Designing and implementing a standard nutritional starter solution for preterm infants

Background Administering parenteral nutrition to preterm infants in their first hours of life improves their survival. As it is not always possible for the pharmacy department to compound individual parenteral nutrition solutions, preparing a standard starter solution for preterm children to be administered within the first 24 h after birth was arranged with the Neonatology Department. Purpose To design and implement a standard starter solution of suitable composition and stability for preterm infants, as a means of meeting their nutritional requirements during their first hours of life. Materials and methods The authors performed a literature search to determine the nutritional requirements for neonates. In order to ensure a positive nitrogen balance and to avoid protein catabolism, adequate inputs of amino acids and glucose should be administered within the first hours of life in order to provide at least 4 g/kg/day of glucose and 1 g/kg/day of amino acids. Results A standard nutritional starter solution was prepared in syringes. Each syringe contained 52.5 ml of solution (+3.5 ml of purge) comprising 1.5 g of amino acids (15 ml Primene 10%) and 3.75 g of glucose (37.5 ml of 10% glucose), with an osmolarity of 629 mOsm/l (allowing either peripheral or central intravenous administration) and a total calorie input of 21 kcal per syringe (15 kcal were non-protein). The stability of the solution was 7 days at 2-8°C, as recommended in the literature. From February 2010 (implementation) until August 2011, 840 starting syringes were prepared in the pharmacy department. Conclusions This formulation makes it possible to meet the glucose and amino acid requirements for preterm neonates within their first 24 h of life, thus preventing excessive protein loss. Its long-term stability makes it possible to store it in the Neonatology Department, thus guaranteeing its availability at times when it is not possible to prepare a parenteral solution in the pharmacy department.