Use of parenteral nutrition in term and late preterm infants: an Australian and New Zealand survey

Abstract

There is limited information regarding the use of parenteral nutrition (PN) in term and late preterm infants. We conducted a survey to study the current clinical practices within Australia and New Zealand (ANZ). A 15-question online-survey was distributed to 232 neonatologists and 55 paediatric intensivists across ANZ between September and November 2019. At least one neonatologist from 27 out of 30 tertiary neonatal intensive care units responded (90%). Responses were received from 69 neonatologists (30%) and seven paediatric Intensivists (13%). The overall response rate was 26% (76/287). Thirty three percent (25/76) commenced PN within 24-hours of admission, 27% (20/75) between 24 and 48 hours, 24% (18/75) between 48 and 72 hours, 9% (7/75) between 72 and 96 hours and 4% (3/75) between 96 hour and 7 days. None of the respondents commenced PN after 7 days of admission. Sixty one percent (46/75) aimed for 1.5-3g/kg/day of parenteral amino acids whereas 27% (20/75) aimed for 2-3g/kg/day. Renal failure (59%; 38/64) and high plasma urea (44%; 28/64) were the major indications for withholding/decreasing the amino acid intake. Eighty three percent (63/76) aimed for a dose of 2.5g-3.5g/kg/day of parenteral lipids; about 9% (7/76) targeted a dose of 1-2.5g/kg/day and 4% (3/76) for >3.5g/kg/day. Thirty two percent (24/74) reported that they would withhold/decrease the dose of parenteral lipids in infants with sepsis. The variations in clinicians’ practices with respect to the use of PN in term and late preterm infants highlight the need for high quality research in this population.

Status and Influencing Factors of Parenteral Nutrition Practice for Late Preterm Infants in China

“…For the prescription of parenteral nutrition, 61% (46/75) aimed for 1.5–3 g/kg/d of amino acids, whereas 27% (20/75) aimed for 2–3 g/kg/d. Eighty-three percent (63/76) aimed for a dose of 2.5g–3.5 g/kg/d of lipids; about 9 % (7/76) targeted a dose of 1–2.5 g/kg/d and 4% (3/76) for >3.5 g/kg/d ( 20 ). Data in our study showed that over half of the late preterm infants were given parenteral nutrition support for at least one day.…”

“…At the end of the 1st week, infants on parenteral nutrition decreased to 10–40%. The composition of parenteral nutrition prescribed varied from intravenous infusion of carbohydrates alone to combinations of dextrose, lipids, and amino acids in addition to minerals and vitamins ( 16 , 20 ). Infants were prescribed with amino acid at 1.5–2.5 g/kg/d and lipid emulsion at 1.5–2.0 g/kg/d at the end of the 1st week.…”

Early versus late parenteral nutrition in term and late preterm infants: study protocol for a randomised controlled trial

“…We conducted a survey (September 2019) to find the current practice and to seek the opinions of clinicians (neonatologists and paediatric intensivists) in Australia and New Zealand [70]. We found that 43% of respondents (32/74) thought that commencing parenteral amino acids "within 24 h of admission" is beneficial, while 32% (24/74) felt that late commencement "after 72 h" is optimal.…”

“…Similarly, 41% (31/75) thought that commencement of parenteral lipids "within 24 h of admission" is optimal, whereas 35% (26/74) felt late commencement "after 72 h" to be beneficial. Only one respondent thought "after 7 days of admission" was an optimal time to commence lipids [70].…”

“…On the other hand, the ESPGHAN/ESPEN/ESPR/CPEN guidelines recommend clinicians to consider withholding parenteral amino acids for 1 week in critically ill term infants; they do not make a recommendation on the timing of parenteral lipids [16]. The surveys have reported variations in clinical practice, demonstrating the uncertainties in this area [17][18][19].…”