Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013 Sep 18;3(9):e003478.
doi: 10.1136/bmjopen-2013-003478.

Quality of newborn care: adherence to guidelines for parenteral nutrition in preterm infants in four European countries

Alexandre Lapillonne  1 , Virgilio Paolo Carnielli, Nicholas David Embleton, Walter Mihatsch
Affiliations

Quality of newborn care: adherence to guidelines for parenteral nutrition in preterm infants in four European countries

Alexandre Lapillonne et al. BMJ Open. .

Abstract

Objective: The level of adherence to guidelines should be explored particularly in preterm infants for whom poor nutrition has major effects on outcomes in later life. The objective was to evaluate compliance to international guidelines for parenteral nutrition (PN) in preterm infants across neonatal intensive care units (NICUs) of four European countries.

Design: Clinical practice survey by means of a questionnaire addressing routine PN protocols, awareness and implementation of guidelines.

Setting: NICUs in the UK, Italy, Germany and France.

Participants: One senior physician per unit; 199 units which represent 74% of the NICUs of the four countries.

Primary outcome measure: Adherence of unit protocol to international guidelines.

Secondary outcome measure: Factors that influence adherence to guidelines.

Results: 80% of the respondents stated that they were aware of some PN clinical practice guidelines. For amino acid infusion (AA), 63% of the respondents aimed to initiate AA on D0, 38% aimed to administer an initial dose ≥1.5 g/kg/day and 91% aimed for a target dose of 3 or 4 g/kg/day, as recommended. For parenteral lipids, 90% of the respondents aimed to initiate parenteral lipids during the first 3 days of life, 39% aimed to use an initial dose ≥1.0 g/kg/day and 76% defined the target dose as 3-4 g/kg/day, as recommended. Significant variations in PN protocols were observed among countries, but the type of hospital or the number of admissions per year had only a marginal impact on the PN protocols.

Conclusions: Most respondents indicated that their clinical practice was based on common guidelines. However, the initiation of PN is frequently not compliant with current recommendations, with the main differences being observed during the first days of life. Continuous education focusing on PN practice is needed, and greater efforts are required to disseminate and implement international guidelines.

Keywords: Neonatology; Nutrition & Dietetics.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Percentage of NICUs (n=161) in Germany, France, Italy and the UK compliant to guidelines for parenteral nutrition in preterm infants. NICUs were considered compliant to guidelines if: for amino acids, initiation=day of birth, initiation dose ≥1.5 g/kg/day, target dose=3–4 g/kg/day; for glucose, initiation dose ≥7 g/kg/day, target dose=10–17 g/kg/day; for lipids, initiation ≤day 3 of life, initiation dose ≥1 g/kg/day, target dose=3–4 g/kg/day; energy, target dose=110–120 kcal/kg/day.
Figure 2
Figure 2
Use of international clinical practice recommendations to guide neonatal parenteral nutrition by country.
Figure 3
Figure 3
Justification for non-implementation of international clinical practice guidelines by country.
See this image and copyright information in PMC

References

    1. Isaacs EB, Gadian DG, Sabatini S, et al. The effect of early human diet on caudate volumes and IQ. Pediatr Res 2008;63:308–14 - PubMed
    1. Lapillonne A, Griffin IJ. Feeding preterm infants today for later metabolic and cardiovascular outcomes. J Pediatr 2013;162(Suppl 3):S7–16 - PubMed
    1. Dit Trolli SE, Kermorvant-Duchemin E, Huon C, et al. Early lipid supply and neurological development at one year in very low birth weight (VLBW) preterm infants. Early Hum Dev 2012;88(Suppl 1):S25–9 - PubMed
    1. Stephens BE, Walden RV, Gargus RA, et al. First-week protein and energy intakes are associated with 18-month developmental outcomes in extremely low birth weight infants. Pediatrics 2009;123:1337–43 - PubMed
    1. Martin CR, Brown YF, Ehrenkranz RA, et al. Nutritional practices and growth velocity in the first month of life in extremely premature infants. Pediatrics 2009;124:649–57 - PMC - PubMed