Concordance with ESPGHAN 2018 electrolyte and mineral guidelines during total parenteral nutrition in a neonatal intensive care unit: A retrospective study

Abstract

Summary: Background & Aims: In 2018, the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) updated their guidelines on parenteral nutrition (PN) in pediatric patients, including recommendations for electrolyte and mineral provision. It is unknown how well clinical practice complies with the updated electrolyte and mineral guidelines due to a lack of observational studies. This study assessed concordance with the ESPGHAN 2018 PN guidelines for electrolytes and minerals at the neonatal intensive care unit (NICU) of the Ghent University Hospital. Methods: Retrospective analysis of TPN in neonates admitted to the NICU between December 15, 2013, and December 31, 2014. Patients were stratified according to their birth weight (BW): <1000 g, 1000 g to <1500 g and ≥1500 g. The TPN provision of electrolytes and minerals was compared against ESPGHAN 2018 PN guidelines for up to 14 days after birth. Results: In total, 76 patients were included, 28 with a BW of <1000 g, 10 with a BW of 1000 g to <1500 g and 38 with a BW ≥1500 g. The concordance with ESPGHAN 2018 PN guidelines varied substantially across BW groups and time. For neonates with a BW <1000 g, sodium provision within the 14 days after birth exceeded guideline recommendations in 61–91% of patients, depending on the day. Sodium provision below minimum recommendations was rare, regardless of BW. Only a small fraction of patients received potassium above maximum recommendations. Calcium provision on the first day of life was below recommendations in 50–60% of neonates with BW <1500 g, with similar observations for magnesium provision. The calcium:phosphorus ratio was generally not in range of recommendations. Conclusion: This study provides real-world evidence on ESPGHAN 2018 PN guideline concordance in a NICU. It identifies specific BW groups of neonates and times after birth when available TPN options might be insufficient to achieve guideline recommendations for electrolytes and minerals.

Keywords

• Parenteral nutrition
• Guideline recommendations
• Neonates
• Practice patterns
• Electrolytes
• Premature birth