Neonatology

Optimizing parenteral nutrition (PN) therapy in preterm infants and neonates through advanced solutions including industry-prepared licensed, ready-to-use three-chamber-bags

Adequate nutritional intake is essential for promoting growth and immunity as well as long-term metabolic, cognitive, and neurodevelopmental health. Most preterm infants, especially those born before 28 weeks of gestation, can face significant nutritional challenges in the early days and weeks of life.¹ PN therapy is an essential part of neonatal care, and international guidelines strongly recommend that standard rather than individualized PN solutions are used in most newborn patients requiring PN therapy including premature infants with very low birthweight (VLBW).² Baxter provides various standard PN solutions for newborns including the first and only licensed ready-to-use three-chamber-bag (3CB) solution specifically designed for neonatal patients.^3,4

Illsustration showing the growth observational study

Neonatal growth is critical for positive outcomes

Worldwide, one in every ten babies is born preterm. This adds up to 15 million preterm babies every year.⁵ Preterm birth complications are the leading cause of death for children below 5 years of age.⁶ Approximately half of VLBW infants experience postnatal growth failure which can affect long-term psychomotor development.^7,8 Moderate to late preterm infants are at an increased risk of delayed development in areas such as language, social emotional competencies, cognition, and motor skills.⁹

Growth velocity during early neonatal life exerts a significant effect on neurodevelopmental and growth outcomes as the child ages. An observational study showed that preterm infants with a low weight gain from birth to discharge had a 2.5 times higher incidence of neurological and movement disorders as compared to preterm infants with a high weight gain.¹⁰

Despite being key to neonatal care, current PN practices often do not meet patient needs

The early weeks of life represent a window of opportunity to avoid cumulative nutritional deficits to improve early growth, reduce postnatal growth restriction, and promote long-term development.¹¹ Because of immaturity and clinical conditions, parenteral nutrition (PN) is frequently the primary or exclusive route for providing nutritional support during the early weeks of life in preterm infants.¹¹

However, even though perinatal undernourishment can have both short-term and long-term consequences, PN therapy (IV lipids and amino acids) is often initiated too late and in doses smaller than recommended by international guidelines.¹²

Parenteral nutrition in VLBW neonates is frequently too low dosed

61% of departments initiate lipids too low dosed. 60% of departments initiate protein too low dosed. 40% follow a non-recommended caloric target. 38% initiate protein too late. For very low birth weight (VLBW) neonates with <1500g. A study of 199 Neonatal Intensive Care Units in total. — 60% of departments initiate lipids too low dosed. 62% of departments initiate protein too low dosed. 43% follow a non-recommended caloric target. 37% initiate protein too late. For very low birth weight (VLBW) neonates with <1500g.
A study of 199 Neonatal Intensive Care Units in total.¹²

The complexity of individualized compounded PN, with approximately 50 components being combined, presents ample opportunity for compounding errors and contamination.¹³

37%

error rate has been documented for manually compounded PN.¹⁴

22%

error rate has been documented for semi-automatically prepared PN.¹⁴

The proven impact of standardized parenteral nutrition for preterm infants

The 2018 ESPGHAN/ESPEN/ESPR/CSPEN guidelines recommend that standard PN solutions should be used in most pediatric and newborn patients, including VLBW premature infants, with individually tailored PN solutions reserved for when nutritional requirements cannot be met by standard PN formulations.² A standardization strategy should be part of the approach for improving quality control and good professional practice for the preparation of PN.²

Higher nutrient intakes associated with better outcomes

Overall, readily available standardized PN solutions are advantageous compared to individualized prescriptions by providing higher nutrient intakes that are associated with better weight gain and less nutritional deficit.¹⁵ Higher calcium and phosphate intake resulting in better bone mineralization has also been shown with standard PN solutions, as has less water intake and decreased incidence of significant electrolyte disturbances.²

Improved safety and pharmacy resources use

Commercially prepared standard PN bags decrease the risk of ordering errors as well as the risk of compounding errors in the hospital pharmacy.¹⁶ They can also provide substantial resource and cost savings to the institution, freeing up resources to optimize hospital care in other areas.¹⁶

