Parenteral nutrition (PN) is a technique used to treat patients who cannot be fully fed by oral and enteral route.1 The nutritional approach in the paediatric age, compared with the adult one, is strongly conditioned by growth, on which the metabolic requirements depend.Whereas a wide variety of standard com. formulas for PN are used for adult patients, only few paediatric formulas have only just been introduced to the market as recently reported.2, 3 Children requiring PN are fed normally with personalised composition solution prepared mostly in the hospital pharmacy on a daily basis adapted to the patient's need.Standard com. formulas have several advantages in terms of safety, by reducing microbiol. contamination and compounding errors.Moreover, using this type of admixture it could decrease the workload at the hospital, resulting in reduced cost and waste.The aim of this study is to evaluate the possibility of using PN formulas with a standardised one (com. or galenic composition) on paediatric patients, ensuring nutritional intake for growth and state of health.This work was conducted in the Women's and Child's Health Department of the Hospital of Padova.With a retrospective study we compared 82 paediatric patients receiving three PN different formulations in three different periods, resp. personalised (IND-PN, between June and Nov. 2009), galenic standardised (PED STD-PN between Dec. 2009 and May 2010) and com. standardised (COM STD-PN, June to Nov. 2010) solutionsWe analyzed all in-patients who were fed with PN in presence of central venous catheter and aged 1-18 years.We excluded patients with kidney or liver failures and children with severe congenital or metabolic abnormalities.The standard formula used in this study was chosen among the formulas present on the market at that time and indicated for adult patients because it was the most suitable in our opinion to meet children's nutritional needs.Particularly we used Oliclinomel N4-550 by Baxter S.p.A.(Rome, Italy).To choose the solution we compared the composition of each parenteral formula with the paediatric needs according to the ESPEN guidelines.The same com. standard formula (added with calcium reaching the concentration of 4 mmol/l) was administered to multiple patients in different volumes calculated in relation to body weightThe group PED STD-PN received five different standardised formulations according to their age.Total volume administered ranged from 1100 to 2200 mL/day, with amino acids, glucose and lipids intakes between 1.84-1.28, 9.22-3.34 and 2.58-1.15 g/Kg/day, resp.Micronutrients were administered according to ESPEN guidelines.1 PN tolerance was checked analyzing plasma biochem. parameters: glucose, triglycerides, sodium, potassium, calcium, magnesium and phosphate1, 10 before starting treatment (basal values), at 3 and 7 days of treatment and, afterward, once a week throughout PN administration.If a patient was out of range for any of the above mentioned parameters and needed a personalised formula he was dropped out of the study.The groups' baseline comparability was conducted with Kruskall-Wallis test followed by Dunn test.The time course of biochem. parameters were compared with a non-parametric repeated measures anal. of variance with SAS PROC MIXED. χ2 test or Fisher's exact test was used for categorical variables.The significance level was set at the 5% value.All the anal. were conducted with SAS 9.2 (SAS Institute Inc., Cary, NC, USA) for Windows.Before study start informed consent was required by the children's parents.Twenty-four patients were treated with PED STD-PN, 26 with COM STD-PN and 32 with IND-PN.Patients needed PN for an average period of 18.2±11.2, 22.5±21.1 and 18.6±14.5 days in the groups COM STD-PN, PED STD-PN and IND-PN, resp. (P=0.9427).Average duration of standard treatment (without the necessity of switching to personalised prescription) was 8±5.87 days for COM STD-PN treatment, whereas that one with PED STD-PN was 12.5±14.2 days (P=0.2700).Basal biochem. was not different at baseline.The biochem. plasma values collected at basal and in the 3rd and 7th days were not statistically different among the three groups (Table 1).Our work represents one of the first studies carried out in Italy in order to verify the possibility of using standard com. or galenic PN formulas in children.The current trend is to have standard solutions available as it is for adult patients also for paediatric ones.The results of this investigation suggest that with adequate monitoring of patient, it is possible to use standard com. PN formulas for paediatric patients, also if the use of this kind of admixture is restricted to a limited period of time (8-12 days).There were no differences between the duration of the treatment with the com. formula and the galenic standard formula.Standard com. formulas can be used as starter admixtures, allowing paediatricians to have more time to evaluate the clin. conditions of patients and to formulate the most appropriate personalised solution when it is necessary.Furthermore 8 days could be a time still sufficient to cover the requirements in case of emergency.Owing to the numerous advantages of standard solution use, these preparations could be considered as a viable alternative to personalisation at least for the 1st week of treatment, though these data must be confirmed with a larger number of patients.Personalised prescriptions are indicated for paediatric patients with critical condition, metabolically unstable and for long-term PN treatment.This study evaluated the tolerability of PN treatment with standardised com. formulas; it remains to verify the effectiveness of this nutritional support for a longer period of time.Furthermore, we analyzed the tolerability of a single standard com. formula used for all COM STD-PN patients; just as there are different standard formulas for adult patients to choose according to the clin. conditions, the same will be possible for paediatric patients.In conclusion standardised paediatric PN was tolerated for 8-12 days.No differences were detected in plasma values of the more common biochem. parameters.Standardised paediatric PN formula could be a safe and useful alternative to compounding at least in the first days of PN requirements.
