Original Paper

European Journal of Pediatrics

, Volume 165, Issue 8, pp 512-518

First online:

Assessment of implementation of a standardized parenteral formulation for early nutritional support of very preterm infants

  • Richard LenclenAffiliated withDivision of Neonatology, Department of Pediatrics, Poissy – Saint Germain en Laye HospitalUnité de Réanimation Néonatale, Centre Hospitalier Poissy/Saint-Germain-en-Laye Email author 
  • , Sylvie Crauste-MancietAffiliated withPharmacy Department, Poissy – Saint Germain en Laye HospitalUniversity of Pharmacy
  • , Philippe NarcyAffiliated withDivision of Neonatology, Department of Pediatrics, Poissy – Saint Germain en Laye Hospital
  • , Saida BoukhounaAffiliated withDivision of Neonatology, Department of Pediatrics, Poissy – Saint Germain en Laye Hospital
  • , Amélie GeffrayAffiliated withPharmacy Department, Poissy – Saint Germain en Laye Hospital
  • , Marie-Noëlle GuerraultAffiliated withPharmacy Department, Poissy – Saint Germain en Laye Hospital
  • , François BordetAffiliated withPharmacy Department, Poissy – Saint Germain en Laye Hospital
  • , Denis BrossardAffiliated withPharmacy Department, Poissy – Saint Germain en Laye HospitalUniversity of Pharmacy

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Abstract

Introduction

Parenteral nutrition (PN) plays an important role in the nutritional support of very preterm newborns. It has been suggested that a high proportion of PN orders could be standardized. In 2002, we implemented in our unit the preparation of three standardized formulations for PN adapted to the nutritional requirements of premature infants <32 weeks. Following this change of practice, a retrospective observational study was conducted to evaluate the relevance of the implemented standardized PN regime. Twenty premature inborn infants <32 weeks gestation who had received standardized (STD) PN in 2003 were matched for 20 infants who had received individualized (IND) PN in 2001. Adequacy of nutrition was assessed by comparing daily intravenous nutrient intake and biochemical parameters during the first week. Amino-acid intakes on day 3 were higher in the STD group (1.5±0.2 g/kg/d vs. 0.9±0.5, p<0.001), and the calcium phosphate intakes were better balanced. The cumulated intake of amino acids for the first week was greater in the STD group (+20% ; p=0.0003). Biochemical parameters were similar in both groups. Insulin infusions were less frequent in the STD group (p<0.06).

Conclusion

Standardized parenteral formulations provided higher early intakes of amino acid and glucose, a better calcium phosphate ratio, and a greater amount of amino-acid intakes during the first week while maintaining the same biochemical parameters. This strategy forms part of an approach concerning quality control and the respect of good professional practice for the preparation of parenteral nutrition solutions.

Keywords

Neonatal parenteral nutrition Amino-acid intake Calcium phosphate ratio Standardized formula Premature infants