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Iatrogenic malnutrition in neonatal intensive care units: urgent need to modify practice

Presented at the Neonatal Society 2007 Summer Meeting (programme).

Grover A1, Khashu M, Mukherjee AL, Kairamkonda V (introduced by Shortland DB)

Neonatal Unit, Leicester Royal Infirmary, Leicester LE1 5WW, UK

Background: Extrauterine growth retardation is a major clinical problem in very low birth infants (VLBW) and has significant long term and short-term consequences (1). Since establishment of full enteral nutrition takes some time, Parenteral Nutrition (PN) serves to achieve rapid maximal nutrition in early postnatal life (2).

Objective: To ascertain current practice regarding neonatal PN prescription in the early postnatal period in the United Kingdom.

Methods: Study questionnaire was emailed to neonatal pharmacists serving level 3 and major level 2 units in the UK. Static numerical information regarding glucose, protein and lipid prescription during the first 10 days of life was collected and compared with recommended intake (ESPEN guidelines 2006) (3).

Results: 52 (81%) units responded to the questionnaire. Only 26 units (54%) initiated PN on day 1. Full PN was achieved by median age of 6 days. 12 units (25%) achieved full TPN only by day 7 or later. Maximum median protein prescription was 2.9 gm/kg/day. Only 13 units (27%) prescribed ≥3 gm/kg/day and 2 prescribed more than 3.5 gm/kg/day.19 units (39%) initiated lipids on day 1. Thirteen units (27%) delayed lipids till day 3 or beyond. In comparison to the recommended intake of calories (120 kcal/kg/day) and protein (≥ 3.5gm/kg/day) (3), current prescription (median) would result in a cumulative deficit of 408.5 kcal/kg and 11.9 gm/kg respectively over the first 10 days of life.

Conclusions: There is diverse practice with regard to neonatal PN prescription in the UK. Current neonatal PN practice entails a significant calorie and protein deficit during early postnatal life and warrants an urgent review.

1. Ehrenkranz RA. Pediatrics 2006; 117:1253-1261.
2. Clark R H. Pediatrics 2003; 111 (5), 986-990.
3. Koletzko B. J Pediatr Gastroenterol Nutr. 2005; 41 Suppl 2:S1-87.

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