Could Commercial Formulations Replace Individualized Prescription in Pediatric Home Parenteral Nutrition?

Abstract

Objectives:Standard parenteral nutrition (PN) solutions are safe and can meet the nutritional requirements of a significant number of pediatric patients. However, they may not always be adequate for those on long term PN. We aimed to compare the composition of individually tailored prescriptions in a pediatric population on home PN with that of available commercial PN formulations.Methods:Retrospective analysis of the individual prescriptions of metabolically stable pediatric patients on home PN over a 1-year period (March 2019 to March 2020). These were compared with commercially available solutions with electrolytes, and replacement was considered adequate if three successive criteria were met: non-protein calorie to volume ratio (maximum variation 15%); non-protein calorie to nitrogen ratio (NPC:N) (maximum variation either 20% for long term use or 35% for possible short term use); electrolyte concentration (maximum increase 20%).Results:Twenty-four patients were included (67% male; median age 7.5 years). The most common diagnosis was short bowel syndrome (58%). Replacement with a standard formulation was considered appropriate for possible short term use (maximum variation of 35% in NPC:N) in 16 (67%) patients and for long term use (maximum variation of 20% in NPC:N), the number of patients decreased to 10 (42%).Conclusions:Standard PN solutions can be adequate for a significant proportion of pediatric patients on home PN. Their use in the short term may also be appropriate in holiday periods or in settings of limited resources or restricted access to hospital facilities, such as those imposed by the COVID-19 pandemic.

An Overview of Parenteral Nutrition from Birth to Adolescence Based on a Composite Fish Oil Containing Lipid Emulsion and a Pediatric Amino Acid Solution

“…PN formulations for pediatric patients can either be individualized, tailored to meet the specific requirements of the patient, or standardized, which may be suitable for a broad range of patients [128,129]. Individualized PN formulations are prescribed and prepared, usually on a daily basis, in the hospital pharmacy or in specialized compounding centers [129]. Individualized PN has long been regarded as the standard for PN in term infants, infants/toddlers, children, and adolescents.…”

“…According to current ESPGHAN/ESPEN/ESPR guidelines [128], standard PN solutions should generally be chosen over individualized PN solutions for the majority of pediatric and newborn patients [128]. Yet, although a wide variety of commercial MCBs are available for adults, these are not optimal for infants and children as their metabolic demands and nutritional needs differ significantly, depending on age, weight, underlying disease, nutritional and hydration status, and environmental factors [3,129,139]. Accordingly, standard PN formulations designed specifically to meet the varying nutritional requirements of newborn infants, infants/toddlers, children, and adolescents have been developed and made commercially available [129].…”

“…Yet, although a wide variety of commercial MCBs are available for adults, these are not optimal for infants and children as their metabolic demands and nutritional needs differ significantly, depending on age, weight, underlying disease, nutritional and hydration status, and environmental factors [3,129,139]. Accordingly, standard PN formulations designed specifically to meet the varying nutritional requirements of newborn infants, infants/toddlers, children, and adolescents have been developed and made commercially available [129]. These modern commercial MCBs contain fixed amounts of nutrients conforming to current guidelines, thus enabling an improved compliance with guidelines [128,136].…”