Standardised neonatal parenteral nutrition formulations – Australasian Neonatal Parenteral Nutrition Consensus update 2017

Abstract

The first consensus standardised neonatal parenteral nutrition formulations were implemented in many neonatal units in Australia in 2012. The current update involving 49 units from Australia, New Zealand, Singapore, Malaysia and India was conducted between September 2015 and December 2017 with the aim to review and update the 2012 formulations and guidelines. Methods: A systematic review of available evidence for each parenteral nutrient was undertaken and new standardised formulations and guidelines were developed. Results: Five existing preterm Amino acid-Dextrose formulations have been modified and two new concentrated Amino acid-Dextrose formulations added to optimise amino acid and nutrient intake according to gestation. Organic phosphate has replaced inorganic phosphate allowing for an increase in calcium and phosphate content, and acetate reduced. Lipid emulsions are unchanged, with both SMOFlipid and ClinOleic preparations included. The physicochemical compatibility and stability of all formulations have been tested and confirmed. Guidelines to standardise the parenteral nutrition clinical practice across facilities have also been developed. Conclusions: Formulations and guidelines to standardise parenteral nutrition practice across the Australasian region have the potential to improve nutrition and clinical outcomes of neonates. Standardisation can also result in cost savings, quality improvement and error minimisation in PN prescribing and ordering.

Use of parenteral nutrition in term and late preterm infants: an Australian and New Zealand survey

“…In Australia and New Zealand, standardised indications for preterm infants < 32 weeks are available (16) . Whilst there are no established guidelines for late preterm and term infants, PN is widely used in Australian hospitals in these infants who are not fed enterally (16) .…”