Subject(s)
Abdominal Wall/surgery , Thoracic Wall/surgery , Abdominal Wall/pathology , Anorectal Malformations , Anus, Imperforate/surgery , Esophageal Atresia/surgery , Evidence-Based Medicine , France , Gastroschisis/surgery , Hernia, Diaphragmatic/surgery , Hernia, Umbilical/surgery , Hernias, Diaphragmatic, Congenital , Humans , Infant, Newborn , Randomized Controlled Trials as Topic , Plastic Surgery Procedures/mortality , Plastic Surgery Procedures/trends , Risk Assessment , Risk Factors , Thoracoplasty/trends , Urogenital Abnormalities/surgeryABSTRACT
OBJECTIVES: The aim of the study was to evaluate parenteral nutrition objectives for very low birth weight (VLBW) infants in neonatal intensive care units (NICUs), and to compare nutritional protocol differences according to levels of care. MATERIALS AND METHODS: A national survey was conducted in France through a questionnaire sent to 296 French neonatal departments to determine each team leader's nutritional objectives for parenteral nutrition of VLBW infants. RESULTS: A total of 172 of the 296 French neonatal departments responded to the questionnaire. Protein administration was not started during the first day of life in half of the responding units. Furthermore, half of the units initiated protein administration with less than 1 g x kg(-1) x day(-1). The day of introduction of lipid emulsions varied considerably from one unit to another, but more than half of the units started the lipid emulsions after the third day of life. Twenty percent of the units reported a target energy intake of 100 kcal x kg(-1) x day(-1), whereas 14% reported a target intake above or equal to 130 kcal x kg(-1) x day(-1). CONCLUSIONS: In comparison with recent guidelines for parenteral nutrition for VLBW infants, the results indicate that the majority of the departments are familiar with target macronutrient and energy intakes, but the time of introduction and the rate of progression of macronutrients, particularly proteins and lipids, are frequently lower than those defined by the guidelines. The large-scale publication of new nutritional guidelines for the parenteral nutrition of neonates and preterm infants as well as regular, specific training in the parenteral nutrition of preterm infants are needed.
Subject(s)
Infant, Premature , Infant, Very Low Birth Weight , Parenteral Nutrition/methods , Practice Patterns, Physicians'/statistics & numerical data , Child Nutrition Sciences , Dietary Proteins/administration & dosage , Energy Intake , Fat Emulsions, Intravenous/administration & dosage , France , Guideline Adherence , Health Care Surveys , Humans , Infant, Newborn , Infant, Premature/physiology , Infant, Very Low Birth Weight/physiology , Intensive Care, Neonatal , Practice Guidelines as Topic , Surveys and QuestionnairesABSTRACT
Considerable effort should be made to optimise parenteral nutrition of preterm infants in order to limit the development of postnatal growth restriction. A monocentric before-and-after study design was used to determine the effects of computerising parenteral nutrition ordering on the composition of parenteral nutrition (PN) solutions and early clinical outcomes of preterm infants born < or =28 weeks of gestation. Parenteral protein intake during the first week of life and parenteral lipid, glucose and energy intakes during the first and second week of life were significantly higher in infants assessed after the introduction of computerised parenteral nutrition ordering. This led to a significant reduction in the cumulative energy deficit over the first 28 days of life and to an improvement in both early growth and pulmonary outcome. Computerising the PN ordering process improves the nutrient content of the PN solutions and early postnatal outcome.
