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99nicu Poll: What solutions for parenteral nutrition do you use in your NICU?

What solutions for parenteral nutrition do you generally use in your NICU? 72 members have voted

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Parenteral nutrition is necessary for critically ill infants, and there are several ways to get solutions for parenteral nutrition.

From mixing own solutions in the NICU to using commercially products "ready-to-use".

What is your current practise regarding the TPN solutions.

I will share the Karolinska way (which we currently discuss to revise...) in a separate post later.

We use this(LINK) installed in a separate computer in NICU (separated from the main hospital IT network) connected via dedicated network to this (LINK) in the IV room in the Pharmacy.

The TPN instructions are entered into the Abacus software in NICU by the NICU doctor along with pharamacist (who comes and stays in the NICU during the TPN entry). The pharmacist is a boon as she often recognizes problems in the TPN order very early (like when calcium precipitation is very likely, etc).

We are using partial parentral nutrition. Aminoacids are available in 10% concentration. Depending up on caloric requirement we take dextrose, multivitamin and aminoacids.

We use Dextrose (plus calcium) from the first day. Electrolytes start from the third day. We use 6% of aminoacid solution (we don't have the 10%) and 20% lipid.. Which are commercially available.. We don't have any special unit for making TPN solutions..

comment_6174
Parenteral nutrition is necessary for critically ill infants, and there are several ways to get solutions for parenteral nutrition.

From mixing own solutions in the NICU to using commercially products "ready-to-use".

What is your current practise regarding the TPN solutions.

I will share the Karolinska way (which we currently discuss to revise...) in a separate post later.

Hi

Our NICU IN GAZA uses ready bottles of amino acids solutions we mix it with other intralipid solitons 20% together with glucose solutions but we don't have minerals and vitamins additives

  • Author

We order TPN solutions from our hospital pharmacy, individualized for each infant. As we increase fat and protein load over three days, we make one new "recipe" per day over the first three days, and then we usually order TPN solution 2-4 times a week for each patient, depending on water balance, volume target per day etc.

We really aim for individualized nutrition but we feel our strategy is expensive and time consuming, and are looking for ways to simplify. I.e. looking for commercially available TPN solutions, or letting the hospital pharmacy pre-produce a set of "bags" that enable an individualized approach that is "good enough".

comment_6192
We order TPN solutions from our hospital pharmacy, individualized for each infant. As we increase fat and protein load over three days, we make one new "recipe" per day over the first three days, and then we usually order TPN solution 2-4 times a week for each patient, depending on water balance, volume target per day etc.

We really aim for individualized nutrition but we feel our strategy is expensive and time consuming, and are looking for ways to simplify. I.e. looking for commercially available TPN solutions, or letting the hospital pharmacy pre-produce a set of "bags" that enable an individualized approach that is "good enough".

The following adverse event happened about 15 years ago, but it occurred on my overnight duty shift, so I can't forget it. Our NICU's norm then was an individual MD-concocted (with the help of a "home-grown" computer software-calculated) recipe every day for patients receiving IV al. The fresh recipe for the first 12 hours of the next 24 hour IV al "dose" was hung at 1800hrs. Around 2200hrs the RN observed something about the baby's behavior that concerned her (I forget exactly what.) She called me, and she continued to investigate on her own also. The baby looked more "puny" than was his norm, but otherwise his findings were non-specific. Among other investigations, the baby's RN did a bedside glucose determination. It was zero. We both were flabbergasted; the baby's bedside glucose was repeated, and again it was zero. A simultaneous "store-bought" laboratory glucose determination was also zero. We gave D25W, and followed blood glucoses which gradually improved. The first and second (not yet entered or hung for the baby, due to be hung at 0600 hrs the following AM) 12-hour IV al bags for that 24 hour period were analyzed by the lab. Instead of finding D15W as we expected from the written IV al recipe order sent to the pharmacy, NEITHER bag contained any glucose at all. It turned out that the pharmacist compounding the child's IV al had simply forgotten to draw up the concentrated dextrose aliquant needed in both IV al bags for that upcoming next 24-hour period. Ostensibly, the short-term followup of the baby was good. I wish I knew and could tell you the results of his Bayley and other developmental assessments over the long term.

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