Related Experiment Videos
Iatrogenic malnutrition in neonatal intensive care units: urgent need to modify practice
Anuj Grover1, Minesh Khashu, Anindyalal Mukherjee
1Neonatal Unit, Leicester Royal Infirmary, Leicester, UK.
Insights
Neonatal parenteral nutrition (PN) practices in the UK show significant variation, leading to calorie and protein deficits in very-low-birth-weight infants. Review of current neonatal PN guidelines is recommended.
Area of Science:
- Neonatology
- Pediatric Nutrition
- Clinical Pharmacy
Background:
- Extrauterine growth retardation is a significant clinical challenge in very-low-birth-weight infants.
- Parenteral nutrition (PN) is crucial for early postnatal nutrition in these vulnerable infants.
- Current neonatal PN practices in the UK lack uniformity.
Purpose of the Study:
- To investigate current practices in neonatal parenteral nutrition (PN) prescription.
- To assess early postnatal PN regimens in the United Kingdom.
- To compare current PN prescriptions with established recommendations.
Main Methods:
- A questionnaire was distributed to neonatal pharmacists in UK level 2 and 3 units.
- Data on glucose, amino acid, and lipid prescriptions within the first 10 days of life were collected.
- Prescriptions were compared against current recommended intake guidelines.
Main Results:
- 52 units responded; 26 initiated PN on day 1, with full PN achieved by day 6 in 50% of units.
- Median amino acid prescription was 2.9 g/kg/d, with only 27% meeting the recommended 3 g/kg/d.
- Lipid initiation varied, with 23% delaying until day 3 or later.
- Current median PN prescriptions result in significant cumulative deficits in calories (420 kcal/kg) and protein (11.9 g/kg) over 10 days.
Conclusions:
- Neonatal PN prescription practices in the UK are diverse.
- Current PN regimens lead to substantial calorie and protein deficits in early life.
- Further review and standardization of neonatal PN are warranted.
Background:
Extrauterine growth retardation is a major clinical problem in very-low-birth-weight infants. Parenteral nutrition (PN) serves to achieve rapid maximal nutrition in early postnatal life. There is a lack of uniformity with regard to neonatal PN practice. The objective of this study is to ascertain current practice regarding neonatal PN prescription in the early postnatal period in the United Kingdom.
Methods:
A study questionnaire was e-mailed to neonatal pharmacists serving level 3 and major level 2 units in the United Kingdom between October 2005 and March 2006. Static numerical information regarding glucose, amino acids, and lipid prescription during the first 10 days of life was collected and compared with current recommendations.
Results:
Fifty-two (81%) units responded to the questionnaire; 4 units were excluded for incomplete data. Twenty-six units (54%) initiated PN on day 1. Full PN was achieved by the median age of 6 days. Twelve units (25%) achieved full PN only by day 7 or later. Maximum median amino acids were 2.9 g/kg/d. Only 13 units (27%) prescribed >/=3 g/kg/d, and 2 prescribed more than 3.5 g/kg/d. Nineteen units (39%) initiated lipids on day 1. Eleven units (23%) delayed lipids until day 3, and 2 units delayed lipids until day 4. In comparison to the recommended intake of calories and amino acids, the current median prescription would result in a cumulative deficit over the first 10 days of 420 kcal/kg and 11.9 g/kg, respectively.
Conclusions:
Our study suggests diverse practice with regard to neonatal PN prescription in the United Kingdom. Current neonatal PN practice entails a significant calorie and protein deficit during early postnatal life and warrants further review.
Related Concept Videos
01:15Enteral Nutrition II: Nasointestinal and Gastrostomy Feeding
Nasointestinal Feeding
Nasointestinal feeding involves placing a tube through...
01:27Parentral Nutrition: Centeral and Peripheral Parental Nutrition
PN can be administered through two primary routes:
1. Central Parenteral Nutrition (CPN):
CPN involves delivering a high concentration of nutrients through a large vein. This is typically achieved using a Peripherally Inserted Central Catheter (PICC) or,...
01:26Enteral Nutrition I: Orogastric and Nasogastric Feeding
Orogastric (OG) and nasogastric (NG) feeding are two standard methods used for enteral nutrition. Enteral nutrition is often preferred over...
01:28Chronic Kidney Disease III: Interprofessional Care
01:30Pneumonia V: Nursing management and Prevention
The nurse must practice strict medical asepsis and adhere to infection control guidelines to minimize healthcare-associated infections.
Enhance airway patency
Position the patient correctly to facilitate drainage of the affected lung segments. Manual or mechanical percussion and vibration can also be employed.
01:20Acute Kidney Injury V: Interprofessional Care