Guidelines for parenteral nutrition in preterm infants: The American Society for Parenteral and Enteral Nutrition

Robinson, Daniel T.; Calkins, Kara L.; Chen, Yimin; Cober, M. Petrea; Falciglia, Gustave H.; Church, David D.; Mey, Jacob; McKeever, Liam; Sentongo, Timothy

doi:10.1002/jpen.2550

Cited by 23 publications

(17 citation statements)

References 69 publications

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“…Many of these NICUs lack sufficient facilities and staff that care for preterm infants. The most recent European and US guidelines recommended that PN should be initiated early, within the first one to two hours of life in preterm infants [ 9 , 10 , 16 , 17 ], and our survey results reported a high level of compliance.…”

Section: Discussionsupporting

confidence: 61%

“…Our survey revealed that the initial dose of AA ranged from 1 to 2 g/kg/day in 85.6% (89 out of 104) NICUs. For the maximum dose of AA, this varies in previous clinical trials, from 2.5 to 4.5 g/kg/day [ 17 ]. Current evidence also shows limited difference in clinical outcomes between a maximum AA dose of 3.5 versus 4 g/kg/day [ 5 , 17 ].…”

Section: Discussionmentioning

confidence: 99%

“…For the maximum dose of AA, this varies in previous clinical trials, from 2.5 to 4.5 g/kg/day [ 17 ]. Current evidence also shows limited difference in clinical outcomes between a maximum AA dose of 3.5 versus 4 g/kg/day [ 5 , 17 ]. Our survey showed that the maximum dose of AA was consistent with the recommendations (ranging from 3.5 to 4 g/kg/day) in 74% (77 out of 104) of the NICUs.…”

Section: Discussionmentioning

confidence: 99%

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

Nguyen,

Nguyen

et al. 2024

Cureus

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Background: 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. Methods: A multicenter nationwide web-based survey on PN practice in preterm infants was conducted across 114 neonatal units from 61 provinces in Vietnam. Results: 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. Conclusion: 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.

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Section: Discussionsupporting

confidence: 61%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

Nguyen,

Nguyen

et al. 2024

Cureus

View full text Add to dashboard Cite

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“…The survey documented that 85.6% (89 out of 104) of NICUs provided amino acids (AA) within 24 hours of life (on the PN was initiated), consistent with existing guidelines [9,10,[16][17][18]. Still, the remaining NICUs (14.4%) deferred providing AA.…”

mentioning

confidence: 67%

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

Nguyen,

Nguyen

et al. 2024

Preprint

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Background: 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. Methods: A multicenter nationwide web-based survey on PN practice in preterm infants was conducted across 114 neonatal units from 61 provinces in Vietnam. Results: 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 showed 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 (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 amino acids ranged from 0.5 to 3 g/kg/day; the dose of amino acids less than 1 g/kg/day was 7.7% (8/104) of respondents; the maximum dose of amino acids ranged from 2 to over 4.5 g/kg/day, with 4 g/kg/day in 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, in 51.9% (54/104) of the respondents; the target lipid dose ranged from 3 to 4 g/kg/day in 93.3% (97/104); 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 04 mg/kg/minute, 21.2% (22/104) used 05 mg/kg/minute, 28.8% (30/104) used 06 mg/kg/minute, and 3.8% (4/104) used 03 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 lacking 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. Conclusions: 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.

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“…To the Editor, We welcomed the American Society for Parenteral and Enteral Nutrition guidelines for parenteral nutrition (PN) in preterm infants, 1 but were surprised to find a recommendation on restriction of amino acids (AAs) based on an increased risk of sepsis. We are writing to express our concerns regarding the authors' interpretation of the data, which led to a recommendation that has the potential to alter practice significantly.…”

mentioning

confidence: 99%

Commentary on “Guidelines for parenteral nutrition in preterm infants: The American Society for Parenteral and Enteral Nutrition”

Liviskie,

McPherson,

Zeller

2024

J Parenter Enteral Nutr

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Guidelines for parenteral nutrition in preterm infants: The American Society for Parenteral and Enteral Nutrition

Cited by 23 publications

References 69 publications

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

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

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

Commentary on “Guidelines for parenteral nutrition in preterm infants: The American Society for Parenteral and Enteral Nutrition”

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