%). Candida albicans was the most common fungal pathogen (75%). 148 (83.1%) newborns survived and 30 (16.9%) died. Conclusions: We showed that a smaller share of hospitalized infants received PN, also, that a smaller share of them developed CRBSI. The most common causes of CRBSI in our study are as ones found in medical literature