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Quality and safety of parenteral nutrition for newborn and preterm infants as an on-ward preparation
  1. Isabelle Sommer1,2,
  2. Lucie Bouchoud3,
  3. Markoulina Berger-Gryllaki1,
  4. Pascal Bonnabry2,3,
  5. Farshid Sadeghipour1,2
  1. 1 Department of Pharmacy, University Hospitals of Lausanne CHUV, Lausanne, Switzerland
  2. 2 School of Pharmaceutical Sciences EPGL, University of Geneva, University of Lausanne, Geneva, Switzerland
  3. 3 Department of Pharmacy, University Hospitals of Geneva HUG, Geneva, Switzerland
  1. Correspondence to Isabelle Sommer, Department of Pharmacy, University Hospitals of Lausanne CHUV, Lausanne 1011, Switzerland; isabelle.sommer{at}chuv.ch

Abstract

Background For newborn and preterm infants, standardised and individual parenteral nutrition (PN) is used. PN preparation is at risk for contamination and dosing errors. The quality of PN is crucial for infants and has a direct impact on their health status and safety.

Purpose The aim of this study is to evaluate the physicochemical and microbial quality of PN for newborn and preterm infants prepared on a neonatal ward.

Methods Sampling of various individual PN prepared by nurses on a neonatal ward was performed. Formulations included maximal four electrolytes, variable dextrose and amino acid concentrations. Depending on the sample volume, up to three quality analyses were performed: (1) test for bacterial endotoxins by kinetic-chromogenic method, (2) sterility according to the European and US Pharmacopoeia, and (3) quantification of electrolytes by capillary electrophoresis and of dextrose by ultraviolet detection after enzymatic reaction of hexokinase. The concentrations obtained were evaluated based on the US and Swiss Pharmacopoeia specifications for compounded preparations and compared to the widened pharmacy specifications.

Results The composition of 86% of the 110 analysed PN prepared by nurses on the neonatal ward corresponded to their medical prescription. 14% were out of the acceptable widened pharmacy ranges. We found no microbial contamination in the samples. All PN were free from endotoxins.

Conclusion Component concentrations of PN prepared on wards by nurses differed frequently and significantly from their medical prescription, and the deviation can be critical depending on the component and its mode of action. The sample size is too small to evaluate the microbial contamination.

  • quality of parenteral nutrition
  • composition
  • microbial contamination
  • endotoxin
  • neonatology
  • preterm infant

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