Impact of a standardised parenteral nutrition protocol: a quality improvement experience from a NICU of a developing country. Issue 4 (13th July 2021)

• Record Type: Journal Article
• Authors: Ambreen, Gul; Kumar, Vikram; Ali, Syed Rehan; Jiwani, Uswa; Khowaja, Waqar; Hussain, Ali Shabbir; Hussain, Kashif; Raza, Syed Shamim; Rizvi, Arjumand; Ansari, Uzair; Ahmad, Khalil; Demas, Simon; Ariff, Shabina
• Is Part Of: Archives of disease in childhood. Volume 107:Issue 4(2022)
• Page Start: 381
• Page End: 386
• Publication Date: 2021-07-13
• Subjects: nutrition -- neonatology; Children -- Diseases -- Periodicals; Infants -- Diseases -- Periodicals; 618.920005
• DOI: 10.1136/archdischild-2021-321552
• Languages: English
• ISSNs: 0003-9888

Abstract

Abstract : Objective: Nutrition 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. Design: This was a quality improvement initiative. Data were collected retrospectively before and after the intervention. Setting: A tertiary-care level 3 NICU at the Aga Khan University in Karachi, Pakistan. Patients: All NICU patients who received individualised PN (IPN) from December 2016 to August 2017 and SPN from October 2017 to June 2018. Interventions: A team of neonatologists and nutrition pharmacists collaborated to design two evidence-based SPN solutions for preterm neonates admitted to the NICU. Main outcome measures: We 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. Results: Neonates 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. Conclusions: We 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. Abstract : Standardised parenteral nutrition formulations are widely used in neonatal intensive care for convenience and safety. This retrospective investigation compares individualised versus standardised feeds in a LMIC setting, in the context of a a quality improvement study. Use of standardised feeds made on site was a feasible alternative to individualised prescription.