Optimal practice in neonatal parenteral nutrition
Neonatal parenteral nutrition at a glance: What is it? For whom is it? How is it applied?
- What: injection of nutrition into the bloodstream
- For whom: preterm and sick infants, who cannot suck-swallow at the same time and have an immature digestive tract
- How: sterile, safe, and according to European guidelines
Adequate nutritional intakes – especially during the first 1000 days of life – are essential for promoting growth and health, including long-term metabolic, cognitive, and neurodevelopmental outcomes. Parenteral nutrition (PN) is a feeding method that bypasses the digestive tract by delivering nutrients directly to the bloodstream. This is a bit similar to feeding the unborn through the umbilical cord. Babies born preterm need some time to establish nutrition intake via the gastrointestinal tract, therefore PN is the only alternative method for them to meet nutrient requirements. PN is also crucial in babies with illnesses affecting the digestive tract (e.g. congenital or acquired gut disorder like necrotising enterocolitis (NEC)).
More information on the administration and composition of PN as well as on associated benefits and risks can be found here and in our Factsheet “Parenteral nutrition for very preterm and ill babies”.
The position paper “Addressing the nutritional emergency of preterm birth – Optimal practice in neonatal parenteral nutrition” highlights the importance of parenteral nutrition as a life-saving treatment for very preterm and sick babies. It was developed during an EFCNI roundtable in Munich involving several experts from various countries discussing and exchanging views and ideas. This position paper was launched during the jENS congress 2019 in Maastricht. It is intended to serve as a supplement to the European ESPGHAN/ESPEN/ESPR/CSPEN guidelines, and as a driving force for the development and implementation of guidelines on a national level. It targets policymakers and hospital administrators but can also be used as a tool by parent representatives and healthcare professionals to convince decision-making bodies to support the delivery of appropriate, high-quality parenteral nutrition.
Calling for national implementation of the European guidelines on paediatric parenteral nutrition (PN), EFCNI sought to first investigate how PN is implemented in Germany and whether healthcare professionals adhere to general standards and requirements as recommended by the guidelines. Therefore, a network was formed with the Federal Association of German Hospital Pharmacists (ADKA) and the German Society for Neonatology and Paediatric Intensive Care (GNPI). EFCNI subsequently co-hosted a joint roundtable, involving an expert panel assembled from German-speaking universities and hospital pharmacies elaborating a survey to collect data on the implementation of the European guidelines in Germany.
In 2020, all German hospital pharmacies and several clinics with neonatal intensive care units were invited to take part. Questions were asked related to the implementation of the guidelines, reasons for deviating from them, but also organisational aspects such as the supply of PN, and the topic of parent information.
Survey findings in brief:
- Majority of respondents are aware of the guidelines and implement them
- However, supply with parenteral solutions on weekends is challenging, leading to deviations from hygiene standards
- Only a third of respondents have access to software that is necessary to calculate the nutrient requirements
- Although European guideline recommends preferring standardised over individualised solutions, only half of respondents use standardised solutions regularly
- The way how parents are informed is insufficient. They are mainly informed orally and directly after birth, which is a format that does not always respect their situation and needs
- The practice of PN partly differs from guideline recommendations, which calls for activities to promote a safe and recommended implementation.
EFCNI hosted two digital roundtables in January 2021, together with ADKA, GNPI, supported by Bundesverband „Das frühgeborene Kind“ e.V. (BVDfK; Federal association ‘The preterm born child’) and Berufsverband Kinderkrankenpflege e.V. (BeDK; Professional association for paediatric nursing). During these roundtables, well-known German-speaking experts discussed how identified barriers could be avoided and overcome in future. Based on the constructive exchange, best-practice recommendations were elaborated to support healthcare professionals in the implementation of the European guidelines on PN and adhering to them in their daily practice. In order to share these solutions with all healthcare professionals, the panel developed the document “Toolkit für die parenterale Ernährung von Früh- und kranken Neugeborenen – Von der Leitlinie in die multidisziplinäre Anwendung“ (Toolkit for parenteral nutrition of preterm and sick newborns – From guideline to multidisciplinary application):
|June 2021||Toolkit launched in German language||Download Toolkit|
|November 2021||Barrier analysis and toolkit presented as e-poster||Download e-Poster (DGPM)|
|January 2022||Scientific article published||Download Article (DE)|
|March 2022||Results of publication and project outcome presented as ePoster||Download e-Poster (ADKA)|
The use of standardised or individual parenteral nutrient (PN) solutions is a much-debated subject in neonatal clinical practice. In Sweden – when it comes to applying PN solutions in neonatal nutritional care – standardised solutions are already the standard approach. The individual PN solution is nevertheless used when patients require individualised nutritional care. In an interview with pharmacist Dr. Mattias Paulsson from Uppsala University Hospital, we had the opportunity to find out how this implementation process of standardised PN took place, what the reasons and the preconditions were to take this step, and how it affects the day-to-day running of clinical units. Learn more about this intriguing topic and watch the full interview.