Comparison of two types of TPN prescription methods in preterm neonates
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Objective Total parenteral nutrition is commonly used in neonates’ intensive care units for nutritional support of preterm neonates. Adequacy and safety of parenteral nutrition support are amongst the major concerns of neonates’ therapy. Parenteral nutrition prescription in Greek hospitals is not based on standardized protocols, thus resulting in wide diversity of formulations. In this study, the results of utilization of standardized computerized parenteral nutrition protocols and regimens for neonates are compared to the results of protocols and regimens prescribed by individual neonatologists on neonates’ outcome (weight changes, adequacy of parenteral nutrition, days of hospitalization, clinical outcome). Setting The study took place at “Mitera” Maternity Hospital of Greece. Method Two groups of 30 preterm infants (28–36 weeks) with respiratory failure were recruited for the study. They were admitted in a Greek maternity hospital and they all received total parenteral nutrition support in neonates’ intensive care unit. Standardized, computer based protocols were applied for the prescription of parenteral nutrition formulations in the first group, while on the other, regimens prescribed by neonatologists were used. Main outcome measures: Macro- and micronutrients provided by the different total parenteral nutrition protocols were recorded. Body weight was measured, blood count and biochemical profile were performed at the beginning and at the end of parenteral nutrition support. The number of days of total parenteral nutrition support as well as the total number of days of hospitalization was recorded. Results Standardized protocols provided more energy (P-value: 0.05), protein (P-value: 0.023) and micronutrients than the non-standardised. Neonates that receive standardized total parenteral nutrition gained weight (+44 ± 114 g) and had better blood count and biochemical values during total parenteral nutrition support compared to the other group, that lost weight during total parenteral nutrition support (−53 ± 156 g). These differences were also statistically significant (P value < 0.05). Regarding the total days of hospitalization, no differences were found between the two groups. Conclusion The use of standardized protocols in preterm neonates resulted in more adequate provision of nutrients, weight gain and better blood count profile compared with protocols prescribed by individual physicians.
- Puntis JW. Nutritional support in the premature newborn. Post Med J. 2006;82:192–8. doi:10.1136/pgmj.2005.038109. CrossRef
- Valentine CJ, Puthoff TD. Enhancing parenteral nutrition therapy for neonates. Nutr Clin Pract. 2007;22:183–93. doi:10.1177/0115426507022002183. CrossRef
- Yu V. Extrauterine growth restriction in preterm infants: importance of optimizing nutrition in neonatal intensive care units. Croat Med J. 2005;46:737–43.
- Evans RA, Thureen P. Early feeding strategies in preterm and critically ill neonates. Neonatal Netw. 2001;20:7–18.
- Thureen PJ, Hay WW Jr. Early aggressive nutrition in preterm infants. Semin Neonatol. 2001;6:403–15. doi:10.1053/siny.2001.0061. CrossRef
- Griffiths RD. Too much of a good thing: the curse of overfeeding. Crit Care. 2007;11:176. doi:10.1186/cc6165. CrossRef
- A.S.P.E.N. Board of Directors. Nutrition support for low birth weight infants. JPEN J Parenter Enteral Nutr.. 1993;17:33SA–8SA.
- National Advisory Group on Standards and Practice Guidelines for Parenteral Nutrition. Safe Practices for parenteral nutrition formulations. JPEN J Parenter Enteral Nutr. 1997;22:49–66. doi:10.1177/014860719802200249.
- Skouroliakou M, Konstantinou D, Papasarantopoulos P, Matthaiou C. Computer assisted total parenteral nutrition for pre-term and sick term neonates. Pharm World Sci. 2005;27:305–10. doi:10.1007/s11096-005-2462-x. CrossRef
- Street JL, Montgomery D, Alder SC, Lambert DK, Gerstmann DR, Christensen RD. Implementing feeding guidelines for NICU patients <2000 g results in less variability in nutrition outcomes. JPEN J Parenter Enteral Nutr. 2006;30:515–8. doi:10.1177/0148607106030006515. CrossRef
- Lenclen R, Crauste-Manciet S, Narcy P, Boukhouna S, Geffray A, Guerrault MN, et al. Assessment of implementation of a standardized parenetral formulation for early nutritional support of very preterm infants. Eur J Pediatr. 2006;165:512–8. doi:10.1007/s00431-006-0124-1. CrossRef
- Whitfield JM, Hendrikson H. Prevention of protein deprivation in the extremely low birth weight infant: a nutritional emergency. Proc Bayl Univ Med Cent. 2006;19:229–31.
