Survey On Clinical Practice Of Parenteral Nutrition In Neonates In Australasia

Following the formation of the Neonatal Parental Nutrition Consensus Group in November 2010 and publication of consensus guidelines, many neonatal intensive care units (NICUs) across Australia have begun to implement the use of standardised parenteral nutrition (PN) formulations.1 These formulations have been shown to provide improved nutritional support and promote optimal weight gain in extremely low birthweight infants.2 A recent systematic review of practice surveys on PN for preterm infants demonstrated significant differences in PN delivery within individual surveys and between surveys, highlighting that there are multiple infrastructural or logistic challenges that need to be addressed to ensure consistent delivery of optimal nutrition across networks of NICUs.3 We conducted a survey (SurveyMonkey Inc., San Mateo, CA, USA) among all the representative units in the consensus group to review current practice, with respect to the use of PN, in each individual unit. The main objective was to use the results of the survey to assist in developing an acceptable and practical consensus guideline for the use of PN. The survey was conducted over a 1-month period from January 2015 to February 2015. Representatives from 48 tertiary (40) and non-tertiary (8) NICUs within Australia, New Zealand, Malaysia, Singapore and India were invited to participate in this survey. The survey was completed by 45 of the 48 representatives. In this survey (Table 1), the majority of respondents administer PN to low birthweight infants within 24 h of birth (<1000 g – 97%; 1000 g–1500 g – 88%). In extremely low birthweight infants (<1000 g), most respondents (47%) opt to cease PN when enteral intake reaches 140–160 mL/kg/day. There was variation in responses with 50% of respondents ceasing PN when enteral intake reaches 100–140 mL/kg/day. In larger infants (>1500 g), practice was variable with respect to both starting and ceasing parenteral nutrition. For all infants, maximum protein and lipid intakes were comparable with maximum recommended amino acid intakes of approximately 4 g/kg/day of protein and 3–4 g/kg/day of lipid.4 The findings of this study highlight many areas of similarity and some inconsistency in PN practice and will contribute in the construction and implementation of an evidence-based, standardised clinical practice guideline for PN administration across the network. Standardised guidelines have the potential to improve the delivery of optimal nutritional intake across the network. Future surveys will be used to determine the level of compliance with these guidelines and identify potential factors that may impact on the delivery of optimal nutrition.