Background Parenteral nutrition (PN) for neonates has to be infused by a central line, due to the high osmolarity resulting from the recommended requirements. The central catheter frequently needs to be removed, and therefore PN may have to be administered by a peripheral line. This problem has been resolved by infusion of enriched glucose solutions, minus the protein input, which is very important in order to avoid catabolism. Purpose To develop a standard PN with glucose, electrolytes and amino acids, suitable for peripheral infusion and available for the Neonatology department at any time. The aim is to infuse 100 mL/Kg. Materials and MethodsWe performed a literature search about standard PN and we made microbiological and biochemical cheques to ensure the stability and integrity of the solution, after keeping it refrigerated for seven days. ResultsWe developed a standard PN solution with the following composition per 100 mL: Amino acids: 2 g Glucose: 9.5 g Sodium: 4 mEq Potassium: 2 mEq Magnesium: 0.2 mEq Calcium: 1.5 mEq Phosphate: 0.8 mmol Osmolarity: 792 mOsm/L Total calories: 46 Kcal Weekly, we prepare four 500 ml bags from a stock solution. We give the neonatology department two so they can hold a small stock and we keep the other two in order to cheque when we need to make another batch. From implementation, in February 2012, the microbiological controls have always been negative and the biochemical controls have demonstrated that degradation does not occur after refrigeration for seven days. Conclusions This formulation makes it possible for the physicians to continue with the nutritional support, by peripheral infusion, at any time. However this type of nutritional solutions is only suitable for meeting the nutritional requirements for short periods, until a new central catheter is placed or the neonate is able to have complete enteral feeding. No conflict of interest.

BackgroundPatients with tuberous sclerosis often develop facial angiofibromas that can be successfully treated with topical 1% sirolimus ointments. Nevertheless, this ointment’s greasy nature can produce acne, causing patients to refuse the treatment.PurposeTo devise a non-oily formula for topical sirolimus for patients with tuberous sclerosis and facial angiofibromas who develop acne due this ointment.Material and methodsWe reviewed the literature searching for standard procedures for making alternative topical formulations of sirolimus. In addition, the physicochemical properties of sirolimus were considered in order to find the most suitable formulation for this particular case.ResultsNo standard ways were found of producing oil-free formulations of sirolimus. We decided to compound a 0.2% sirolimus gel with the following procedure. First, prepare a 2% carmellose gel. For this, heat aqua conservans (Nipagin 0.25 g + Nipasol 0.11 g + distilled water 500 mL) to 50°C. In a mortar, mix 2 g of sodium carboxymethylcellulose and 10 g of glycerol. Then, add the content of the mortar to 88 g of heated aqua conservans and stir the mixture until room temperature is reached. Once the carmellose gel has been prepared, weigh 0.2 g of sirolimus and add a few drops of glycerol to it. Slowly, pour the carmellose gel onto the sirolimus, mixing them by stirring, until 100 g has been added. Let it stand for 12 h until the gel is homogeneous. We give it an expiry date of 2 months, stored in an opaque container and at room temperature (below 25°C). Mask and gloves must be used throughout the procedure.ConclusionWe found a way to formulate sirolimus in non-oily excipients in order to diminish the development of acne with its use. Further studies will be needed to determine the efficacy of this formula in the treatment of facial angiofibromas of patients with tuberous sclerosis and the improvement of the acne presented by these patients.References and/or acknowledgementsNo conflict of interest.