ORIGINAL ARTICLEParenteral nutrition with standard solutions in paediatric intensive care patients
Introduction
Parenteral nutrition (PN) is often required in seriously ill paediatric patients because of their large caloric and substrate needs and their high susceptibility to clinically relevant consequences of suboptimal nutrient supplies. While a wide variety of standard solutions for PN is available today for adult patients, only very few standard mixtures are available for infants and children.1, 2 Rather, individualized prescriptions and compounding of PN solutions are mostly used in this age group. In larger hospitals, individually prescribed PN solutions tend to be prepared in the hospital pharmacy on a daily basis under strict aseptical conditions by trained pharmaceutical staff with semi-automated compounding devices, but in a number of cases PN solutions need to be prepared on the ward by the nursing staff, usually under laminar air flow units. Severe disadvantages of manual compounding are the greater risk of compounding errors3 and of microbial contamination.4 Standard PN solutions might be a preferable alternative if their use is feasible in paediatric practice, but only very limited information has been published on their use. Therefore, we evaluated the use of standard solutions in our clinical practice.
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Patients and methods
This observational study monitored the PN practice over a period of 8 months (from 2002/02 until 2002/10) on the paediatric intensive care unit of the von Hauner Children's Hospital at the University of Munich, a large tertiary referral centre. Patient charts were reviewed, but the practice of the attending staff was not influenced. PN solutions were either prescribed individually or as standard solutions, according to the choice of the attending physician.
All prescriptions were made with a
Results
During the 8 month period, a total of 337 prescriptions for PN solutions were made for 46 children (age 3 months to 18 years) treated in the ICU, with 171 prescriptions for partial and 166 prescriptions for total PN. Standard PN solutions were prescribed in 68% of cases (226 prescriptions), individual PN solutions in 32% (111 prescriptions). The distribution of standard vs. individual PN solution was similar in partial and total PN. In partial PN standard PN solutions were used in 69% of cases
Discussion
Standard PN solutions were used in about of the PN prescriptions in a paediatric ICU with a modification in about half of the prescriptions. The intake of a number of macronutrients and electrolytes was similar with individual and standard PN, but calcium and phosphate intakes were lower with individual PN, and a number of patients received no phosphate at all. Hyperphosphatemia was present in only one case receiving no phosphate, whereas we assume the omission of phosphate in individual
Acknowledgment
Dr. Kathrin Krohn was financially supported in part by an unconditional grant from the Schweisfurth Foundation, Munich, Germany. We are indebted to Stephan Hiedl for his support.
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