Neonatal Parenteral Nutrition: Is It All In Vein ?

Booth D, Ball P, Broadbent R.
Pharmacy Department, Dunedin Hospital and
School of Pharmacy, University of Otago,New Zealand.

Received: November 1997

Journal

 

Introduction

 In 1993 the Neonatal Intensive Care Unit (NICU) of Dunedin Hospital adopted standardised total parenteral nutrition (TPN) formulations in place of individual formulations. Published and unpublished studies from overseas suggested that under infusion could be a common problem with standardised formulations as their use did not allow the prescriber to make allowance for concurrent fluid and electrolyte therapy. The neonatal period is a time of rapid growth, and malnutrition during this period is a cause for serious concern. The aim of the study was to examine the nutritional adequacy of TPN at this hospital in terms of what was prescribed and what the patient actually received.
Methods The study was conducted over a six month period from 1/4/96 to 30/9/96.
All patients in the NICU receiving TPN were included. The infused intake was determined by weighing the solution before and after infusion.
Allowance was made for the infusion line 'dead space'.
This information was cross checked with the fluid balance charts.
All glucose and electrolytes infused as concurrent therapy were included in the calculations, together with any enteral energy intake.
The prescribed energy intake was compared to recommendations taken from the literature.
Results
  • Twenty seven infants received a total of 227 line-days of therapy and complete data was available for 113 line-days.
  • While the prescribed energy intake did not differ significantly from the recommended energy intake, the infused TPN intake was significantly lower (p<0.01) than either the prescribed or recommended intakes.
  • Subgroup analysis was performed on the 37% of line days on which no enteral intake was administered.
  • In this group, both the prescribed energy intake and the energy administered were significantly lower than the ideal intake (p<0.001).
  • In 81% of these line days, the actual energy intake was less than 80% of that recommended in the literature.
Conclusions
  • The majority of patients studied did not actually receive either the intake they had been prescribed or their recommended intake.
  • The extent of under-infusion is a cause for concern.

 


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