Parenteral Nutrition Practices Research Articles

Adherence to Nutritional Practice Guideline in Premature Infants: A Nationwide Survey in Taiwan.

This study aimed to assess the current neonatal nutritional practices in Taiwan and promote consensus on standardized protocols. An online questionnaire comprising 95 items on parenteral nutrition (PN) and enteral nutrition (EN) practices was distributed to neonatal care units across Taiwan via email between August and December 2022. The responses were compared with the recommendations from the European Society for Pediatric Gastroenterology Hepatology and Nutrition for preterm infant care. Most of the 35 neonatal units, comprising 17 level III and 18 level II units, that participated in this study adhered to standard PN protocols; however, only 30% of units used protein-containing solutions as the initial fluid. Over half of the neonatal units provided calcium, phosphate, and magnesium at less than the recommended dosage. Trophic feeding commenced within 48 h in 88% of the units, with the mother's milk used as the first choice. All the units preferred commencing advanced feeding at <25 mL/kg/day. Most nutrient protocols for preterm infants in neonatal units in Taiwan meet recent guidelines, but discrepancies such as lower mineral supplements in PN and a slower advancement of enteral feeding increase nutritional risk. These issues warrant further research.

Parenteral nutrition in clinical practice: International challenges and strategies.

Parenteral nutrition (PN) is an established therapy when oral/enteral feeding is not sufficient or is contraindicated, but nevertheless PN remains a complex, high-alert medication that is susceptible to errors that may affect patient safety. Over time, considerable progress has been made to make PN practices safer. The purpose of this article is to address ongoing challenges to improve the PN use process from prescription to administration and monitoring, and to outline practical aspects fostering the safety, quality, and cost-effectiveness of PN, as discussed at the International Safety and Quality of PN Summit. Opportunities to improve the PN use process in clinical practice include the promotion of inter-disciplinary communication, vigilant surveillance for complications, staff education to increase competency, and more consistent use of advanced technologies that allow automated safety checks throughout the PN process. Topics covered include considerations on PN formulations, including the value of intravenous lipid emulsions (ILEs), trends in compounding PN, the current and future role of market-authorized multi-chamber PN bags containing all 3 macronutrients (amino acids, glucose/dextrose, and ILE) in the United States and in Europe, and strategies to cope with the increasing global problem of PN product shortages. This review outlines potential strategies to use in clinical practice to overcome ongoing challenges throughout the PN use process, and ultimately promote PN patient safety.

Vietnam National Survey on Parenteral Nutrition Practice in Preterm Neonates: Practice Status, Barriers, and Implications.

Due to high risks of feeding intolerance, preterm infants often receive parenteral nutrition (PN) to ensure sufficient nutrition and energy intake. However, there is a lack of data on the status of clinical PN practice and barriers among neonatal care units in low- to middle-income countries like Vietnam. This extensive survey explores the status and barriers of PN practice for preterm infants in neonatal units across Vietnam and identifies the practical implications of enhancing nutritional outcomes in preterm infants. A multicenter nationwide web-based survey on PN practice in preterm infants was conducted across 114 neonatal units from 61 provinces in Vietnam. Among 114 neonatal units receiving a request for surveys, 104 units (91.2%) from 55 provinces participated. Neonatal units were categorized as level I (2/104, 1.9%), II (39/104, 37.5%), III (56/104, 53.8%), and IV (7/104, 6.8%). We found that the initiations of PN within the first hour and the first two hours of life occurred in 80.8% (84/104) and 95.2% (99/104) of the units, respectively. The early provision of amino acids, or AA (within the first day of life) and lipids (within two days of life) were documented by 85% (89/104) and 82% (84/104) of the respondents, respectively. The initial dose of AA ranged from 0.5 to 3 g/kg/day; the dose of AA less than 1 g/kg/day was reported by 7.7% (8/104) of the respondents; the maximum dose of AA ranged from 2 to over 4.5 g/kg/day, with 4 g/kg/day reported by 47.1% (49/104) of the respondents. The initial dose of lipids was between 0.5 and 2 g/kg/day, frequently 1 g/kg/day, reported by 51.9% (54/104) of the respondents; the target lipid dose ranged from 3 to 4 g/kg/day in 93.3% (97/104) respondents; the maximum target dose for lipid was 4 g/kg/day in 36.5% (38/104) of the respondents. The initial glucose dose was distributed as follows: 46.2% of respondents (48/104) administered 4 mg/kg/minute, 21.2% (22/104) used 5 mg/kg/minute, 28.8% (30/104) used 6 mg/kg/minute, and 3.8% (4/104) used 3 mg/kg/minute. Additionally, 48.1% of respondents (50/104) reported a maximum glucose infusion rate above 13 mg/kg/min and 19.2% (20/104) above 15 mg/kg/min. Nineteen percent (20/104) of the respondents reported a lack of micronutrients. Barriers to PN initiation included difficulty in establishing intravenous lines, the absence of standardized protocols, the lack of lipids and micronutrients, infections, and unavailable software supporting neonatologists in calculating nutrition paradigms. This study's findings highlight the highly variable PN practice across neonatal units in Vietnam. Deviations from current practical guidelines can be explained by various barriers, most of which are modifiable. A monitoring network for nutritional practice status and a database to track the nutritional outcomes of preterm infants in Vietnam are needed.

