Pediatrics

Optimizing parenteral nutrition therapy in pediatric patients through advanced solutions including licensed industry-prepared ready-to-use three-chamber bags.

In critically ill children, poor nutritional status is associated with higher mortality and can result in long-term effects on growth.¹ For children with chronic intestinal failure, parenteral nutrition (PN) is required to achieve adequate growth and fluid and electrolyte homeostasis.² Baxter is dedicated to improving the nutritional status of children who require PN therapy by providing a range of standardized solutions optimized for pediatric patients to support growth and recovery.

Optimal nutritional balance plays a crucial role in growth and recovery in pediatric patients

As many as 40% of hospitalized children suffer from acute malnutrition.³ Children who are critically ill or recovering from serious injury are vulnerable to reduced intake of energy and protein, and the resulting malnutrition may have severe health consequences and impair long-term growth.¹ For some pediatric patients who cannot receive adequate enteral nutrition, PN can be life-saving.¹

Malnutrition in pediatric patients is associated with poor clinical outcomes^4-11

Malnutrition in pediatric patients can lead to: Increased length of hospital stay, increased length of PICU stay, prolonged mechanical ventilation, increased mortality, increased risk of hospital-acquired infections, impaired quality of life and increased economic burden of care. — Malnutrition in pediatric patients can lead to: Increased length of hospital stay^4-7, increased length of PICU stay^8-10, prolonged mechanical ventilation^8-10, increased mortality^8,11, increased risk of hospital-acquired infections¹¹, impaired quality of life⁴ and increased economic burden of care.⁶
PICU, Pediatric Intensive Care Unit.

Hospitalized children often receive suboptimal PN therapy

When PN is used to supplement or replace enteral nutrition, the timing, quality, and quantity of nutritional intake are not consistently achieved.¹² Individualized PN provides a lower nutrient intake that is associated with poorer weight gain and increased nutritional deficits.¹³ Compounded PN also entails increased risk of safety issues including compounding errors, contamination, or incompatibility, which can arise at any stage from prescription to preparation to administration.¹⁴

37%

of manually compounded PN solutions had errors according to a US study¹⁵

22%

of partly automated PN solutions had errors according to a US study¹⁵

4 of 5

PN orders can be met with standardized formulations¹⁶

PN solutions optimized for pediatric patients

PN formulations for children should provide sufficient nutrients not only for the maintenance of body tissues but also for growth.¹⁹

International guidelines recommend standardized PN solutions

According to the 2018 ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric PN, children’s nutritional goals can often be met using standardized PN formulations.¹³ The guidelines recommend that standard PN should be used over individualized PN solutions for most hospitalized children.¹³ For children over 2.5 years of age on home PN with chronic intestinal failure and stable nutritional need, standardized PN mixtures show comparable growth when compared with individualized PN mixtures.²

International guidelines recommend composite lipid emulsions

Lipid emulsions based on 100% soybean oil can contribute to unbalanced nutrition and higher oxidative stress.¹⁷ For this reason, the latest ESPGHAN/ESPEN/ESPR/CSPEN guidelines recommend the use of a composite lipid emulsion, with or without fish oil.¹⁷ Among composite lipid emulsions, studies have shown no difference between lipid emulsions with or without fish oil in relation to growth.¹⁸

Standardized pediatric PN solutions may reduce errors

Ready-to-use PN formulations for children have the potential to reduce errors that may result from using adult formulas such as inadequate nutrition delivery or inappropriate macronutrient dosing.¹ Likewise, using commercially prepared standard PN bags rather than individualized formulations decreases the risk of ordering and compounding errors in the hospital pharmacy.¹³ Large-scale commercial production of standard PN bags can also offer better aseptic manufacturing conditions, thus decreasing the risk of infections associated with PN therapy.¹³

Commercially produced PN solutions are more cost-effective

Commercially batch-produced standardized PN bags may also reduce the large costs related to individualized PN production.¹³ One study showed that even a modest 10% increase in the use of an industry-produced three-chamber PN bag would reduce labor costs associated with PN by ~9.6% and overall PN costs by ~2.9% on average, in addition to reducing PN errors and improving nutrient provision.¹²

Optimizing nutritional therapy with ready-to-use three-chamber bag (3CB) solutions specifically designed for your pediatric patients

