Authors
Koletzko B, Fewtrell MS, Domellöf M, Embleton ND, Gruszfeld D, McNulty A, Lapillonne A, Szitanyi P
Click on the image to read the standard in brief.
Very preterm term infants and parents
Healthcare professionals, neonatal units, hospitals, and health services
In very preterm infants (<32 weeks of gestation)/very low birthweight infants (<1500 g birthweight), parenteral nutrition should start on the first day after birth, usually using standard solutions, and should continue until sufficient enteral feeding is established.
The goal is to provide appropriate nutrient supply and to prevent the early occurrence of nutrient deficits and growth faltering.
Very preterm infants/very low birthweight infants have high nutritional requirements per kilogram body weight but only limited reserves to withstand the interruption of placental nutrient supply at delivery. Establishing full enteral feeding may take many days, especially if the infant is ill. Early commencement of parenteral nutrition (PN) was shown to shorten the time interval until birth weight was regained. (1) PNshould commence on the first day, as soon as the infant is admitted to the neonatal unit, to avoid interruption of nutrient supply and accumulation of nutrient deficits whilst enteral feeds are established. (1–5) PN should be continued until an adequate amount of enteral nutrition is established. (6)
PN with amino acids and glucose should be commenced in all very preterm infants and be complemented by intravenous lipid emulsions and micronutrients. (7–9) It is safe to start lipid emulsions on day one. (2,10,11) Attention should be paid to provide enough phosphorus and limit chloride delivery to prevent hypophosphatemia and metabolic acidosis, respectively. The delivery of adequate PN usually requires central venous access, although peripheral venous access may also be used, if a higher fluid intake is tolerated (see Patient safety & hygiene practice). (12)
Standardised PN solutions prepared for preterm infants and most ill term infants were shown to be safe, to contribute to cost savings, and to help to broadly implement initiation of nutrition on the first day. (1,9,13–15)
For parents and family
B (High quality)
Clinical records, parent information sheet1*
(see example)
For healthcare professionals
B (High quality)
Guideline
A (Moderate quality)
Audit report2
B (High quality)
Training documentation
B (Moderate quality)
Audit report2
For neonatal unit
B (High quality)
Guideline
B (High quality)
Audit report2
For hospital
B (High quality)
Training documentation
A (Low quality)
B (Moderate quality)
Audit report2
B (High quality)
Guideline
For health service
B (High quality)
Guideline
1The indicator ‘patient information sheet’ is an example for written, detailed information, in which digital solutions are included, such as web-based systems, apps, brochures, information leaflets, and booklets.
2The indicator ‘audit report” can also be defined as a benchmarking report.
*The TEG Nutrition very much supports the need of good communication with families and regular sharing of key information, but it is not in favour of sharing information on each standard by a “parent information sheet”, which is the term chosen by the Chair Committee. In our view, sharing multiple parent information sheets bears the risk of overloading families with a plethora of written information during a stressful time period, which may not be very helpful. We suggest to consider other means of sharing information.
For parents and family
N/A
For healthcare professionals
N/A
For neonatal unit
N/A
For hospital
N/A
For health service
A (Moderate quality)
B (Moderate quality)
For parents and family
For healthcare professionals
For neonatal unit
For hospital
For health service
PN can be delivered with solutions that are individually tailored for each infant, which may be necessary in infants with special requirements or those requiring long-term PN. Individual prescription and compounding of PN solutions has the major disadvantage that the start of PN is usually delayed by the additional time required to make solutions available, and frequently occurring limitations of availability on weekends and holidays. (1,15) The use of standardised PN solutions tailored to the needs of most preterm or ill term infants that are prepared by hospital pharmacies or commercial providers can enable PN initiation through 24 hours every day and hence improves nutrient delivery and quality of care.
Components of standardised PN solutions are prepared by hospital pharmacies and commercial providers, and hence carry less risk of microbial contamination and infection than mixing PN solutions on the ward. They also reduce the risk of prescription errors.
September 2022 / 2nd edition / previous edition reviewed by van den Akker CHP / next revision: 2025
Recommended citation
EFCNI, Koletzko B, Fewtrell MS et al., European Standards of Care for Newborn Health: Effective implementation of early parenteral feeding. 2022.
You are currently viewing a placeholder content from Facebook. To access the actual content, click the button below. Please note that doing so will share data with third-party providers.
More InformationYou are currently viewing a placeholder content from Instagram. To access the actual content, click the button below. Please note that doing so will share data with third-party providers.
More InformationYou are currently viewing a placeholder content from X. To access the actual content, click the button below. Please note that doing so will share data with third-party providers.
More Information