Advanced Practice of Total Parenteral Nutrition by Physicians in Saudi Arabia

Advanced Practice of Total Parenteral Nutrition by Physicians in Saudi Arabia

The Effect of Nutrition Education on Enteraland Parenteral Nutrition Practices on Nurses' Knowledge Level in a City Hospital: Experimental Study

Amaç: Hastanede kalış süresinin uzaması ile maliyetin artışına sebep olan beslenme sorunlarından olan malnütrisyonun tanımlanması ve yeterli beslenme desteğinin sağlanması çok önemlidir. Hastaların beslenmesinde hemşirelerin önemli düzeyde katkılarının olduğu bilinmektedir. Bu araştırma enteral ve parenteral beslenme uygulamalarına yönelik hemşirelere verilen nutrisyon eğitiminin hemşirelerin bilgi düzeyine etkisini belirlemek amacıyla yapılmıştır.&#x0D; Gereç ve Yöntem: Araştırma deneysel düzende öntest sontest çalışması olarak tasarlanmıştır. İstanbul’da bir hastanede çalışan 193 hemşire ile araştırma tamamlanmıştır. Verilerin toplanmasında araştırmacılar tarafından oluşturulan tanımlayıcı bilgi formu ve enteral-parenteral beslenme bilgi formu kullanılmıştır. Verilerin değerlendirilmesinde tanımlayıcı istatistikler için sayı, yüzde, ortalama ve standart sapma değerleri verilmiştir. Sayısal verilerin analizinde öntest ve sontest bilgi düzeyi puanları arasındaki farklılığı belirlemek için bağımlı gruplar için t testi yapılmıştır. Eğitim öncesi ve sonrası karşılaştırmalar McNemar testi ile gerçekleştirilmiştir. İstatistiksel anlamlılık düzeyi için p

The Basic Practice of Total Parenteral Nutrition by Physicians in Saudi Arabia

The Basic Practice of Total Parenteral Nutrition by Physicians in Saudi Arabia

Exploring the practice of nutritional support during hospitalization across physicians, dietitians, and pharmacists based in Saudi Arabia.

