9 INFECTIOUS AND THROMBOTIC RISKS OF PARENTERAL NUTRITION IN HOSPITALIZED PEDIATRIC IBD PATIENTS. (18th January 2018)

• Record Type: Journal Article
• Authors: Egberg, Matthew D; Barnes, Edward L; Kappelman, Michael D
• Is Part Of: Inflammatory bowel diseases. Volume 24(2018)Supplement 1
• Page Start: S54
• Page End: S54
• Publication Date: 2018-01-18
• Subjects: Inflammatory bowel diseases -- Periodicals; Colitis, Ulcerative -- Periodicals; Crohn Disease -- Periodicals; Inflammatory Bowel Diseases -- Periodicals; 616.344
• DOI: 10.1093/ibd/izy037.017
• Languages: English
• ISSNs: 1078-0998

Abstract

Abstract: Background: Among hospitalized pediatric inflammatory bowel disease (IBD) patients, the decision to initiate parenteral nutrition (PN) involves balancing the nutritional benefits against the risks of infectious and thrombotic complications. However, the absolute risks of these complications remains unknown. We sought to 1) assess time trends in the use of PN among hospitalized pediatric patients with IBD and, 2) determine the rate of and risk factors for infectious and thrombotic complications. Methods: We performed a cross-sectional analysis of 1997–2012 data from the Healthcare Cost and Utilization Project Kids' Inpatient Database (KID). We used ICD-9 diagnosis codes to identify pediatric patients (<18 years of age) with discharge diagnoses of Crohn's disease (CD), ulcerative colitis (UC), PN, thrombus formation, and PN-associated infections (sepsis, septic arteritis, bacteremia, endocarditis, cellulitis). We used descriptive and bivariate statistics to evaluate PN utilization, complications, and risk factors. We then used multivariate logistic regression to evaluate the association between PN and infection/thrombotic complications, while adjusting for age, race, gender, disease type and surgical status. Results: PN was utilized in 4, 526 (11.1%) of 40, 744 IBD hospitalizations. The proportion of hospitalizations requiring PN did not differ by CD vs UC or by calendar year. Overall, 8.7% of PN patients experienced an infectious complication and 1.5% experienced a thrombotic complication. In multivariate analysis, PN was an independent risk factor for infection (OR 2.9, 95% confidence interval (CI) 2.6–3.3) and thrombus (OR 4.0, 95% CI 2.9–5.6). Other factors associated with these complications are shown in Table 1. Conclusion: Hospitalized pediatric IBD patients receiving PN are at increased risk for infectious and thrombotic complications. Clinicians must balance these risks with the benefits of PN and consider alternatives such as enteral nutrition.