Brianna Hemmann1, Justin Josephsen2, Noah Hillman2, Rita Chrivia3, Paula Buchanan4, Howard Williams5, Nikki Burleyson6. 1. Pharmacy (BH), Cincinnati Children's Hospital Medical Center, Cincinnati, OH. 2. Neonatology (JJ, NH), Saint Louis University and SSM Health Cardinal Glennon Children's Hospital, St. Louis, MO. 3. Nutrition (RC), SSM Health Cardinal Glennon Children's Hospital, St. Louis, MO. 4. Statistics (PB), Saint Louis University School of Public Health, St. Louis, MO. 5. Information Technology (HW), SSM Health Cardinal Glennon Children's Hospital, St. Louis, MO. 6. Pharmacy (NB), SSM Health Cardinal Glennon Children's Hospital, St. Louis, MO.
Abstract
OBJECTIVE: The devastation of pharmaceutical production facilities from Hurricane Maria caused a national shortage of parenteral amino acids in October 2017. Our institution decreased trophamine in very low birth weight (VLBW) infants and initiated human milk fortification at a lower feeding volume to increase enteral protein intake more quickly. The objective of this study was to assess how protein management during the shortage period affected the incidence of malnutrition. METHODS: This was a retrospective cohort study of infants admitted to 2 neonatal intensive care units from June 1, 2017 to May 31, 2018. Infants between 23 and 32 weeks' gestation were included in this study. The primary outcome was the incidence of malnutrition at 14 days, defined as a z score decline of ≥0.8 SDs, in the pre-shortage period compared with the shortage period. Clinical data regarding adverse effects associated with early fortification and pharmacy costs were recorded. RESULTS: There were 68 infants prior to and 65 during the shortage who met inclusion criteria. There was no difference in malnutrition between the pre-shortage and shortage groups; however, a significant increase in malnutrition was observed in infants who did not receive early fortification during the shortage. No difference in time to full enteral feeds or necrotizing enterocolitis was observed with early fortification. CONCLUSIONS: Early fortification in VLBW infants receiving less trophamine during the shortage was not associated with an increase in malnutrition. Restricting trophamine in neonates during the shortage allowed for distribution to other critically ill patients. Copyright. Pediatric Pharmacy Association. All rights reserved. For permissions, email: mhelms@pediatricpharmacy.org 2022.
OBJECTIVE: The devastation of pharmaceutical production facilities from Hurricane Maria caused a national shortage of parenteral amino acids in October 2017. Our institution decreased trophamine in very low birth weight (VLBW) infants and initiated human milk fortification at a lower feeding volume to increase enteral protein intake more quickly. The objective of this study was to assess how protein management during the shortage period affected the incidence of malnutrition. METHODS: This was a retrospective cohort study of infants admitted to 2 neonatal intensive care units from June 1, 2017 to May 31, 2018. Infants between 23 and 32 weeks' gestation were included in this study. The primary outcome was the incidence of malnutrition at 14 days, defined as a z score decline of ≥0.8 SDs, in the pre-shortage period compared with the shortage period. Clinical data regarding adverse effects associated with early fortification and pharmacy costs were recorded. RESULTS: There were 68 infants prior to and 65 during the shortage who met inclusion criteria. There was no difference in malnutrition between the pre-shortage and shortage groups; however, a significant increase in malnutrition was observed in infants who did not receive early fortification during the shortage. No difference in time to full enteral feeds or necrotizing enterocolitis was observed with early fortification. CONCLUSIONS: Early fortification in VLBW infants receiving less trophamine during the shortage was not associated with an increase in malnutrition. Restricting trophamine in neonates during the shortage allowed for distribution to other critically ill patients. Copyright. Pediatric Pharmacy Association. All rights reserved. For permissions, email: mhelms@pediatricpharmacy.org 2022.
Entities:
Keywords:
VLBW infants; early fortification; malnutrition; neonates; parenteral amino acids; shortage; total parenteral nutrition
Authors: Dena L Goldberg; Patricia J Becker; Katherine Brigham; Susan Carlson; Laura Fleck; Laura Gollins; Maura Sandrock; Michell Fullmer; Holly A Van Poots Journal: J Acad Nutr Diet Date: 2018-04-11 Impact factor: 4.910
Authors: Jeffrey D Horbar; Richard A Ehrenkranz; Gary J Badger; Erika M Edwards; Kate A Morrow; Roger F Soll; Jeffrey S Buzas; Enrico Bertino; Luigi Gagliardi; Roberto Bellù Journal: Pediatrics Date: 2015-07 Impact factor: 7.124