Nutrition and Metabolism Research Oral Paper Session Abstracts

Background: Trace elements (TE) are essential micronutrients that the body requires in small doses to support normal physiological processes and allow optimal growth and health.There is limited data to suggest the optimal TE level monitoring strategy in infants on long-term parenteral nutrition (PN).In 2013, The Nutrition Support Team Steering Committee (NSTSC) at our institution implemented a protocol that provided dosing and monitoring parameters for zinc, copper, manganese, chromium, and selenium.The objective of this study was to evaluate if appropriate monitoring occurred in patients on PN in the NICU pre-and post-implementation of a protocol.Methods: This was a retrospective cohort study from January 1, 2010 -December 31, 2020, evaluating TE monitoring both pre-implementation and post-implementation of the NSTSC protocol.A random number generator was utilized to select a convenient sample of patients for each group.There were 30 infants in the pre-protocol group and 30 infants in the post-protocol group.The primary outcome for this study focused on answering if an initial TE level panel was collected per-protocol, defined as drawn when on PN 60-90 days or if cholestasis developed.Secondary outcomes included evaluating if follow-up monitoring occurred per-protocol or every 1 to 3 months after the initial TE collection, if TE supplements were adjusted, and number of elevated (or deficient) TE levels.Nominal data was analyzed using chi-square and continuous data using Mann-Whitney or T-test.A p-value of < 0.05 was considered statistically significant.Results: Baseline characteristics were similar (Table 1) between groups.The initial TE level panel was drawn per-protocol in 18/30 (60%) patients in the pre-protocol group vs 22/30 (73%) patients in the post-protocol group (p-value = 0.273).Follow-up levels were drawn perprotocol in 10/14 (71%) patients in the pre-protocol group vs 15/16 (94%) patients in the post-protocol group (p-value = 0.157).When evaluating the secondary outcome of TE supplements being adjusted based on TE level panel results, 20/45 (44%) vs 37/49 (76%) of the TE panels in the pre-protocol and post-protocol group respectively were adjusted based on TE level results (p-value = 0.002).The number of elevated (or deficient) TE levels in both groups were also evaluated (Table 2).The pre-protocol group had a greater number of manganese and chromium levels that were elevated while selenium levels were low as compared to the post-protocol group. Conclusion:There was no difference seen between the pre-and post-protocol groups for appropriate TE monitoring both at initial TE panel collection and follow-up TE panel collection.When evaluating TE supplementation adjustments, there was more TE panels adjusted in the postprotocol group compared to the pre-protocol group based on resulted TE levels.Evaluating elevated and deficient TE levels, there were still greater than 50% selenium levels that were low in the post-protocol group which could warrant revisiting current selenium supplementation