Effect of different chloride infusion rates on plasma base excess during neonatal parenteral nutrition

Routine biochemical monitoring of parenterally fed newborn infants revealed plasma chloride levels which were higher than widely quoted reference ranges. The parenteral nutrition solutions were reformulated to reduce the chloride infusion rate. In a historically controlled study, 28 infants receiving the original formulation were compared with 31 infants receiving the new formulation. The mean plasma chloride level was 4.8 mmol/l lower in the new formulation group than in the original formulation group (95% confidence interval 2.5-7.2 mmol/l). The mean base excess level was 3.1 mmol/l higher in the new formulation group than in the original formulation group (95% confidence interval 1.9-4.8 mmol/l). A reduction in the chloride load by using acetate salts can be safely achieved and may decrease the plasma chloride levels and decrease acidosis during the first seven days of life.