Nutritional support has a pivotal role in preventing and treating malnutrition. Recognizing the gaps in nutritional support practice can aid the development of tailored nutritional protocols. Therefore, this study aimed to assess the current practices, attitudes, and perceptions related to nutritional support for hospitalized patients in one of the largest Middle Eastern countries. A cross-sectional study was conducted among different healthcare professionals currently working in hospitals in Saudi Arabia and involved in nutritional support practice. Data were collected using convenient sample via a self-administered web-based questionnaire. A total of 114 participants were included in this study. The majority were dietitians (54%), followed by physicians (33%) and pharmacists (12%), and were from the western region (71.9%). Various attitudes in many practices were observed among the participants. Only 44.7% of the participants had a formal nutritional support team. The mean confidence level of all respondents was significantly higher for enteral nutrition practice (7.7 ± 2.3) than for parenteral nutrition practice (6.1 ± 2.5) (p < 0.01). The confidence level for enteral nutrition practice was significantly influenced by nutritional qualification (β = 0.202, p < 0.05), type of healthcare facility (β = 0.210, p < 0.05), profession (β = -0.308, p < 0.01), and years of experience (β = 0.220, p < 0.05). This study comprehensively assessed various aspects of nutritional support practice in Saudi Arabia. Healthcare practice of nutritional support should be guided by evidence-based guidelines. Professional qualification and training in nutritional support are essential for promoting practice in hospitals.

Current parenteral nutrition practice and clinical outcomes of term and late preterm infants: A retrospective study

Limited studies have described parenteral nutrition (PN) practices and clinical outcomes in term and late preterm infants. The aim of this study was to describe the current practice of PN in term and late preterm infants and their short-term clinical outcomes. We conducted a retrospective study in a tertiary NICU between October 2018 and September 2019. Infants (gestation ≥34 weeks) admitted on the day of birth or the following day and received PN were included. We collected data on patient characteristics, daily nutrition, clinical and biochemical outcomes until discharge. A total of 124 infants [mean (SD) gestation: 38 (1.92) weeks] were included; 115 (93%) and 77 (77%) commenced on parenteral amino acids and lipids, respectively, by day 2 of admission. The mean parenteral amino acid and lipid intake on day 1 of admission was 1.0 (0.7) g/kg/day and 0.8 (0.6) g/kg/day respectively and increased to 1.5 (1.0) g/kg/day and 2.1 (0.7) g/kg/day by day 5, respectively. Eight (6.5%) infants accounted for 9 episodes of hospital-acquired infections. The mean z-scores for anthropometrics at discharge were significantly lower than at birth (Weight:-0.72 (1.13) vs - 0.04 (1.11); p<0.001; Head circumference:-0.14 (1.17) vs 0.34 (1.05); p<0.001; Length:-0.17 (1.69) vs 0.22 (1.34); p<0.001). A total of 28 (22.6%) and 16 (12.9%) infants had mild and moderate postnatal growth restriction (PNGR), respectively. None had severe PNGR. Thirteen infants (11%) experienced hypoglycaemia, whereas 53 (43%) experienced hyperglycaemia. The intakes of parenteral amino acids and lipids in term and late preterm infants were at the lower end of the currently recommended doses, especially in the first five days of admission. One third of the study population had mild to moderate PNGR. Randomised trials investigating the impact of initial PN intakes on clinical, growth and developmental outcomes are recommended.

Evolution of parenteral nutrition practices in a comprehensive cancer center: Comparative audits

Malnutrition affects 20% to 70% of oncology patients depending on the patient's age, type and stage of cancer. Two audits were carried out in 2016 and 2019 to evaluate the practice of Parenteral Nutrition (PN). Records of adult medical inpatients who received PN between January 1, 2018 and April 30, 2019 were retrospectively analysed. Twenty criteria were defined. We conducted a statistical analysis to compare the two audit data. Between January 1, 2018 and April 30, 2019, 86 hospitalizations with a PN prescription were analysed. Of the 69 patients, 66% were female, the mean and median age was 60 years. These were most often medical oncology patients in palliative care. Gynecological and digestive tumors were the two main tumor localization. Bowel obstruction and palliative care management were the two main reasons for hospitalization. Nutritional assessment, amount of energy prescribed, monitoring, and duration of PN remain with poor results. Our study seems to show improvements in the relevance of PN indications, the prescription, and monitoring in patients due to the computerization of prescription and training of professionals. PN remains often prescribed in exclusive palliative situations. We need to continue our improvements, particularly for the initial clinical and biological assessment, and the monitoring. It requires a referral team to improve management of patients treated with PN.

