title: Assessment of implementation of a standardized parenteral formulation for early nutritional support of very preterm infants.
abstract: BACKGROUND
  Parenteral nutrition (PN) plays an important role in the nutritional support of very preterm newborns. It has been suggested that a high proportion of PN orders could be standardized. In 2002, we implemented in our unit the preparation of three standardized formulations for PN adapted to the nutritional requirements of premature infants<32 weeks. Following this change of practice, a retrospective observational study was conducted to evaluate the relevance of the implemented standardized PN regime. Twenty premature inborn infants<32 weeks gestation who had received standardized (STD) PN in 2003 were matched for 20 infants who had received individualized (IND) PN in 2001. Adequacy of nutrition was assessed by comparing daily intravenous nutrient intake and biochemical parameters during the first week. Amino-acid intakes on day 3 were higher in the STD group (1.5+/-0.2 g/kg/d vs. 0.9+/-0.5, p<0.001), and the calcium phosphate intakes were better balanced. The cumulated intake of amino acids for the first week was greater in the STD group (+20% ; p=0.0003). Biochemical parameters were similar in both groups. Insulin infusions were less frequent in the STD group (p<0.06).
  
  
  CONCLUSIONS
  Standardized parenteral formulations provided higher early intakes of amino acid and glucose, a better calcium phosphate ratio, and a greater amount of amino-acid intakes during the first week while maintaining the same biochemical parameters. This strategy forms part of an approach concerning quality control and the respect of good professional practice for the preparation of parenteral nutrition solutions.
authors.affiliation: Division of Neonatology, Department of Pediatrics, Poissy-Saint Germain en Laye Hospital, and University of Pharmacy, Paris, France. rlenclen@chi-psg.com
authors.forename: Richard
authors.initials: R
authors.lastname: Lenclen
authors.forename: Sylvie
authors.initials: S
authors.lastname: Crauste-Manciet
authors.forename: Philippe
authors.initials: P
authors.lastname: Narcy
authors.forename: Saida
authors.initials: S
authors.lastname: Boukhouna
authors.forename: Amélie
authors.initials: A
authors.lastname: Geffray
authors.forename: Marie-Noëlle
authors.initials: MN
authors.lastname: Guerrault
authors.forename: François
authors.initials: F
authors.lastname: Bordet
authors.forename: Denis
authors.initials: D
authors.lastname: Brossard
mesh_terms: D000596:Amino Acids / Q000008:administration & dosage / Q000592:standards; D002130:Calcium Phosphates / Q000008:administration & dosage; D002241:Carbohydrates / Q000008:administration & dosage; D016022:Case-Control Studies; D002985:Clinical Protocols; D003404:Creatinine / Q000097:blood; D005602:France; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007231:Infant, Newborn; D007234:Infant, Premature; D007328:Insulin / Q000627:therapeutic use; D009751:Nutritional Requirements; D010288:Parenteral Nutrition / Q000592:standards*; D010758:Phosphorus / Q000097:blood; D012189:Retrospective Studies; D013813:Therapy, Computer-Assisted; D014131:Trace Elements / Q000008:administration & dosage / Q000592:standards; D014815:Vitamins / Q000008:administration & dosage / Q000592:standards; D015430:Weight Gain
chemical_list: D000596:Amino Acids; D002130:Calcium Phosphates; D002241:Carbohydrates; D007004:Hypoglycemic Agents; D007328:Insulin; D014131:Trace Elements; D014815:Vitamins; D010758:Phosphorus; C020243:calcium phosphate; D003404:Creatinine