Commercial Premixed Parenteral Nutrition and Its Potential Role in Pediatrics.

Total parenteral nutrition (TPN) and peripheral parenteral nutrition (PN) are commonly used for patients who cannot meet their nutritional needs orally or via a feeding tube. These patients benefit from PN to optimize their nutritional status. PN can be manufactured by companies in premixed, standardized bags, or the nutrients can be compounded in individual pharmacies in their respective hospitals or even outsourced to a compounding pharmacy. Although a variety of standard premixed PN solutions are available and used by adult patients, this practice is rare in pediatrics. Internationally, premixed PN solutions for adults are much more common as well. More than 80% of European adult patients receiving PN are given premixed PN. However, in pediatrics, PN bags are more commonly custom-made, starting with a base dextrose solution with amino acids and other nutrients added. This process allows for precise delivery of individualized, specific content to each patient. Typically, pharmacists make these bags in the pharmacy or outsource to a compounding pharmacy. This approach may present an opportunity for error or microbial contamination. The compounding process is labor intensive and expensive. Due to the time it takes to produce these individual solutions, many pharmacies have a daily deadline before which PN orders must be received. Orders not completed before this deadline are often not filled, leaving the patient without PN for that day. Premixed PN solutions would decrease or eliminate many of these issues. Adult data have shown that commercial premixed solutions can meet a majority of PN needs while reducing cost, error, and infection. Several previous studies have linked the use of PN with the development of bloodstream infections. These infections are often due to factors associated with the PN bags, not the central lines they are delivered through. Further assessment shows that there is a significantly lower risk of bloodstream infections when dealing with premixed PN solutions versus custom solutions. This finding translates into shorter lengths of stay and lower cost.