NICE guidelines on neonatal parenteral nutrition: a step towards standardised care but evidence is scarce

Webbe, James; Gale, Chris

doi:10.1016/s2352-4642(20)30179-6

Cited by 2 publications

(2 citation statements)

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“…Similar recommendations are proposed by experts in the field and ESPGHAN/ESPEN/ESPR/CPEN guidelines [5,6,7 ▪▪ ,9 ▪▪ ,28]. These recommendations enable standardization of care and have the potential to improve outcomes [29]. The findings of the recent survey [30] are in line with these recommendations.…”

Section: Recent Studies In Very Premature Infants (<32 Weeks)mentioning

confidence: 53%

“…Furthermore, recent observational studies have highlighted that refeeding syndrome is common in ELBW infants receiving high doses of parenteral amino acids in the first week of life [25 ]. The NICE guidelines recommend commencing parenteral nutrition as soon as possible after birth in preterm infants less than [29]. The findings of the recent survey [30] are in line with these recommendations.…”

Section: Key Pointsmentioning

confidence: 71%

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Early or delayed parenteral nutrition for infants: what evidence is available?

Moon

Rao

2020

Current Opinion in Clinical Nutrition &Amp; Metabolic Care

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Purpose of review To review the current evidence evaluating early versus delayed commencement of parenteral nutrition in infants. Recent findings Recent studies in very premature infants (<32 weeks gestation) have shown that early commencement of parenteral nutrition immediately after birth improves physical growth. However, there are concerns that early use of very high dose of amino-acids (>3.5 g/kg/day immediately after birth) may cause metabolic acidosis, elevated blood urea, slower head growth and refeeding-hypophosphatemia syndrome. A recent multicentre randomized controlled trial found that commencement of parenteral nutrition within 24-h of admission increases the risk of infections and prolongs the duration of ventilation and ICU stay in full-term neonates, older infants and children. The study also found that delaying to day 8 of admission increased the risk of hypoglycaemia. Summary Benefits of commencing parenteral nutrition on the first day of life appear to outweigh risks in very premature infants; however, it is prudent to avoid early very high doses of amino acids (>3.5 g/kg/day) in the first few days of life. In moderate to late preterm infants, if enteral feeds are not tolerated by 72 h, it is reasonable to commence parenteral nutrition. In full-term and older infants, it is preferable to avoid parenteral nutrition within 24 h of admission and consider delaying by further few days. Diligent monitoring of blood glucose, serum phosphate and other parameters is essential while on parenteral nutrition.

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Section: Recent Studies In Very Premature Infants (<32 Weeks)mentioning

confidence: 53%

Section: Key Pointsmentioning

confidence: 71%

Early or delayed parenteral nutrition for infants: what evidence is available?

Moon

Rao

2020

Current Opinion in Clinical Nutrition &Amp; Metabolic Care

View full text Add to dashboard Cite

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Impact of a standardised parenteral nutrition protocol: a quality improvement experience from a NICU of a developing country

et al. 2021

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ObjectiveNutrition societies recommend using standardised parenteral nutrition (SPN) solutions. We designed evidence-based SPN formulations for neonates admitted to our neonatal intensive care unit (NICU) and evaluated their outcomes.DesignThis was a quality improvement initiative. Data were collected retrospectively before and after the intervention.SettingA tertiary-care level 3 NICU at the Aga Khan University in Karachi, Pakistan.PatientsAll NICU patients who received individualised PN (IPN) from December 2016 to August 2017 and SPN from October 2017 to June 2018.InterventionsA team of neonatologists and nutrition pharmacists collaborated to design two evidence-based SPN solutions for preterm neonates admitted to the NICU.Main outcome measuresWe recorded mean weight gain velocity from days 7 to 14 of life. The other outcomes were change in weight expressed as z-scores, metabolic abnormalities, PN-associated liver disease (PNALD), length of NICU stay and episodes of sepsis during hospital stay.ResultsNeonates on SPN had greater rate of change in weight compared with IPN (β=13.40, 95% CI: 12.02 to 14.79) and a smaller decrease in z-scores (p<0.001). Neonates in the SPN group had fewer hyperglycemic episodes (IPN: 37.5%, SPN: 6.2%) (p<0.001), electrolyte abnormalities (IPN: 56.3%, SPN: 21%) (p<0.001), PNALD (IPN: 52.5%, SPN: 18.5%) (p<0.001) and sepsis (IPN: 26%, SPN: 20%) (p<0.05). The median length of stay in NICU was 14.0 (IQR 12.0–21.0) for the IPN and 8.0 (IQR 5.0–13.0) days for the SPN group.ConclusionsWe found that SPN was associated with shorter NICU stay and greater weight gain. In-house preparation of SPN can be used to address the nutritional needs in resource-limited settings where commercially prepared SPN is not available.

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NICE guidelines on neonatal parenteral nutrition: a step towards standardised care but evidence is scarce

Cited by 2 publications

References 10 publications

Early or delayed parenteral nutrition for infants: what evidence is available?

Early or delayed parenteral nutrition for infants: what evidence is available?

Impact of a standardised parenteral nutrition protocol: a quality improvement experience from a NICU of a developing country

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