P2.I174: Utility of Ultrafiltration to Optimize Nutrition in Neonatal ECMO

Background: Neonates requiring extracorporeal membrane oxygenation (ECMO) constitute the most vulnerable group of pediatric patients. During ECMO, fluid overload is associated with increased morbidity and mortality. Therefore, managing organ dysfunction and fluid restriction are paramount, often taking precedence over nutrition compromising caloric intake. One promising approach to enhance nutrition is the incorporation of ultrafiltration (UF) techniques. UF was implemented into our institutional guidelines in July 2016. Despite widespread adoption of UF, its specific advantages on enhancing nutritional provision remain undetermined.

Methods: Demographics and nutritional data were collected retrospectively from charts of neonates on ECMO at the Texas Children’s Hospital West Tower neonatal intensive care unit between 2012 and 2022.
Neonates with gestational ages ≥ 34 weeks and ≥ 2 kg were included.
Neonates on ECMO for < 3 days were excluded.
Data were compared between neonates by era: “pre” or before July 2016 and “post” or on and after July 2016.
Calorie and protein information were collected from prescribed TPN and lipid emulsions.
The distributions of normally distributed variables were described with the mean ± standard deviation while the median (inter-quartile range) was used for quantitative variables that were not normally distributed. The Shapiro-Wilk test was used to assess normality. Frequencies (percentages) were used to summarize the distributions of categorical variables. The two-sample t-test and Wilcoxon rank sum test were used to compare the pre vs post cohorts in terms of quantitative variables that were and were not normally distributed, respectively, while Fisher’s exact test was used for categorical variables. Spearman’s correlation was used to assess the bivariate associations between quantitative variables.

Results: There was a total of 95 ECMO patients included in the study. Neonates post-July 2016 were found to receive higher mean values of amino acids [3.5 (3.3, 3.7) versus 3.0 (2.5, 3.3), p< 0.001)], TPN calories [(60.6 ±11.5 versus 55.1 ±12.8), p< 0.030], and lipid calories [20.9 (15.6, 24.9) vs 9.3 (6.9, 12.3), p< 0.001] compared to prior. Additionally, increasing UF was associated with increasing calorie administration but not amino acid administration. Limitations of our study: a retrospective study, small sample size, and a single institution study.

Conclusion: After inclusion of UF in the institutional ECMO guidelines, neonates received more calories, amino acids, and lipids. UF can assist but is not mandatory for improving nutrition.