Porcelli Peter
Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC 27103, USA.
J Perinatol. 2004 Mar;24(3):137-42. doi: 10.1038/sj.jp.7210991.
Parenteral nutrition is an important component of postnatal hospital care for very-low-birth-weight infants (VLBW; birth weight < or =1500 g). Designing and preparing parenteral nutrition for VLBW infants is a complicated process requiring many nutrition decisions and mathematical computations, a process most medical centers have developed independently. The goal of this project was to examine the nutrition design practices and resources of regional neonatal intensive care units (NICUs).
In depth interviews were conducted with neonatal nutrition health-care providers at eight medium to large NICUs in North Carolina to describe the patient population, the nutrition support staff, nutrition decision-making procedures and resources, the design of parenteral nutrition, and problems with parenteral nutrition design and preparation.
The eight centers reported an average of 182 VLBW infant admissions and prepared 4810 parenteral nutrition orders per year. Five centers employed experienced neonatal nutrition staff to offer decision support. Six centers used paper parenteral nutrition order forms, all of which provided some decision guidance such as a recommended ordering dose range. Self-reported medical mistakes included incorrect parenteral nutrition additive dilutions and incorrect supplementation of parenteral nutrition additives.
Most NICUs offered nutrition resource personnel and used paper parenteral nutrition order forms, which offered a wide range of decision guidance. About half the reported medical errors could be addressed using electronic parenteral nutrition design; however, a broader, more general approach to the entire design and administration system would reduce more errors. Last, as development of electronic neonatal nutrition resources in the clinical arena progresses, standards for recording neonatal nutrition content, and evaluating the effect of decision support need to be identified.
肠外营养是极低出生体重儿（VLBW；出生体重≤1500克）出生后住院治疗的重要组成部分。为极低出生体重儿设计和准备肠外营养是一个复杂的过程，需要做出许多营养决策并进行数学计算，大多数医疗中心都是独立开展这一过程的。本项目的目标是研究区域新生儿重症监护病房（NICU）的营养设计实践和资源情况。
对北卡罗来纳州8家中大型新生儿重症监护病房的新生儿营养医疗服务提供者进行了深入访谈，以描述患者群体、营养支持人员、营养决策程序和资源、肠外营养的设计以及肠外营养设计和准备中存在的问题。
这8个中心报告称，平均每年收治182例极低出生体重儿，开出4810份肠外营养医嘱。5个中心聘请了经验丰富的新生儿营养人员提供决策支持。6个中心使用纸质肠外营养医嘱单，所有医嘱单都提供了一些决策指导，如推荐的医嘱剂量范围。自我报告的医疗差错包括肠外营养添加剂稀释错误和肠外营养添加剂补充错误。
大多数新生儿重症监护病房配备了营养资源人员，并使用纸质肠外营养医嘱单，这些医嘱单提供了广泛的决策指导。约一半报告的医疗差错可通过电子肠外营养设计解决；然而，对整个设计和管理系统采用更广泛、更通用的方法将减少更多差错。最后，随着临床领域电子新生儿营养资源的发展，需要确定记录新生儿营养内容的标准以及评估决策支持效果的标准。
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