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Increased parenteral nutrition calcium and phosphorus for very-low-birth-weight infants using computer software
1Department of Pediatrics, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, North Carolina 27157, USA.
Insights
Computer software assisted ordering (CSAO) improved parenteral nutrition (PN) for preterm infants by increasing calcium and phosphorus delivery without precipitation. This system enhances nutrient administration for very-low-birth-weight infants.
Area of Science:
- Neonatal Nutrition
- Clinical Pharmacy
- Parenteral Nutrition
Background:
- Administering adequate calcium (Ca) and phosphorus (P) to preterm very-low-birth-weight (VLBW) infants via parenteral nutrition (PN) is challenging due to low Ca:P solubility.
- Computer software assisted ordering (CSAO) was developed to optimize PN Ca and P administration by integrating solubility with clinical data.
Purpose of the Study:
- To evaluate if CSAO improves the design of PN by increasing ordered Ca and P amounts.
- To determine if CSAO prevents Ca:P precipitation in PN for VLBW infants.
Main Methods:
- Control PN orders used preprinted forms with fixed Ca and P concentrations.
- CSAO assessed fluid volumes and Ca:P solubility to recommend daily doses during order entry.
- Analysis included PN orders providing ≥80% of total nutrition volume as PN.
Main Results:
- CSAO resulted in significantly higher ordered Ca (60.3 mg/kg/day) and P (32.8 mg/kg/day) compared to controls (50.0 mg/kg/day and 25.1 mg/kg/day, respectively).
- CSAO achieved ≥80% of the minimum recommended daily Ca in 82% of PN orders, versus 51% in controls.
- No instances of Ca:P precipitation were observed in PN mixtures designed with CSAO.
Conclusions:
- CSAO significantly improved the PN design process.
- The system effectively increased Ca and P content in PN for VLBW infants.
- CSAO ensures adequate nutrient delivery without compromising PN safety due to precipitation.
Background:
Providing adequate calcium (Ca) and phosphorus (P) in an appropriate ratio to preterm very-low-birth-weight (VLBW: BW < 1500 g) infants receiving parenteral nutrition (PN) is difficult because Ca:P solubility in PN is relatively low. Computer software assisted ordering (CSAO) was developed to integrate PN Ca:P solubility with clinical data to improve parenteral Ca and P administration. Our hypothesis was that CSAO would improve the system of designing PN by increasing the amount of Ca and P ordered without Ca:P precipitation.
Methods:
Control PN orders were designed using proprietary preprinted PN forms which incorporated predefined PN Ca and P concentrations to prevent precipitation, independent of patient Ca or P administration. CSAO assessed total daily fluids and correlated parenteral volume with Ca:P solubility during order entry to recommend daily Ca and P doses. PN orders which provided > or = 80% of total nutrition volume as PN were analyzed.
Results:
PN was designed with more Ca (60.3 +/- 16.7 mg/k/day, mean +/- 1 SD) and P (32.8 +/- 13.9 mg/k/day) using CSAO compared to control group Ca (50.0 +/- 17.1 mg/k/day) and P (25.1 +/- 9.1 mg/k/day), both Ca and P, p < 0.001, CSAO provided > or = 80% of the minimum recommended daily Ca in 82% of PN orders compared to 51% of the control orders, p < 0.001. No PN mixture demonstrated Ca:P precipitation.
Conclusion:
The system of designing PN was improved using computer software assisted ordering indicated by increased PN Ca and P content without Ca:P precipitation.