Impact of Customized Parenteral Nutrition in a Pediatric Hospital

Abstract

In pediatric hospitals, several factors interfere with the delivery of parenteral nutrition (PN). The purpose of this study was to assess the impact of a customized system of PN ordering on PN delivery, using a retrospective chart review before (n = 40) and after (n = 43) implementation of the system. No difference was observed in the proportions of children who did not receive the ordered amount of dextrose and amino acids (30% versus 23%, p = .49). Before customization, the subjects were more likely to receive intralipids (42% versus 19%, p = .02), and micronutrients (67% versus 9%, p < .0001) out of range. These results remained unchanged after adjustment for age, hospital unit, other fluids, and presence of a central line. Our findings highlight the discrepancy between ordered and received PN in pediatric patients. Customized PN ordering was associated with improved delivery of intralipids and micronutrients.

Get full access to this article

View all access options for this article.

References

1. Butterworth, C. E.

The skeleton in the hospital closet.

Nutr Today 9:4–8, 1974

2. Bistrian, B. R. , Blackburn, G. L. , Vitale, J. , et al. Prevalence of malnutrition in general medical patients. JAMA 235:1567–1570, 1976

3. Hill, G. L. , Pickford, I. , Young, G. A. , et al. Malnutrition in surgical patients: An unrecognized problem. Lancet 1:689–692, 1977

4. Coates, K. G. , Morgan, S. L. , Bartolucci, A. A. , et al. Hospital-associated malnutrition: A reevaluation 12 years later. J Am Diet Assoc 93:27–33, 1993

5. Kamath, S. K. , Lawler, M. , Smith, A. E. , et al. Hospital malnutrition: A 33–hospital screening study. J Am Diet Assoc 86:203–206, 1986

6. Veterans Affairs

Total Parenteral Nutrition (TPN) Cooperative Study Group. Perioperative TPN in surgical patients.

N Engl J Med 325:525–532, 1991

7. Grimes CJC , Younathan MT , Lee WC.

The effect of preoperative TPN on surgery outcomes.

J Am Diet Assoc 87:1202–1206, 1987

8. Shils, M. E. Parenteral nutrition. IN Modern Nutrition in Health and Disease. 9th ed, Shils ME , Olson JA , Shike M , et al (eds). Lippincott Williams & Wilkins, Philadelphia, PA, 1998, pp 1657–1688

9. Dudrick, S. J. , Wilmore, D. W. , Vars, H. M. , et al. Long-term TPN with growth, development, and positive nitrogen balance. Surgery 64:134–142, 1968

10.

10. Fisher, A. A. , Poole, R. L. , Machie, R. , et al. Clinical pathway of pediatric parenteral nutrition. Nutr Clin Pract 12:76–80, 1997

11.

11. Schneider, P. J. , Bothe, A. , Bisognago, M. , Improving the nutrition support process: Assuring that more patients receive optimal nutrition support. Nutr Clin Pract 14:221–226, 1999

12.

12. Porcelli, P. J. , Block, S. M. , Increased parenteral nutrition calcium and phosphorus for very-low-birth-weight infants using computer software assisted ordering. J Am Coll Nutr 16:283–287, 1997

13.

13. Foulks, C. J. , Krenek, G. , Maxwell, K. , The effect of changing the TPN order form on resident physician ordering behavior. Nutr Clin Pract 12:30–34, 1997

14.

14. Puangco, M. A. , Nguyen, H. L. , Sheridan, M. J. , Computerized PN ordering optimizes timely nutrition therapy in a neonatal intensive care unit. J Am Diet Assoc 97:258–261, 1997