BackgroundNeonatal Intensive Care (NICU) patients have individual nutritional requirements often requiring Patient Specific Parenteral Nutrition (PSPN). From October 2015, the national PSPN compounding service availability changed from 7 days per week service to 5 days per week (i.e. no weekend and limited bank holiday ordering available). The aim of this study was to examine the introduction of a 5 day only PSPN supply on neonatal patient parenteral nutrition availability in a tertiary NICU.MethodsWe performed a prospective assessment of the provision of a 5 day rather than 7 day ordering of PSPN over a one month period (June 2017).ResultsFifteen neonatal patients received a cumulative 89 days of PN during June 2017. 10 (66%) patients received PSPN during this time period. There was same day availability of PSPN in 62 of 89 days of PN (69%).ConclusionThorough education and training will help prescribers to make appropriate PSPN ordering decisions. Improvements to available stock bags may reduce the amount of PSPN that is required but a 7 day PSPN ordering service would improve efficient provision of clinically indicated PSPN to premature infants in NICU in Ireland.

Background: Advantages of early discharge of VLBW infants include cost savings, decreased exposure to nosocomial infections, and benefit for families. Aim: To evaluate the effect of discharge planning on duration of stay of VLBW infants. Methods: Retrospective review of VLBW infants from 1.1.1996 -31.12.2009. Results: 850 VLBW infants were discharged home alive, accounting for 49,917 hospital days. Mean LOS was 50.81 days (2009) and was significantly lower than 2004-2007 (p =.015), with no increase in readmissions. 5.6% (n=48) had delayed discharge (>42/40 CGA) which was less in 2009 than 2007 (2 vs 6 infants). Infants discharged >42/40 CGA had an earlier mean GA (28.5 vs. 29.3 weeks), lower mean BW (870g vs. 1144g) and mean LOS (117.9 days). Delayed discharge was significantly associated with NEC requiring surgery (42.9%), BPD (20.4%), discharge home on O2 (22.4%), or requiring an apnoea monitor. Overall LOS was associated with GA, and sepsis (CONS) (p< 0.05). The total incidence of sepsis decreased from 46 infants per year in 2007 to 25 infants in 2009. 197 infants were transferred to local hospitals. Mean LOS pre transfer was 31.96 days (2009) compared 38.21 days (2007), and significantly reduced compared to 2004-2008 (p =.026) with no corresponding increased combined LOS in Rotunda and local hospital (2007=67.3 days vs 2009= 57.4 days). Conclusions: Reduction in mean LOS for VLBW infants with improvement in discharge planning was associated with the appointment of a discharge coordinator. Discharge coordinators are cost effective and should be appointed in all neonatal units.

Background: Not all LBW infants require admission to the SCBU. Hypothermia (< 36.5C) in premature infants may necessitate admission to SCBU. This interferes with mother-infant bonding and breastfeeding. LBW infants are particularly at risk of hypothermia because of larger surface-area-toweight ratio, reduced subcutaneous fat and impaired metabolic compensation. This study examines the incidence of hypothermia in moderately low birth weight (LBW) infants. Aims: To document the incidence of hypothermia on admission in moderately LBW infants between 1800 - 2500 grams admitted to the Neonatal Unit of the Rotunda Hospital between 2002 and 2009 and compare it to the hypothermia rate in larger babies. Methods: Retrospective review of moderately LBW infants admitted to the SCBU in the Rotunda with birth weights >1800g and < 2500g. Patients were identified using the unit database; further information obtained from chart review where necessary. All infants had temperature recorded on admission. Results: 340 infants fulfilled the weight criteria. 44% of these were hypothermic on admission: 27% had mild hypothermia (36-36.4°C); 17% had moderate hypothermia (32-35.9°C). No patients had severe hypothermia. The lowest recorded temperature was 34° C. Overall rate of hypothermia in this group: 44% versus 32.4% in infants >2.5kg. Conclusion: A significant number (44%) of LBW infants weighing 1.8 to 2.5kg admitted to the SCBU had mild to moderate hypothermia. The rate of hypothermia in larger infants (>2.5kg) was 32%. This indicates the need for improving practices to prevent hypothermia in the delivery room and during transfer of LBW infants.