Can ‘stock’ PN meet the requirements of the neonatal population?
Aims In 2011, the recipes of our 3 ‘stock’ parenteral nutrition (PN) solutions were reformulated to optimise nutrition according to recommended guidelines1 2 and reduce the amount of compounded PN needed. The aim of this audit was to evaluate whether our stock PN recipes could meet the metabolic requirements of the majority of our Neonatal Unit population.
Methods The details of all patients on the Neonatal Unit prescribed PN over an 11 month period from 1 August 2011 to 30 June 2012 was analysed retrospectively. Data was collated from the pharmacy technical services unit PN orders and patient's medical records to assess why patients were not prescribed stock PN. This was defined as either: changing from stock to compounded PN or that stock PN was unsuitable from the outset.
Results Over the 11 month period, 191 patients received PN resulting in 3047 PN days. The course length varied from 1 to 79 days, with a mean of 16 days.
45.5% of patients required PN for greater than 14 days, and 14.1% for greater than 28 days.
52.4% of the patients initiated on PN were prescribed stock PN for the whole of their treatment course, which accounted for 1579 PN days: 47.6% of patients required compounded PN at some point during their stay, equating to a total of 1468 compounded PN days.
The main reason (19.8%) for changing from stock to compounded PN was to reduce the glucose concentration due to hyperglycaemia. Other reasons included concentrating the PN either due to: illness or other infusion volumes (18.7%) or during the transition to enteral feeds (13.2%). 11% and 15.4% of patients needed an increase in the amount of sodium and potassium respectively.
The final 14% were documented as needing an increase in fluid volume, acetate, glucose, calcium, phosphate or a decrease in potassium. 7.7% of reasons were not documented.
Conclusions Sick newborn infants admitted to the neonatal unit may not be able to obtain adequate nutrition for growth and development via the enteral route, therefore PN is required until enteral feeding is established.
The primary aim of this audit was to evaluate whether the new ‘stock’ PN recipes met the metabolic requirements of the majority of our Neonatal Unit population, in the hope of reducing the amount of compounded PN required. From this data, it can be concluded that for over half the patients, stock PN met these requirements. There were numerous reasons for compounded PN demonstrating that a change in recipe would not negate the need for compounded PN.
Stock PN enables and encourages nutrition to be initiated soon after birth and has been shown to meet the requirements of the majority of patients.