État des lieux des pratiques de nutrition parentérale dans quatre pharmacies à usage intérieur de centre hospitalier et universitaire de la région Auvergne-Rhône-Alpes

To carry out an assessment of parenteral nutrition (PN) practices in hospital pharmacies of the Auvergne-Rhône-Alpes region in order to explore a harmonisation of practices and a collaboration between the different centres. Status of practices was carried out on the basis of an observational study inspired by the survey of the General Inspectorate of Social Affairs. It was carried out in Auvergne-Rhône-Alpes region in four university hospital pharmacies with a production unit of PN. It focused on the different stages of the PN process: prescription, formulation, compounding and quality control. It also covered the support processes such as the quality assurance system and the management of premises and equipment. Most preparations made in the region are individualized parenteral nutritional admixtures for paediatric and neonatal hospitalization departments. The production units of PN of each centre are located in premises in compliance with Good Preparation Practices. However, compounding equipment and raw materials used are heterogeneous in the four centres. All centres control the quality of their finished preparations. But, the performance of analytical control is disparate in terms of equipment and specifications. This assessment explains the similarities and differences in PN practices between various university hospitals in the Auvergne-Rhône-Alpes region and thus makes possible to provide a collective regional work to harmonise practices.

Status and Influencing Factors of Parenteral Nutrition Practice for Late Preterm Infants in China.

ObjectivesTo explore the status of parental nutrition practice of hospitalized late preterm infants and the factors influencing the clinical prescription.MethodsA multi-center, prospective cohort study was conducted during October 2015 to October 2017. Infants born after 34 weeks and before 37 weeks were enrolled from twenty-five hospitals in the Beijing area of China. Data of enteral and parenteral nutrition were collected.ResultsA total of 1,463 late preterm infants were enrolled in this study, 53.9% of infants were supported by parenteral nutrition. Over 60% of 34 weeks’ infants were on parenteral nutrition during the 2nd to the 4th day. Logistic regression analysis showed that gestational age(GA) (OR = 0.69, 95%CI 0.58–0.81), birth weight (OR = 0.41, 95%CI 0.26–0.65), hypoglycemia (OR = 2.77, 95%CI 1.90–4.04), small for gestational age (SGA) (OR = 2.18, 95%CI 1.34–3.55), feeding intolerance (OR = 6.41, 95%CI 1.90–21.59), neonatal respiratory distress syndrome (NRDS) (OR = 2.16, 95%CI 1.12–4.18), neonatal infection(OR = 1.56 95%CI 1.16–2.10), and slow enteral nutrition advancement rate (OR = 0.92, 95%CI 0.90–0.95) were factors influencing the administration of parenteral nutrition.ConclusionOver half of hospitalized late preterm infants were prescribed with parenteral nutrition. Infants with lower GA, lower birth weight, diagnosed with hypoglycemia, SGA, feeding intolerance, NRDS, neonatal infection, or a slower rate of enteral nutrition advancement had a higher likelihood of receiving parenteral nutrition.

