Optimizing parenteral nutrition (PN) therapy in preterm infants and neonates through advanced solutions including industry-prepared licensed, ready-to-use three-chamber-bags

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Adequate nutritional intake is essential for promoting growth and immunity as well as long-term metabolic, cognitive, and neurodevelopmental health. Most preterm infants, especially those born before 28 weeks of gestation, can face significant nutritional challenges in the early days and weeks of life.1 PN therapy is an essential part of neonatal care, and international guidelines strongly recommend that standard rather than individualized PN solutions are used in most newborn patients requiring PN therapy including premature infants with very low birthweight (VLBW).2 Baxter provides various standard PN solutions for newborns including the first and only licensed ready-to-use three-chamber-bag (3CB) solution specifically designed for neonatal patients.3,4

Illsustration showing the growth observational study

Neonatal growth is critical for positive outcomes

Worldwide, one in every ten babies is born preterm. This adds up to 15 million preterm babies every year.5 Preterm birth complications are the leading cause of death for children below 5 years of age.6 Approximately half of VLBW infants experience postnatal growth failure which can affect long-term psychomotor development.7,8 Moderate to late preterm infants are at an increased risk of delayed development in areas such as language, social emotional competencies, cognition, and motor skills.9

Growth velocity during early neonatal life exerts a significant effect on neurodevelopmental and growth outcomes as the child ages. An observational study showed that preterm infants with a low weight gain from birth to discharge had a 2.5 times higher incidence of neurological and movement disorders as compared to preterm infants with a high weight gain.10

Nurse with neonatal patient

Despite being key to neonatal care, current PN practices often do not meet patient needs

The early weeks of life represent a window of opportunity to avoid cumulative nutritional deficits to improve early growth, reduce postnatal growth restriction, and promote long-term development.11 Because of immaturity and clinical conditions, parenteral nutrition (PN) is frequently the primary or exclusive route for providing nutritional support during the early weeks of life in preterm infants.11

However, even though perinatal undernourishment can have both short-term and long-term consequences, PN therapy (IV lipids and amino acids) is often initiated too late and in doses smaller than recommended by international guidelines.12

Parenteral nutrition in VLBW neonates is frequently too low dosed

61% of departments initiate lipids too low dosed. 60% of departments initiate protein too low dosed. 40% follow a non-recommended caloric target. 38% initiate protein too late. For very low birth weight (VLBW) neonates with <1500g.  A study of 199 Neonatal Intensive Care Units in total.
60% of departments initiate lipids too low dosed. 62% of departments initiate protein too low dosed. 43% follow a non-recommended caloric target. 37% initiate protein too late. For very low birth weight (VLBW) neonates with <1500g. 
A study of 199 Neonatal Intensive Care Units in total.12

The complexity of individualized compounded PN, with approximately 50 components being combined, presents ample opportunity for compounding errors and contamination.13


error rate has been documented for manually compounded PN.14


error rate has been documented for semi-automatically prepared PN.14

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The proven impact of standardized parenteral nutrition for preterm infants

The 2018 ESPGHAN/ESPEN/ESPR/CSPEN guidelines recommend that standard PN solutions should be used in most pediatric and newborn patients, including VLBW premature infants, with individually tailored PN solutions reserved for when nutritional requirements cannot be met by standard PN formulations.2 A standardization strategy should be part of the approach for improving quality control and good professional practice for the preparation of PN.2 

Positive growth illustration

Higher nutrient intakes associated with better outcomes

Overall, readily available standardized PN solutions are advantageous compared to individualized prescriptions by providing higher nutrient intakes that are associated with better weight gain and less nutritional deficit.15 Higher calcium and phosphate intake resulting in better bone mineralization has also been shown with standard PN solutions, as has less water intake and decreased incidence of significant electrolyte disturbances.2

Accomplished medal illustration

Improved safety and pharmacy resources use

Commercially prepared standard PN bags decrease the risk of ordering errors as well as the risk of compounding errors in the hospital pharmacy.16 They can also provide substantial resource and cost savings to the institution, freeing up resources to optimize hospital care in other areas.16

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Available when needed

Commercially prepared standard PN bags are available for immediate use. Since they have a shelf life of up to 18 months and do not require refrigeration, commercially produced standardized PN bags provide a nutritional safety net for neonates born at any time of day, any day of the year.3,4

Licensed ready-to-use three-chamber
bag PN solution specifically designed for neonatal infants

Importance of micronutrients in neonates