It is common for total parenteral nutrition (TPN) bags for children to be custom made, starting with a base dextrose solution and then amino acids (AA) and other nutrients added. This process allows for precise delivery of individualized specific content to each patient. However, each additive presents an opportunity for error or microbial contamination and the compounding process is expensive. While a variety of standard pre‐mixed TPN solutions are available and used by adult patients, this practice is rare in pediatrics. Adult data has demonstrated that commercial pre‐mixed solutions can meet a majority of TPN needs while reducing cost, error, and infection. We were interested to see if pediatric TPN orders are similar to adult orders in that a few standard base solutions of dextrose and AA would satisfy most patients’ needs. Additionally, we wanted to compare the composition of these solutions and see how similar they were to current commercially available pre‐mix TPN solutions.
We retrospectively identified children 1yr‐18yrs of age needing TPN at a tertiary care children’s hospital between September 2010 and September 2013. Excluded were patients with complex chronic medical conditions requiring TPN such as short gut patients, patients on dialysis etc. The initial TPN order was reviewed for dextrose and AA content. The results were analyzed to see how much variation existed between these TPN orders. Furthermore, TPN compositions were compared to standard bags already produced commercially.
Of 160 eligible patient charts reviewed, 100 met inclusion criteria. Of these charts, there was very little variation in TPN composition. Largely, central TPN composed of Dextrose 20% and AA of 3%. Peripheral TPN was largely Dextrose 12.5% and AA 2.2% or 3%. These 3 base solutions met 82% of TPN orders. There are no commercially available products in the US with these dextrose and AA compositions.
Three standard TPN solutions would have met >80% of initial TPN orders at a larger tertiary care children’s hospital. These 3 compositions are the default choices under ‘standard’ in the electronic medical record which probably influenced ordering. Currently, commercially available products have a higher AA content than what is used at our hospital but is similar to what is used at some other facilities. There may be a market for pediatric standard pre‐mixed TPN that could produce cost savings and improve safety.
To cite this abstract:Singh A, Rauch D. Commercial Premixed Parenteral Nutrition and Its Potential Role in Pediatrics. Abstract published at Hospital Medicine 2014, March 24-27, Las Vegas, Nev. Abstract 93. Journal of Hospital Medicine. 2014; 9 (suppl 2). https://www.shmabstracts.com/abstract/commercial-premixed-parenteral-nutrition-and-its-potential-role-in-pediatrics/. Accessed April 4, 2020.