- Yeung MY. Postnatal growth, neurodevelopment and altered adiposity after preterm birth-from a clinical nutrition perspective. Acta Paediatr. 2006;95:909–17. doi:10.1080/08035250600724507. CrossRef
- McLeod G, Sherriff J. Preventing postnatal growth failure-the significance of feeding when the preterm infant is clinically stable. Early Hum Dev. 2007;83:659–65. doi:10.1016/j.earlhumdev.2007.07.010. CrossRef
- Pallotto EK, Kilbride HW. Perinatal outcome and later implications of intrauterine growth restriction. Clin Obstet Gynecol. 2006;49:257–69. doi:10.1097/00003081-200606000-00008. CrossRef
- Hack M. Young adult outcome of very-low-birth-weight children. Semin Fetal Neonatal Med. 2006;11:127–37. doi:10.1016/j.siny.2005.11.007. CrossRef
- Orzalesi M. Vitamins and the premature. Biol Neonate. 1987;52(suppl 1):97–112.
- Mactier H, Weaver LT. Vitamin A and preterm infants: what we know, what we don’t know, and what we need to know. Arch Dis Child Fetal Neonatal Ed. 2005;90:103–8. doi:10.1136/adc.2004.057547. CrossRef
- Debier C. Vitamin E during pre- and postnatal periods. Vitam Horm. 2007;76:357–73. doi:10.1016/S0083-6729(07)76013-2. CrossRef
- Atkinson SA. Special nutritional needs of infants for prevention of and recovery from bronchopulmonary dysplasia. J Nutr. 2001;131:942S–6S.
- Tyson JE, Wright LL, Oh W, Kennedy KA, Mele L, Ehrenkranz RA, et al. Vitamin A supplementation for extremely-low-birth-weight infants. National institute of child health and human development neonatal research network. N Engl J Med. 1999;340:1962–8. doi:10.1056/NEJM199906243402505. CrossRef
- Darlow BA, Graham PJ. Vitamin A supplementation for preventing morbidity and mortality in very low birthweight infants. Cochrane Database Syst Rev. 2007;4:CD000501.
- Petrich C, Voss HV, Lietke K, Gobel U. Vitamin E concentrations in term and preterm newborns and their clinical course. Eur J Pediatr. 1976;122:275–9. doi:10.1007/BF00481507. CrossRef
- Yeung MY. Influence of early postnatal nutritional management on oxidative stress and antioxidant defence in extreme prematurity. Acta Paediatr. 2006;95:153–63. doi:10.1080/08035250500301133. CrossRef
- Salsbury DC. Anemia of prematurity. Neonatal Netw. 2001;20:13–20.
- Donovan R, Puppala B, Angst D, Coyle BW. Outcomes of early nutrition support in extremely low-birth-weight infants. Nutr Clin Pract. 2006;21:395–400. doi:10.1177/0115426506021004395. CrossRef
- Comparison of two types of TPN prescription methods in preterm neonates
Pharmacy World & Science
Volume 31, Issue 2 , pp 202-208
- Cover Date
- Print ISSN
- Online ISSN
- Springer Netherlands
- Additional Links
- Computer based calculations
- Preterm neonates
- Standardized TPN
- Total parenteral nutrition
- Industry Sectors
- Author Affiliations
- 1. Harokopio University of Athens, Eleutheriou Venizelou 70, Athens, 17.671, Greece
- 2. “Mitera” Maternity Hospital, Athens, Greece
- 3. General Hospital of Piraeus “Ag. Panteleimon”, Piraeus, Greece