Improving early protein intake for very preterm infants using a standardised concentrated parenteral nutrition formulation

Abstract

summary Background & aims: Neonatal parenteral nutrition (NPN) does not prevent early postnatal growth failure and negative nitrogen balance in very preterm infants. Individualised NPN (iNPN) prescribing remains standard practice. Macronutrient delivery is often suboptimal with iNPN. Aim: to establish whether a new standardised concentrated NPN (scNPN) regimen can improve protein intake while maintaining metabolic stability. Methods: Demographic and biochemical data was collected from the NICU electronic/paper data management system. In the infant subset ( 12 days) detailed fluid/drug infusion data was collected. Actual calorie and protein intake were calculated and compared to the previous RCT control group receiving a nutritionally identical iNPN. Cost analysis of scNPN was performed. Results: ScNPN usage was: scNPN1 (18%); scNPN (65%); scPN3 (17%) in 118 infants receiving scNPN in June–December 2006 (1483 scNPN days). In the patient subset (n ¼ 38; 526scNPN days) median (range) of 98 (80–102)% prescribed scNPN target volume was delivered. Mean (SD) protein intake (g/kg/14 days) was 34.5 (4.1) for scNPN and 28.1 (2.5) for iNPN (p < 0.001). Rates of electrolyte derangement, treated hyperglycaemia or metabolic acidosis were within an acceptable range. Annual cost savings were £39 510 (38% reduction). Conclusions: Using scNPN improves the efficiency of PN delivery and early protein intake while maintaining biochemical and metabolic stability and at less cost.