National Survey on Very Low Birth Weight Starter Parenteral Nutrition

Parenteral nutrition (PN) is initiated as early as possible in very-low-birth-weight (VLBW) neonates to prevent protein catabolism. Each institution takes a different approach to ensure that appropriate nutrition is administered as soon as possible after birth. This study aimed to describe the initial nutritional management for VLBW infants in various neonatal intensive care units.

A 16-question electronic survey was distributed to Pediatric Pharmacy Association (PPA) members through PPA listservs. The primary outcome was to identify the most common macronutrients and micronutrients in starter PN and their concentrations. Secondary outcomes were starting concentrations of electrolytes in the VLBW starter PN, maximum osmolarity, dextrose and calcium concentration permitted in peripheral PN, and use of fat emulsion, including starting dose, start time, and type of fat emulsion.

Of 70 individual institutions included, 64 institutions (91%) stocked standardized starter PN, and 6 institutions (9%) stocked custom-compounded starter PN. The most common contents were amino acids (100%), dextrose (100%), calcium gluconate (73%), and heparin (74%), with mean (range) reported concentrations of 3.5% (1.8%-6%), 8.9% (5%-12.5%), 14 mEq/L (0.2-38 mEq/L), and 0.5 units/mL (0.2-1 units/mL), respectively. Among 66 institutions, the mean initial fat emulsion dose was 1.2 g/kg/day (0.5-3 g/kg/day). Mean maximum osmolarity for peripheral PN was 1016 mOsm/L (900-1250 mOsm/L).

This study found that although there are common contents reported in VLBW starter PNs, there is wide variation in their concentrations. Future research on the nutritional needs of VLBW neonates may provide an opportunity to develop more widely accepted standardized starter PNs.