Presented at the Neonatal Society 2016 Autumn Meeting.
Callaghan F, Howells B, Babarao S, Ramdeny S, Bunni L, Morgan C
Arrowe Park Hospital, Wirral, UK
Liverpool Women’s Hospital, Liverpool, UK
Background: We have previously shown that parenteral/total protein target attainment is improved by using standardised, concentrated parental nutrition (PN) compared to conventional individualised PN. We subsequently embarked on a regional implantation programme (CoMPaSS). Target attainment for protein intake was the audited in detail at one level 3 NICU to investigate whether the benefits of standardisation and concentration could be replicated outside the original centre of research.
Methods: A continuous cohort of 31 patients born after August 2014 at less than 30 weeks gestation and weighing less than 1.5kg who received TPN were identified using the Badger system. Case notes (both electronic and paper) were retrospectively reviewed and parenteral nutrition, infusions and enteral intake was recorded on a data collection form for the first 15 days of life. Parenteral and total protein intake was calculated from these volumes. This data was compared to the standard expected to be attained according to the CoMPaSS protocol.
Results: Results for PN protein intake and target attainment are summarized below: Target attainment is higher than described for individualised regimens (75-80%) but protocol violations due to delayed initiation (large impact of removing day 1 from target attainment calculation), hyperglycaemia and transition to enteral feeds indicate still room for improvement.
Conclusion: Improvements in nutrition target attainment using standardised concentrated PN regimens can be translated across different neonatal services. Training packages are essential to ensure protocol compliance maximises nutritional intake.
Acknowledgement: The CoMPaSS (Concentrated Macronutrients in Parenteral Standardised Solutions) neonatal nutrition project has been supported by a small grant from Bliss to fund a cascade trainer.