See references

Colomb V et al. Practical use of a new three-chamber bag for parenteral nutrition in pediatricpatients. e-SPEN Journal. (2012) e93-e99.
Nagelkerke SCJ et al. Standardized and Individualized Parenteral Nutrition Mixtures in a Pediatric Home Parenteral Nutrition Population. J Pediatr Gastroenterol Nutr. 2020;70(2):269-274.
Hartman C et al. Malnutrition screening tools for hospitalizedchildren. Curr Opin Nutr Meta Care. 2012;15:303-309.
C. Hecht et al. Disease associated malnutrition correlates with length of hospital stay in children. Clinical Nutrition 2015; 34, 53-59.
Abdelhadi, RA, et al. Characteristics of Hospitalized Children With a Diagnosis of Malnutrition: United States, 2010. JPEN J Parenter Enteral Nutr. 2016 Jul;40(5):623-35.
Kittisakmontri K, Sukhosa O. The financial burden of malnutrition in hospitalized pediatric patients under five years of age. Clin Nutr ESPEN 2016;15:38-43.
Toole BJ, et al. Perioperative Nutritional Support and Malnutrition in Infants and Children with Congenital Heart Disease. Congenit Heart Dis 2014;9:15-25.
de Souza Menezes F, et al. Malnutrition as an independent predictor of clinical outcome in critically ill children. 2012 Mar;28(3):267-70.
Leite HP, et al. Malnutrition may worsen the prognosis of critically ill children with hyperglycemia and hypoglycemia. JPEN J Parenter Enteral Nutr. May-Jun 2013;37(3):335-41.
Radman M, et al. The effect of preoperative nutritional status on postoperative outcomes in children undergoing surgery for congenital heart defects in San Francisco (UCSF) and Guatemala City (UNICAR). J Thorac Cardiovasc Surg. 2014 Jan;147(1):442-50.
Bechard LJ, et al. Nutritional Status Based on Body Mass Index Is Associated With Morbidity and Mortality in Mechanically Ventilated Critically Ill Children in the PICU. Crit Care Med. 2016 Aug;44(8):1530-7.
Kriz A et al. Cost-Consequences Analysis of Increased Utilization of Triple-Chamber-Bag Parenteral Nutrition in Preterm Neonates in Seven European Countries. Nutrients. 2020;12(9):2531.
Riskin A et al. ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Standard versus individualized parenteral nutrition. Clin Nutr. 2018;37(6 Pt B):2409-2417.
Gallagher V, et al. Parenteral nutrition: a call to action for harmonization of policies to increase patient safety. Eur J Clin Nutr. 2021; 75:3-11
Flynn EA et al. Observational study of accuracy in compounding i.v. admixtures at five hospitals. Am J Health Syst Pharm.1997;54:904-912
Crews J, et al. Total Parenteral Nutrition Standardization and Electronic Ordering to Reduce Errors: a Quality Improvement Initiative. Pediatr Qual Saf. 2018;3:e093
Lapillonne A et al. ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Lipids. Clin Nutr. 2018;37(6 Pt B):2324-2336.
Lezo A et al. Plasma and Red Blood Cell PUFAs in Home Parenteral Nutrition Paediatric Patients-Effects of Lipid Emulsions. Nutrients. 2020;12(12):3748.
Koletzko B, et al. Guidelines on Paediatric Parenteral Nutrition of the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and the European Society for Clinical Nutrition and Metabolism (ESPEN), Supported by the European Society of Paediatric Research (ESPR). J Pediatr Gastroenterol Nutr. 2005 Nov;41 Suppl 2:S1-87.

Therapies

Pediatrics

Optimal nutritional balance plays a crucial role in growth and recovery in pediatric patients

Malnutrition in pediatric patients is associated with poor clinical outcomes^4-11

Hospitalized children often receive suboptimal PN therapy

37%

22%

4 of 5

PN solutions optimized for pediatric patients

International guidelines recommend standardized PN solutions

International guidelines recommend composite lipid emulsions

Standardized pediatric PN solutions may reduce errors

Commercially produced PN solutions are more cost-effective

Optimizing nutritional therapy with ready-to-use three-chamber bag (3CB) solutions specifically designed for your pediatric patients

Are you interested in additional information about Pediatric Parenteral Nutrition?

Optimal nutritional balance plays a crucial role in growth and recovery in pediatric patients

Malnutrition in pediatric patients is associated with poor clinical outcomes4-11

Hospitalized children often receive suboptimal PN therapy

37%

22%

4 of 5

PN solutions optimized for pediatric patients

International guidelines recommend standardized PN solutions

International guidelines recommend composite lipid emulsions

Standardized pediatric PN solutions may reduce errors

Commercially produced PN solutions are more cost-effective

Optimizing nutritional therapy with ready-to-use three-chamber bag (3CB) solutions specifically designed for your pediatric patients

Are you interested in additional information about Pediatric Parenteral Nutrition?

Malnutrition in pediatric patients is associated with poor clinical outcomes^4-11