The stability and incompatibility of parenteral nutrition in the neonatal intensive care unit: A narrative review

The administration of parenteral nutrition (PN) to neonates presents challenges related to the stability and incompatibility of both 2-in-1 and 3-in-1 admixtures when co-administered with drugs. Incompatibility data derived from adult patients cannot be applied to neonates because of distinct clinical conditions and differences in components of the admixture (e.g., neonatal amino acid formulation). This review presents an overview of the stability and influencing factors, along with the incompatibility of drug-PN mixtures in neonates within the neonatal intensive care unit setting. Various nutritional components and non-nutritional factors such as oxygen, light, pH, temperature, containers, and drugs affect the stability of PN. Patient conditions and the dosage of PN and drugs influence the stability and incompatibility of drug-PN admixtures, whether 2-in-1 or 3-in-1. Furthermore, assessing identification methods is crucial to ensure precise data regarding the stability and incompatibility of drug-PN. The standardization of PN formulas is essential for the safe administration of PN in neonates; however, individualized PN formulas offer more advantages in addressing specific nutritional requirements. Collaboration among healthcare professionals, including inter-institutional efforts, is essential to establish a consensus on the safe administration of PN to neonates.