Improved nutrient intake following implementation of the consensus standardised parenteral nutrition formulations in preterm neonates – a before-after intervention study

Abstract

BackgroundNew standardised parenteral nutrition (SPN) formulations were implemented in July 2011 in many neonatal intensive care units in New South Wales following consensus group recommendations. The aim was to evaluate the efficacy and safety profile of new consensus formulations in preterm infants born less than 32 weeks.MethodsA before-after intervention study conducted at a tertiary neonatal intensive care unit. Data from the post-consensus cohort (2011 to 2012) were prospectively collected and compared retrospectively with a pre-consensus cohort of neonates (2010).ResultsPost-consensus group commenced parenteral nutrition (PN) significantly earlier (6 v 11 hours of age, p 0.005). In comparison to the pre-consensus cohort, there was a higher protein intake from day 1 (1.34 v 0.49 g/kg, p 0.000) to day 7 (3.55 v 2.35 g/kg, p 0.000), higher caloric intake from day 1 (30 v 26 kcal/kg, p 0.004) to day 3 (64 v 62 kcal/kg, p 0.026), and less daily fluid intake from day 3 (105.8 v 113.8 mL/kg, p 0.011) to day 7 (148.8 v 156.2 mL/kg, p 0.025), and reduced duration of lipid therapy (253 v 475 hr, p 0.011). This group also had a significantly greater weight gain in the first 4 weeks (285 v 220 g, p 0.003).ConclusionsNew consensus SPN solutions provided better protein intake in the first 7 days and were associated with greater weight gain in the first 4 weeks. However, protein intake on day 1 was below the consensus goal of 2 g/kg/day.Electronic supplementary materialThe online version of this article (doi:10.1186/s12887-014-0309-0) contains supplementary material, which is available to authorized users.

Fluid restriction negatively affects energy intake and growth in very low birthweight infants with haemodynamically significant patent ductus arteriosus

“…Results from recent studies have highlighted the importance of optimal nutrition intake during the first week of life to prevent cumulative energy deficits . Protein and energy intakes during the first week have been shown to have a major impact on outcomes associated with short‐term morbidities, improved growth and neurological development . Consistent with findings in these studies, we observed low energy and protein intakes in infants with hsPDA and a correlation between decreased fluid intake and lower energy and protein intakes after hsPDA diagnosis.…”

Early hypophosphatemia in very low birth weight preterm infants

“…More and more data advocate intake safety from the 1 st day of standard nutrition which contains phosphates. [26][27][28] However, phosphorus supplementation is currently recommended from the 3 rd day of life; before that, neonates receive only a small amount of phosphorus in a lipid solution. Fears of early phosphate intake result from the need to intake sodium and potassium simultaneously, which is not recommended in the first days of life until diuresis stabilizes.…”

When Is Parenteral Nutrition Appropriate?

“…This suggests that the necessity for daily laboratory tests for monitoring parameters such as electrolytes is a question to be evaluated through quality improvement activities, particularly for the smallest preterm infants, who are at high risk of iatrogenic anemia. In consideration of the resources needed to administer PN, including personnel and cost, an area that remains unanswered is whether standardized PN admixtures in neonatal populations are safe and cost‐effective 27 . ‐ 30 With increased support for outcomes research in hospital settings, it should be expected that addressing nutrition will lead to improved care with fewer resources.…”