Neves A, Pereira-da-Silva L, Fernandez-Llimos F
Servicios Farmacéuticos, Hospital da Luz, Lisboa, Portugal.
Unidad de Cuidados Intensivos Neonatales, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central, Lisboa, Portugal; Departamento de Pediatría, Facultad de Ciencias Médicas, Universidad Nova de Lisboa, Lisboa, Portugal.
An Pediatr (Barc). 2014 Feb;80(2):98-105. doi: 10.1016/j.anpedi.2013.05.026. Epub 2013 Jul 4.
The use of guidelines for neonatal parenteral nutrition (PN) improves its clinical efficiency and the safety of prescription.
To evaluate the practices of neonatal parenteral nutrition prescription in Portugal, and the adherence to the National Consensus on neonatal PN (2008).
A questionnaire based on a multiple choice response on parenteral nutrition prescription was conducted, and sent to the coordinators of the 50 public and private Portuguese neonatal special care units, 25 being level III and 25 level II.
Parenteral nutrition was prescribed in 32 neonatal units, 23 of which (71.9%) responded to the questionnaire. Of the respondents, 19 (82.6%) refer to follow the National Consensus, the remaining following local guidelines; 17 (73.9%) of units referred to using an electronic based system for prescription. In preterm neonates, most mentioned: administering judiciously the fluid intake during the first post-natal week; starting amino acids from the first post-natal day with 1.5-3g/kg/d, increasing up to 3-4g/kg/d; starting lipids from the first three post-natal days with 1g/kg/d, increasing up to 3g/kg/d; administering 40-70mg/kg/d of calcium and of phosphorus with the fixed calcium:phosphorus ratio of 1.7: 1 (mg:mg); and estimating the osmolality of the solutions, and weekly monitoring of serum triglycerides, blood urea, serum phosphorus and liver function.
The high response rate is probably representative of the practice of PN prescription in Portugal. Most of the units used the National Consensus on neonatal PN as a reference, thus contributing to better nutritional support for neonates.
采用新生儿肠外营养（PN）指南可提高其临床效率和处方安全性。
评估葡萄牙新生儿肠外营养处方的实践情况，以及对《新生儿PN国家共识（2008年）》的遵循情况。
开展了一项基于肠外营养处方多项选择题的问卷调查，并发送给葡萄牙50家公立和私立新生儿特殊护理单位的协调员，其中25家为三级单位，25家为二级单位。
32家新生儿单位开具了肠外营养处方，其中23家（71.9%）回复了问卷。在回复者中，19家（82.6%）表示遵循《国家共识》，其余遵循当地指南；17家（73.9%）单位表示使用基于电子的处方系统。对于早产儿，大多数提到：在出生后第一周谨慎控制液体摄入量；出生后第一天开始给予氨基酸，剂量为1.5 - 3g/kg/d，逐渐增加至3 - 4g/kg/d；出生后前三天开始给予脂肪，剂量为1g/kg/d，逐渐增加至3g/kg/d；给予40 - 70mg/kg/d的钙和磷，钙磷固定比例为1.7:1（mg:mg）；估计溶液的渗透压，并每周监测血清甘油三酯、血尿素、血清磷和肝功能。
高回复率可能代表了葡萄牙肠外营养处方的实践情况。大多数单位将《新生儿PN国家共识》作为参考，从而有助于为新生儿提供更好的营养支持。
