Comparison of two types of TPN prescription methods in preterm neonates

Objective Total parenteral nutrition is commonly used in neonates’ intensive care units for nutritional support of preterm neonates. Adequacy and safety of parenteral nutrition support are amongst the major concerns of neonates’ therapy. Parenteral nutrition prescription in Greek hospitals is not based on standardized protocols, thus resulting in wide diversity of formulations. In this study, the results of utilization of standardized computerized parenteral nutrition protocols and regimens for neonates are compared to the results of protocols and regimens prescribed by individual neonatologists on neonates’ outcome (weight changes, adequacy of parenteral nutrition, days of hospitalization, clinical outcome). Setting The study took place at “Mitera” Maternity Hospital of Greece. Method Two groups of 30 preterm infants (28–36 weeks) with respiratory failure were recruited for the study. They were admitted in a Greek maternity hospital and they all received total parenteral nutrition support in neonates’ intensive care unit. Standardized, computer based protocols were applied for the prescription of parenteral nutrition formulations in the first group, while on the other, regimens prescribed by neonatologists were used. Main outcome measures: Macro- and micronutrients provided by the different total parenteral nutrition protocols were recorded. Body weight was measured, blood count and biochemical profile were performed at the beginning and at the end of parenteral nutrition support. The number of days of total parenteral nutrition support as well as the total number of days of hospitalization was recorded. Results Standardized protocols provided more energy (P-value: 0.05), protein (P-value: 0.023) and micronutrients than the non-standardised. Neonates that receive standardized total parenteral nutrition gained weight (+44 ± 114 g) and had better blood count and biochemical values during total parenteral nutrition support compared to the other group, that lost weight during total parenteral nutrition support (−53 ± 156 g). These differences were also statistically significant (P value < 0.05). Regarding the total days of hospitalization, no differences were found between the two groups. Conclusion The use of standardized protocols in preterm neonates resulted in more adequate provision of nutrients, weight gain and better blood count profile compared with protocols prescribed by individual physicians.