Changes in adult home parenteral nutrition practice over 25 years

Home Parenteral Nutrition (HPN) is the established treatment of intestinal failure. This study considers the changes in practice in a single UK centre over the past twenty-five years. Data was culled from a database used for clinical care and maintained prospectively. Two hundred and five patients were included from 1993 to 2018. Patient numbers increased from 22 during 1999-2003 to 158 during 2014-2018. The median age at discharge increased from 52 years during 1999-2003 to 59 years during 2014-2018. Thirty percent of patients discharged during 1999-2003 had Crohn's disease, reducing to 14% during 2014-2018. Fifteen percent of patients discharged during 1999-2003 had small bowel fistula or obstruction in comparison to 44% during 2014-2018. Only 18 patients were treated with palliative intent, the majority in recent years. An increasing number of patients required help with HPN care over the years. Survival in non-palliative patients was 85% at 1 year, 67% at 3 years, 53% at 5 years and 42% at 10 years. The majority of deaths were due to underlying disease and only 5 of 55 deaths were attributed to HPN alone. HPN dependence in non-palliative patients was 73% at 1 year, 59% at 3 years, 56% at 5 years and 43% at 10 years. Fifty eight patients stopped HPN after reconstructive surgery. Patients experienced 5.1 admissions/1000 HPN days (64.7 admission days/1000 HPN days). Admission rate did not change over the years though the percentage due to catheter problems fell from 52% to 40% while the percentage due to underlying disease or unrelated cause rose. The increase in numbers, age and dependency of HPN patients requires increasing resource and consideration of new models of service. Many patients with short bowel syndrome now survive to old age and the care needs of the HPN patient who has become elderly can be complex. A significant proportion of patients are being referred for HPN as a bridge to reconstructive surgery after surgical complication and this requires close involvement of gastrointestinal surgeons in HPN teams. The need for hospital admissions remains a burden for HPN patients and there is scope for changes in service provision to try to reduce hospital days.

Better preterm parenteral nutrition practice

At birth preterm babies are unable to tolerate sufficient enteral nutrition to support growth and development. Parenteral nutrition provides a means to bridge the transition from placental transfer of nutrients to the establishment of enteral feeds. Despite preterm babies being one of the highest users of parenteral nutrition amongst all patient groups and that it has been in use in preterm infants for several decades, the evidence base for its use remains weak. There are several areas of uncertainty in practice, including the optimal and relative intakes of macronutrients and the optimal timing of initiation of parenteral nutrition after birth. High quality randomised controlled trials powered to detect differences in long term functional outcomes are needed to determine best practice in preterm parenteral nutrition practice.

Practice of Parenteral Nutrition in Preterm Infants.

Practice of Parenteral Nutrition in Preterm Infants.

Characteristics and Practice of Parenteral Nutrition in Hospitalized Adult Cancer Patients in Korea

Characteristics and Practice of Parenteral Nutrition in Hospitalized Adult Cancer Patients in Korea

Audit of parenteral nutrition practices in a surgical setting

Audit of parenteral nutrition practices in a surgical setting

ANALYSIS OF THE USE OF FAT EMULSIONS IN NEONATAL PARENTAL `NUTRITION IN UKRAINE

Fat emulsions are extremely important for newborns, especially for seriously ill, premature babies with very low and extremely low body weight (congenital or acquired pathology that causes gastrointestinal failure), if routine enteral feeding is problematic and sometimes impossible. All current updated data on the quality, efficacy and feasibility of using lipid emulsions in parenteral nutrition for medical reasons were published in the 2019 Cochrane Review “Systematic review of lipid emulsions for intravenous nutrition in term and late preterm infants”. More recently, fatty emulsions obtained from several sources have become available for clinical use. SMOFLipid is one of such fat emulsion. It`s a mixture of soybean oil, medium-chain triglycerides, olive oil and fish oil in a 30: 30: 25: 15 ratio that has certain benefits. Due to the content of medium-chain triglycerides, it`s rapidly metabolized; soybean oil - a source of polyunsaturated fatty acids; olive oil - less immune effects; and fish oil - the antiinflammatory effect is enhanced, and a decrease in the frequency of bronchopulmonary dysplasia and infection in premature infants is noted. Today in Ukraine, to cover the needs for energy, calories, and essential fatty acids in term and premature babies, when oral or enteral nutrition is not possible, insufficient or contraindicated, lipid emulsion SMOFLipid is actively used as part of total parenteral nutrition. The general dynamics of prescribing lipid emulsions in Ukraine are regressive due to certain regions, where the practice of parenteral nutrition for newborns differs from other areas in sporadicity and less priority due to objective and subjective circumstances. One of the key ways to solve the problem of improving the quality of medical care for newborns in neonatal hospitals should be the introduction of a training system (seminars, practical training, etc.) for neonatologists in modern principles of conducting and international clinical guidelines for parenteral nutrition of newborns at all levels in all regions. Ukraine.

