Audit of neonatal parenteral nutrition in Northern Ireland

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“The practices and support for delivery of Neonatal Parenteral Nutrition (PN) in Northern Ireland were audited against standards derived from the ESPGHAN guidelines, NCEPOD Report on PN and the NICE Quality Standards for Specialist Neonatal Care.” Courtney et al (2014).

Reference:

Courtney, J., Gupta, C., Mayes, C. and Craig, S. (2014) PC.114 Audit of Neonatal Parenteral Nutrition in Northern Ireland. Archives of Disease in Childhood. Fetal and Neonatal Edition. 99 (Suppl 1), p.A75-6.

Abstract:

The practices and support for delivery of Neonatal Parenteral Nutrition (PN) in Northern Ireland were audited against standards derived from the ESPGHAN guidelines, NCEPOD Report on PN and the NICE Quality Standards for Specialist Neonatal Care.

METHOD: The records of the first 40 babies consecutively admitted to 5 neonatal units in Northern Ireland after 1st April 2012 were audited (~10% of all NI admissions).

RESULTS: 100% have a policy for PN and access to MDT nutritional expertise; 80% had access to standard PN. Infant characteristics were gestation median (range) 34 (24-41) weeks; birthweight median (range) 2.24 (0.6-4.97) kg. PN commenced at a median (range) age 9 (1-96) hrs; Individual unit medians ranged from 2-24 hrs. Overall 48% initially commenced standard PN. This varied between units with a range of 15-95% Access used for PN delivery was; 75% peripheral, 19% UVC, 6% long line. 2% (4 babies) had complications with central access. 1 accidental removal, 1 extravasation and 2 sepsis of which 1 CoNS and 1 staph epidermis. 100% of chart entries regarding IV access had doctor’s name, grade, date, time and catheter type, 95% documented tip position. PN duration median (range) was 3 (0-89) days. EN commencement median (range) was 1 (0-74) days. Full EN was reached median (range) 4 (0-21) days.

CONCLUSIONS: There is significant variation in practice for PN administration and probable overuse. A regional guideline may assist with ensuring each infant receives care determined by regional consensus ‘best practice’.

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