Related Experiment Video
Updated: Aug 30, 2025
A Clinical Trial Assessing the Safety, Efficacy, and Delivery of Olive-Oil-Based Three-Chamber Bags for Parenteral Nutrition
Published on: September 20, 2019
Evaluation of Inpatient Starter Parenteral Nutrition Use in the Neonatal Intensive Care Unit
Kayla Novick1, M Petrea Cober2
1Department of Pharmacy (KN, MPC), Akron Children's Hospital, Akron, OH. At the time of this study KN was completing her residency training and is currently at the University of New Mexico Hospitals, Albuquerque, NM.
Insights
A new standard starter parenteral nutrition (PN) protocol reduced PN use and variability in neonatal intensive care units (NICUs). This optimized care for premature infants and resulted in significant cost savings.
Area of Science:
- Neonatology
- Pediatric Nutrition
- Healthcare Protocol Implementation
Background:
- Parenteral nutrition (PN) is crucial for neonatal growth and preventing malnutrition.
- Early PN initiation (24-48 hours) is recommended for very low birth weight infants.
- Variability in starter PN use can lead to suboptimal patient outcomes and increased costs.
Purpose of the Study:
- To compare starter PN solution utilization before and after implementing a standardized protocol in a children's hospital.
- To evaluate the impact of the protocol on PN usage patterns and associated costs.
- To assess adherence to the new standardized PN protocol.
Main Methods:
- A single-center, retrospective chart review was conducted.
- Neonates receiving starter PN in the NICU setting were analyzed.
- Data from October-December 2020 (post-protocol) were compared to usage trends from October-December 2019 (pre-protocol).
Main Results:
- Starter PN use decreased significantly post-protocol (170 vs. 94 neonates).
- Protocol adherence reached 88%.
- Mean gestational age and birth weight of infants receiving starter PN decreased, indicating earlier initiation.
- Estimated annual cost savings of approximately $13,000 were achieved.
Conclusions:
- Implementation of a standard starter PN protocol effectively reduced PN usage and practice variability in the NICU.
- The protocol aligned NICU practices with recommendations from the American Society for Parenteral and Enteral Nutrition.
- Standardization of PN protocols can lead to improved resource utilization and potential cost savings.
Objective:
Parenteral nutrition (PN) promotes growth and development in neonatal patients while avoiding malnutrition and metabolic derangements. Very low birth weight premature infants should be started on PN within 24 to 48 hours after birth. The objective of this study was to compare starter PN solution use at a freestanding children's hospital health care system before and after the development of a standard starter PN protocol. The secondary objective was to evaluate the estimated annual cost savings due to a standard protocol.
Methods:
A single-center, retrospective chart review of neonates who received starter PN in the NICU setting from October through December 2020 after the implementation of the protocol was conducted. The protocol was developed based on usage trends from October through December 2019. Starter PN use was compared within neonatology groups before and after the development of a standardized protocol.
Results:
In 2019, 108 neonates weighing <1.8 kg were admitted to the NICUs, while 101 were admitted in 2020. However, 170 neonates received starter PN in 2019, while only 94 neonates received starter PN in 2020. Overall, protocol adherence was 88%. The mean gestational age for patients who were initiated on starter PN decreased from 31 weeks in the pre-protocol group to 28 weeks in the post-protocol group (p < 0.001). The mean birth weight pre-protocol was 1.61 kg, which decreased to a mean of 1.23 kg in the post-protocol group (p < 0.001). The estimated annual cost savings for the inpatient pharmacy department was approximately $13,000 with the initiation of a standard protocol.
Conclusions:
The implementation of a standard starter PN protocol decreased usage and variability in NICU practice and aligned more with the American Society for Parenteral and Enteral Nutrition recommendations.
More Related Videos
Related Concept Videos
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,...
01:15Enteral Nutrition II: Nasointestinal and Gastrostomy Feeding
Nasointestinal Feeding
Nasointestinal feeding involves placing a tube...
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...
01:24Parenteral Anesthetics: Overview
01:30Inflammatory Bowel Disease III: Diagnostic Studies and Management I-Nutritional Therapy
Diagnostic studies
A colonoscopy is the definitive screening test, distinguishing ulcerative colitis from other colon diseases with similar symptoms. During a colonoscopy test, inflamed mucosa with exudate ulcerations can be observed, and biopsies are taken to determine the histologic characteristics of the...
01:29Nursing Interventions II: Selecting and Classifying the Nursing Interventions