Retrospective differential analysis between 3971 prescriptions of individualized parenteral nutrition and 2 commercial parenteral nutrition

Context
The preparation of parenteral nutrition bags is a risky process that requires ensuring that no suitable commercial alternative is available before being realized. The objective of this work was to verify if the individualized parenteral nutrition (IPN) were different from the commercial parenteral nutrition available in our hospital and if so, on which nutrients were the differences.

Methods
We collected all the IPN prescribed by the neonatal resuscitation unit (NRU) and the intensive care unit (ICU) in 2021. We measured the difference between the prescribed IPN and the commercial Pediaven^® neonatal 1 (PNN1) and 2 (PNN2) bags by calculating a Euclidean distance (Eq. 1) for all nutrients "i" between the prescribed concentrations " " and the concentrations in the commercial nutrition " ".
Then we observed the individual differences between all the nutrients.

Results
Over 2021, we respectively made 2495 IPN for NRU (335 patients concerned) and 1476 for ICU (197 patients concerned)
The median Euclidean distances (interquartile ranges) were respectively 297 (188 - 395) mmol/L and 283 (174 - 383) mmol/L in the NRU for PNN1 and PNN2 bags, and 155 (103 - 230) mmol/L and 141 (85.9 - 213) mmol/L in the ICU for PNN1 and PNN2 bags.
These high variations were essentially due to a lack of amino acids and sodium within the PNN1 and PNN2 pockets compared with the IPN. Furthermore, they were impacted by a phosphorus deficiency, and for the NRU by a glucose deficiency.

Discussion
The Euclidean distance allows us to measure a difference between the PNN1 or PNN2 pockets and the IPN. However, it has the disadvantage of giving the same weight to all nutrients. The possibility of weighting the impact of nutrients on the Euclidean distance according to the clinical importance of the variations observed could be explored to overcome this shortcoming. This tool can also be used to measure the observed variation with other commercial products.

We observed a lack of amino acids and phosphorus within the PNN1 and PNN2 bags, which can be explained by the fact that these bags are based on the old recommendations, contrary to the computer-aided prescriptions [1]. Similarly, the fabrication of IPN allows nutrients to be concentrated to meet the constraints of water intake in neonates, which may explain the discrepancies observed for glucose.

[1] MIHATSCH, W. A. et al. (2018). Espghan/espen/espr/cspen Guidelines on Pediatric Parenteral Nutrition. Clinical Nutrition, 37(6), 2303-2305.

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