P21 Introduction of standardised parenteral nutrition for use in preterm neonates in a neonatal intensive care unit at a large tertiary hospital

Aim Following the publication of updated NICE guidelines 1 recommending use standardised parenteral nutrition (PN) in preterm and term babies, alongside known associated risks to patient safety with increased manipulations, 2 need reduce workload pressures aseptic department, decision was made introduce PN, Numeta G13 G16 produced by Baxter, for all babies neonatal unit. When initially introduced, 85% weighing less than 1kg were changed a bespoke PN. Of who required switch, 75% had hyponatraemia and/or hypophosphatemia 45% switched due hyperglycaemia. Insulin usage this cohort from 33% 76%. An earlier study trialling standard additions sodium glycerophosphate reduced switch rate electrolyte imbalance. The aim prospective trial an alternative building regimen number patients requiring PN Method Standardised routinely titrated 20ml/kg/day, starting at 60ml/kg/day, up 120ml/kg/day, extra glucose 5% provide enough fluid hydration. For study, any neonate 1.5kg commenced on slower build 40ml/kg/day 20ml/kg/day 120ml/kg/day. Glucose continued be used as ‘top-up’ choice. This equated more gradual over initial 5 day period. Hyperglycaemia managed using Trust’s ‘Management Neonate’ guideline. 3 22 included their insulin requirements requirement recorded. Results decreased 45%. Although higher prior introduction is likely explained hyperglycaemia guideline which resulted not receiving restricted amounts (16g/kg/day compared average 9g/kg/day previously). More 90% remained 15% when first introduced. Conclusion titration 1.5kg, most now tolerating it deemed suitable cohort. recommended nutritional support reached management also cohort, resulting reduction being frequently. Reference National Institute Health Care Excellence. Neonatal Parenteral Nutrition: Guideline [NG154], 2020. Available at: https://www.nice.org.uk/guidance/ng154 Beaney AM. Quality assurance aseptics preparation services: standards part A. Fifth Edition. 2016. https://www.rpharms.com/Portals/0/RPS%20document%20library/Open%20access/Professional%20standards/Quality%20Assurance%20of%20Aseptic%20Preparation%20Services%20%28QAAPS%29/rps---qaaps-standards-document.pdf Management Neonate. Local Trust – reference available upon request.