Evaluation of Premixed Parenteral Nutrition Solutions in Children

Purpose: In response to the intravenous amino acid shortage, our institution began using premixed parenteral nutrition (PN) solutions in 2010. Although some of these products have been marketed for use in children, safety and efficacy have not been established in this patient population. We aimed to review the use of premixed PN solutions in children, focusing on safety and the ability to meet nutritional goals.

Methods: This was a retrospective review of all patients less than 18 years of age who received a premixed PN solution at Le Bonheur Children’s Hospital between October 2010 and April 2012.  Data collection included patient demographics, PN indication, duration of premixed PN use, reason for change to individualized PN (if applicable), and estimated goal and actual protein and total caloric intake.

Results: Sixty-nine patients received 82 courses premixed PN solutions for a median duration of 3 (1-31) days. Median age and weight were 12 (1.1-18) years and 39 (8.8-118) kg, respectively. Indications for PN were critical illness (n=27), appendicitis (n=22), gastrointestinal disease (n=12), pancreatitis (n=3), seizure disorder (n=3), and inadequate enteral intake (n=2). The premixed PN regimens provided estimated protein goals in 78 of 82 (96%) PN courses and estimated caloric goals in 46 of 82 (56%) courses. Twenty-four patients (35%) required a change from premixed to individualized PN due to electrolyte abnormalities (n=17), need to increase caloric intake (n=7), and preparation for home PN (n=5).

Conclusion: Premixed PN solutions were used safely and effectively in a wide range of pediatric patients, and most patients were able to receive premixed PN for the entire course of therapy. Premixed solutions provide a potential option in pediatric patients when drug shortages limit product supply required for individualized PN. Close monitoring for electrolyte abnormalities and protein and caloric intake is recommended during therapy with premixed PN solutions in children.