A Retrospective Study Evaluating Guideline Adherence of Neonatal Parenteral Nutrition in a Belgian Neonatal Intensive Care Unit

Abstract

Introduction Clinical nutrition for preterm and critically ill neonates remains a challenge. Preterms are often hemodynamically and metabolically compromised, which limits infusion volumes of nutrients and hinders achieving recommended nutrient intakes. While guidelines provide recommended ranges for parenteral nutrition (PN) intakes, they generally recommend enteral nutrition as soon as possible. Thus, in clinical practice, gradually increasing EN intakes complicates assessments of PN guideline adherence. Via a pragmatic approach, we assessed adherence to PN recommendations for macronutrients and energy as stated in the 2018 guidelines of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN). Methods In this retrospective study, we assessed the nutrition of preterm and critically ill term neonates from the neonatal intensive care unit of the University Hospital Brussels. We analyzed intakes for the first week of life, in which critically ill neonates at our center usually receive the majority of nutrients via PN. The PN-based provision of macronutrients and energy was analyzed descriptively in relation to the ESPGHAN 2018 recommendations. Results Macronutrients and energy provision gradually increased until they reached recommended or targeted values. Compared to term neonates, energy and lipid provision for preterms increased faster, while amino acid provision exceeded the ESPGHAN 2018 recommendations. Conclusions This study adds clinical practice data to the severely understudied field of the ESPGHAN 2018 PN guideline compliance. Using a pragmatic assessment of our nutrition protocols, we found the need to reduce the amount of amino acids per kg body weight per day to meet guideline recommendations.

Keywords: guideline adherence; infant; newborn; parenteral nutrition; practice patterns; premature birth.

Figure 1. Calculated mean nutrient provision in very preterm infants (GA <32 weeks) over time for (A) energy, (B) amino acids, (C) lipids, and (D) glucose

Data points show the mean ± SD. The numbers on top show patient numbers. Shaded areas show the minimum and maximum intakes for energy, amino acids, and carbohydrates recommended by the ESPGHAN 2018 guidelines, and the dotted line shows the lipid intake target used in the UZ Brussel. GA, gestational age; ESPGHAN, European Society for Paediatric Gastroenterology, Hepatology and Nutrition [13,14,16]

Figure 2. Calculated mean nutrient provision in preterm infants (GA 32–36 weeks) over time for (A) energy, (B) amino acids, (C) lipids, and (D) glucose

Data points show the mean ± SD. The numbers on top show patient numbers. Shaded areas show the minimum and maximum intakes for energy, amino acids, and carbohydrates recommended by the ESPGHAN 2018 guidelines, and the dotted line shows the targeted lipid intake in the UZ Brussel. GA, gestational age; ESPGHAN, European Society for Paediatric Gastroenterology, Hepatology and Nutrition [13,14,16]

Figure 3. Calculated mean nutrient provision in term infants (GA >36 weeks) over time for (A) energy, (B) amino acids, (C) lipids, and (D) glucose

Data points show the mean ± SD. The numbers on top show patient numbers. Shaded areas show the minimum and maximum intakes for energy, amino acids, and carbohydrates recommended by the ESPGHAN 2018 guidelines, and the dotted line shows the targeted lipid intake in the UZ Brussel. GA, gestational age; ESPGHAN, European Society for Paediatric Gastroenterology, Hepatology and Nutrition [13,14,16]