Available when needed

Commercially prepared standard PN bags are available for immediate use. Since they have a shelf life of up to 18 months and do not require refrigeration, commercially produced standardized PN bags provide a nutritional safety net for neonates born at any time of day, any day of the year.^3,4

Licensed ready-to-use three-chamber
bag PN solution specifically designed for neonatal infants

Importance of micronutrients in neonates

See References

European Foundation for the Care of Newborn Infants. Position paper: Addressing the nutritional emergency of preterm birth – Optimal practice in neonatal parenteral nutrition. EFCNI 09/2019. First edition.
Riskin A, et al. ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Standard versus individualized parenteral nutrition. Clin Nutr. 2018 Dec;37(6 Pt B):2409-2417.
Numeta G13E SmPC
Numeta G16E SmPC
https://www.who.int/en/news-room/fact-sheets/detail/preterm-birth (assessed april 2021)
Liu L, et al. Global, regional, and national causes of under-5 mortality in 2000-15: an updated systematic analysis with implications for the Sustainable Development Goals. Lancet. 2016 Dec 17;388(10063):3027-3035.
Horbar JD, et al. Weight Growth Velocity and Postnatal Growth Failure in Infants 501 to 1500 Grams: 2000-2013. Pediatrics. 2015 Jul;136(1):e84-92.
Shah PS, et al. Postnatal growth failure in preterm infants: ascertainment and relation to long-term outcome. J Perinat Med. 2006;34(6):484-9.
Cheong JL, et al. Association Between Moderate and Late Preterm Birth and Neurodevelopment and Social-Emotional Development at Age 2 Years. JAMA Pediatr. 2017 Apr 3;171(4):e164805.
Ehrenkranz RA, et al. Growth in the neonatal intensive care unit influences neurodevelopmental and growth outcomes of extremely low birth weight infants. Pediatrics. 2006 Apr;117(4):1253-61.
Rigo J et al. Benefits of a new pediatric triple-chamber bag for parenteral nutrition in preterm infants. J Pediatr Gastroenterol Nutr. 2012 Feb;54(2):210-7.
Lapillonne A, et al. Quality of newborn care: adherence to guidelines for parenteral nutrition in preterm infants in four European countries. BMJ Open. 2013 Sep 18;3(9):e003478.
Mühlebach S et al. Practical handling of AIO admixtures - Guidelines on Parenteral Nutrition, Chapter 10. Ger Med Sci. 2009 Nov 18;7:Doc18.
Flynn EA, et al. Observational study of accuracy in compounding i.v. admixtures at five hospitals. Am J Health Syst Pharm. 1997 Apr 15;54(8):904-12
Simmer K et al. Standardised parenteral nutrition. Nutrients. 2013 Mar 28;5(4):1058-70.
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 Aug 20;12(9):2531.

Therapies

Neonatology

Neonatal growth is critical for positive outcomes

Despite being key to neonatal care, current PN practices often do not meet patient needs

Parenteral nutrition in VLBW neonates is frequently too low dosed

The complexity of individualized compounded PN, with approximately 50 components being combined, presents ample opportunity for compounding errors and contamination.¹³

37%

22%

The proven impact of standardized parenteral nutrition for preterm infants

Higher nutrient intakes associated with better outcomes

Improved safety and pharmacy resources use

Available when needed

Licensed ready-to-use three-chamber
bag PN solution specifically designed for neonatal infants

Importance of micronutrients in neonates

Are you interested in additional information about Neonatal Parenteral Nutrition?

Neonatal growth is critical for positive outcomes

Despite being key to neonatal care, current PN practices often do not meet patient needs

Parenteral nutrition in VLBW neonates is frequently too low dosed

The complexity of individualized compounded PN, with approximately 50 components being combined, presents ample opportunity for compounding errors and contamination.13

37%

22%

The proven impact of standardized parenteral nutrition for preterm infants

Higher nutrient intakes associated with better outcomes

Improved safety and pharmacy resources use

Available when needed

Licensed ready-to-use three-chamber bag PN solution specifically designed for neonatal infants

Importance of micronutrients in neonates

Are you interested in additional information about Neonatal Parenteral Nutrition?

The complexity of individualized compounded PN, with approximately 50 components being combined, presents ample opportunity for compounding errors and contamination.¹³

Licensed ready-to-use three-chamber
bag PN solution specifically designed for neonatal infants