Background and Importance Parenteral nutrition (PN) is a high alert medication, essential for the survival of infants born preterm. European expert guidelines recommend that standardised parenteral nutrition (SPN) rather the individualised (IPN) is used for the majority of infants, due to increased patient safety and resource efficiency.¹ There has been a failure to implement this practice, with large variations in the quality and models of PN provision and practices.^2,3

Nationally, neonatal units (NUs) have introduced a precision SPN system, including two externally compounded SPN bags and accompanying clinical decision support tool. The SPN system, developed over 10 years of multidisciplinary translational research has demonstrated improved clinical and economic outcomes.^4,5 In 2018 the SPN system was endorsed as the national Model of Care for Preterm Standardised Parenteral Nutrition and an implementation group oversaw a national rollout, completed mid-2021.

Aim and Objectives To describe the pattern of preterm PN purchased by NUs from before implementation to the completion of national roll-out.

Material and Methods A retrospective analysis of preterm PN purchasing data from NUs (n=13) over 6 years, 2017 – 2022.⁶

Results The percentage of preterm SPN purchased by NUs increased nationally year on year from 56% (3,662/6,522) pre-implementation to 95% (4,823/5,074) in the first full year following a national rollout. This corresponded to a ~90% reduction in IPN purchased nationally.

Conclusion and Relevance This is the first time a country has reported this level of preterm SPN usage, delivering safe and equitable care. A national study is underway to evaluate the implementation and economic impact.

References and/or Acknowledgements 1. Riskin A, et al. ESPGHAN/ESPEN/ESPR guidelines on pediatric parenteral nutrition: Standard versus individualized parenteral nutrition. Clinical Nutrition. 2018. https://www.clinicalnutritionjournal.com/article/S0261-5614(18)31174-9/fulltext

2. Lapillonne A, et al. Quality of newborn care: adherence to guidelines for parenteral nutrition in preterm infants in four European countries. BMJ Open. 2013. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3780296/pdf/bmjopen-2013-003478.pdf

3. Sommer I, et al. Quality and safety of parenteral nutrition for newborn and preterm infants as an on-ward preparation. Eur J Hosp Pharm. 2020. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7447241/pdf/ejhpharm-2018-001788.pdf

4. Brennan AM, et. al. Standardized parenteral nutrition for the transition Phase in preterm infants: A bag that fits. Nutrients. 2018. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5852746/pdf/nutrients-10-00170.pdf

5. 9th Congress of the European Academy of Paediatric Societies. 2022. https://www.frontiersin.org/books/9th_Congress_of_the_European_Academy_of_Paediatric_Societies/8754

6. Correspondence from national PN compounder, June 2023.

Conflict of Interest No conflict of interest.