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The use of parenteral nutrition (PN) is well established within neonatal units in the UK. Although preterm infants are among the highest users of PN within any patient group, practices vary.1 2 The National Confidential Enquiry into Patient Outcome and Death and the Paediatric Chief Pharmacist’s Group highlighted that up to only a quarter of babies in a study of 264 neonates across neonatal units in the UK received optimal nutrition.3 Responding to this, the British Association of Perinatal Medicine (BAPM) published ‘The Provision of Parenteral Nutrition within Neonatal Services – A Framework for Practice’ in April 2016.4 This guidance incorporated recommendations from the European Society for Paediatric Gastroenterology, Hepatology and Nutrition and the European Society of Clinical Nutrition and Metabolism, with the aim of defining practice and recommending the minimum standards for the provision of PN.
In February 2020, the National Institute for Health and Care Excellence (NICE) published a guideline on neonatal PN (NG154) (see box 1).5 This guideline covers PN for preterm babies, up to 28 days after their due birth date; and term babies, up to 28 days after their birth. The content is relevant to neonatal practitioners, neonatal networks, commissioners and parents.
Preterm babies algorithm.
Term babies algorithm.
Evidence and basis for NICE recommendations
There is limited evidence available for the majority of areas relating to PN use in neonates. This includes defining inclusion criteria and appropriate growth parameters for preterm babies, which has led to recommendations based on in utero growth patterns. Where some evidence is available, it is of uncertain quality due to inconsistency of regimens involved in study subjects. Hence, all the recommendations in the NICE guidance are based on the knowledge and experience of the committee members, which comprised neonatologists, a neonatal nurse, paediatric dieticians with expertise in neonatal nutrition, pharmacists with expertise in …
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.