NICE guideline review: Neonatal parenteral nutrition (NG154)

Ray, Sagarika

doi:10.1136/archdischild-2020-320581

Cited by 5 publications

(10 citation statements)

References 3 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%

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%

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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“…At present, the problem of insufficient blood supply in China is becoming more serious [37]. In order to make rational use of chylous plasma, clinical blood transfusion department through fine management of clinical blood use, it is particularly important to control clinical scientific and rational use of blood, save blood, and protect limited blood resources [38].…”

Section: Discussionmentioning

confidence: 99%

Effects of Adipose Plasma Transfusion Compared with Normal Plasma Transfusion on Adverse Transfusion Reactions, Important Functional Indicators, and Clinical Safety in Patients with Parenteral Nutrition: Based on a Retrospective Cohort Study

Gong

Qin

Chen

et al. 2022

Evidence-Based Complementary and Alternative Medicine

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Objective. Based on a retrospective cohort study, the study aims to investigate the effects of adipose plasma transfusion compared with normal plasma transfusion on adverse transfusion reactions, important functional indicators, and clinical safety in patients with parenteral nutrition (PN). Methods. One hundred and twenty inpatients who needed PN and plasma transfusion in Xianning Central Hospital from September 1, 2021, to March 31, 2022, were enrolled as the actual application verification cases. All the patients in the group noticed the informed consent form, and the normal plasma transfusion was set as the control group (n = 40), and the fat plasma transfusion was set as the study group. Mild adipose plasma transfusion was adopted in study group ① and moderate adipose plasma transfusion was used in study group ②, 40 cases in each group. The blood routine tests, blood lipids, blood coagulation, liver function tests, and the incidence of adverse reactions of blood transfusion were compared. Results. The comparison results of platelet count, red blood cell count, hemoglobin, and hematocrit among the three groups are as follows: study group ②> study group ①> control group ( P < 0.05 ).The levels of blood lipids in the three groups, triglyceride, total cholesterol, high density lipoprotein, and low density lipoprotein were compared in group ②>group ①>control group ( P < 0.05 ).The liver function tests indexes of the three groups were compared: ALT, AST, LDH: study ②<study ①<control group; ALP: study ②>study ①>control group. Regarding the incidence of adverse transfusion reactions, the incidence of adverse transfusion reactions in the study group was lower than in the control group ( P < 0.05 ). Conclusion. Compared with normal plasma transfusion, the inpatients who need PN and plasma transfusion can effectively use the scrapped mild and moderate fatty plasma and reduce the plasma scrap rate. In the meantime, it has little effect on the function of the important indexes of the patients, and the incidence of adverse reactions of blood transfusion is low and the safety is high. Infusion of adipose plasma can also improve the effective individual and rational utilization of blood products. Trial registration: This trial is registered with chiCTR220005918.

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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: 65%

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.

show abstract

NICE guideline review: Neonatal parenteral nutrition (NG154)

Cited by 5 publications

References 3 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

Effects of Adipose Plasma Transfusion Compared with Normal Plasma Transfusion on Adverse Transfusion Reactions, Important Functional Indicators, and Clinical Safety in Patients with Parenteral Nutrition: Based on a Retrospective Cohort Study

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

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