Practice of parenteral nutrition in hospitalized adult patients in Korea: A retrospective multicenter cross-sectional study.

There have been no studies on the characteristics of parenteral nutrition (PN) supply for adult inpatients in South Korea. The aim of this retrospective multicenter cross sectional study was to investigate the current practice and characteristics of PN support in hospitalized adult patients in South Korea for the first time. This study was conducted retrospectively for the adult patients who were hospitalized and received PN in nine hospitals on August 1st, 2017 to October 30th, 2017. We evaluated the type of PN formulation, PN administration period, administration route, calories supplied, amount of protein supplied, and laboratory results. Among the 11,580 inpatient admissions on that day, 1,439 patients received PN (12.4%). The majority of enrolled patients (96.5%) used the commercial PN, of which 86.2% were multi-chamber. 71.2% of them received PN peripherally. The average in hospital PN duration was 17.8 ± 52.6 days. Patients received only 65.4 ± 25.4% calories of their target calories. The in-hospital mortality of enrolled patients was 22%. In South Korea, commercial PN was usually administered to hospitalized adult patients and in-hospital mortality in adult patients using PN was higher in South Korea compared to other countries. This study provides the characteristics and the PN support status of hospitalized adult patients receiving PN in South Korea.

E-Learning Training to Improve Pediatric Parenteral Nutrition Practice: A Pilot Study in Two University Hospitals.

Education and training may improve the prescription of pediatric parenteral nutrition. The aim was to evaluate the impact of an e-learning method on parenteral nutrition prescription skills among pediatric residents in 2 pediatric hospitals. A randomized double-blind control study was conducted over a 9-month period among pediatric residents in HOSP1, Geneva, Switzerland, where physicians prescribe parenteral nutrition directly, and in HOSP2, Montreal, Canada, where physicians prescribe only occasionally because clinical pharmacists are devoted to this activity. The intervention consisted of an e-learning session about key issues of parenteral nutrition. Physician parenteral nutrition knowledge was evaluated with a standardized questionnaire based on clinical cases before and after the e-learning in the intervention groups; in the control groups, only the 2 tests were conducted. In HOSP1, participants also underwent iterative tests every 2 months to measure the retention of knowledge. Sixty-five physicians participated. Initial knowledge scores were higher in HOSP1 (pretest scores 180±29 vs 133±24, p<0.001). Overall, there was no significant difference in the impact of the e-learning intervention between the control and e-learning groups (p>0.05). A significant knowledge improvement was observed in HOSP2 in the e-learning group (p = 0.033). Iterative tests in HOSP1 showed persistence of knowledge without significant differences between the groups. E-learning satisfaction among the participants was outstanding (100%). E-learning seems to be an effective method for teaching parenteral nutrition among pediatric residents and fellows at the beginning of the training. High satisfaction with this teaching method was observed in this study.

Enteral and parenteral nutrition considerations in pediatric patients

Current clinical practice guidelines on management of enteral nutrition (EN) and parenteral nutrition (PN) in pediatric patients are reviewed. The provision of EN and PN in pediatric patients poses many unique considerations and challenges. Although indications for use of EN and PN are similar in adult and pediatric populations, recommended EN and PN practices differ for pediatric versus adult patients in areas such as selection of EN and PN formulations, timing of EN and PN initiation, advancement of nutrition support, and EN and PN goals. Additionally, provision of EN and PN to pediatric patients poses unique compounding and medication administration challenges. This article provides a review of current EN and PN best practices and special nutrition considerations for neonates, infants, and other pediatric patients. The provision of EN and PN to pediatric patients presents many unique challenges. It is important for pharmacists to keep current with pediatric- and neonatal-specific guidelines on nutritional management of various disease states, as well as strategies to address compounding and medication administration challenges, in order to optimize EN and PN outcomes.