Neonatal Total Nutritional Pharmacy Service at Intensive Care Unit at a University Hospital in Korea

신생아 중환자실 영양요법치료에서 약사의 역할과 영향

  • Oh, Yun Kyoung (College of Pharmacy, Ewha Womans University) ;
  • Lee, Gwang Sup (Division of Pharmacy, Konkuk University Medical Center) ;
  • Rhie, Sandy (College of Pharmacy, Ewha Womans University)
  • 오윤경 (이화여자대학교 약학대학) ;
  • 이광섭 (건국대학교병원 약제부) ;
  • 이정연 (이화여자대학교 약학대학)
  • Received : 2013.03.14
  • Accepted : 2013.06.11
  • Published : 2013.06.30

Abstract

Objective: The study evaluated the impact of pharmacist inventions with the implementation of pharmacistinvolved nutritional support service at neonate intensive care unit in a tertiary teaching hospital. Method: A retrospective and observational study was carried out. The total of 58 infants in neonate intensive care unit was enrolled between January 2011 and October 2012. The pharmacist-involved total parenteral nutritional program was initiated in June of 2012. During the program, pharmacist actively participated in the multidisciplinary round with performing the interventions from reviewing the amount of combined total parenteral nutrition and enteral fluid intakes, the amount of total calories, the glucose infusion rate, and the amounts of proteins per weight in kilogram. The outcome was compared with the results from the control group which reflected the prior period of the program initiation. Result: The number of days of regaining birth weight was significantly shorter (14.5 vs. 19 days, p=0.049) and the percentage of total calorie days with >90 kcal/kg/day was increased significantly (40 vs. 13%, p=0.008) in intervention group compared to the values in control group. In addition, the total mean daily caloric intakes ($84.78{\pm}13.8$ vs. $74.86{\pm}15.36$ kcal/kg/day, p=0.018) was significantly higher in intervention group than those results in control group. There were no significant differences in safety parameters between two groups related to nutritional services of necrotizing enterocolitis, intraventricular hemorrhage, proven sepsis, and also parenteral nutrition-induced hepatotoxicity. Conclusion: Pharmacist-involved total parenteral nutrition managed program was successfully implemented. The outcome showed the improved effectiveness of total parenteral nutrition with pharmacist interventions and no differences in adverse reactions. This could prove the positive effects of pharmacist involvement on nutritional therapy for neonate population.

Keywords

References

  1. Kim YJ. Management and prevention of possible complications associated with total parenteral nutrition. Hanyang Medical Reviews 2011; 31: 269-75. https://doi.org/10.7599/hmr.2011.31.4.269
  2. Marks CE, Crill CM. Calcium and phosphorous in pediatric parenteral nutrition. Journal of pharmacy practice 2004; 17(6): 432-46. https://doi.org/10.1177/0897190004270424
  3. Pittiruti M, Mamilton H, Biffi R, et al., ESPEN guidelines on Parenteral Nutrition: central venous catheters. (Access, care, diagnosis and therapy of complications). Clinical Nutrition 2009; 28: 365-77. https://doi.org/10.1016/j.clnu.2009.03.015
  4. Meadows N. Monitoring and complications of parenteral nutrition. Nutrition 1998; 14(10): 806-8. https://doi.org/10.1016/S0899-9007(98)00089-6
  5. Brine E, Ernst JA. Total parenteral nutrition for premature infants. Newborn and infant reviews 2004; 4(3): 133-55. https://doi.org/10.1053/j.nainr.2004.03.006
  6. Traeger SM, Williams GB, Milliren G, et al., Total parenteral nutrition by a nutrition support team: Improved quality of care. Journal of Parenteral Enteral Nutrition 1986; 10(4): 408-12 https://doi.org/10.1177/0148607186010004408
  7. Stephens BE, Walden RV, Gargus RA, et al., First-week protein and energy intakes are associated with 18-month developmental outcomes in extremely low birth weight infants. Pediatrics 2009; 123(5): 1337-43. https://doi.org/10.1542/peds.2008-0211
  8. Corpeleijn WE, Vermeulen MJ, van den Akker CH, et al., Feeding very-low-birth-weight infants: our aspirations versus the reality in practice. Annals of Nutrition & Metabolism 2011; 58 Suppl 1: 20-9. https://doi.org/10.1159/000323384
  9. Ehrenkranz RA, Dusick AM. Growth in the neonatal intensive care unit influences neurodevelopmental and growth outcomes of extremely low birth weight infant. Pediatrics 2006; 117: 1253-61. https://doi.org/10.1542/peds.2005-1368
  10. Embleton NE, Pang N, Cooke RJ. Postnatal malnutrition and growth retardation: an inevitable consequence of current recommendations in preterm infants. Pediatrics 2001; 107: 270-3. https://doi.org/10.1542/peds.107.2.270
  11. Cooke RJ, Ainsworth SB, Fenton AC. Postnatal growth retardation: a universal problem in preterm infants. Archives of Disease in Childhood-Fetal and Neonatal Edition 2004; 89: F428-30. https://doi.org/10.1136/adc.2001.004044
  12. Ahn SY. Effects of early parenteral nutrition for extremely low birth weight Infants. Journal of Korean Society of Neonatology 2011; 18: 76-81. https://doi.org/10.5385/jksn.2011.18.1.76
  13. Wilmore DW, Dudrick SJ. Growth and development of an infant receiving all nutrients exclusively by vein. Journal of American Medical Association 1968; 203: 860-4. https://doi.org/10.1001/jama.1968.03140100042009
  14. Chang YS. Nutritional support in preterm infants. Hanyang Medical Reviews 2011; 31(4): 246-53. https://doi.org/10.7599/hmr.2011.31.4.246
  15. Agostoni C, Buonocore G, Carnielli VP, et al., Enteral nutrient supply for preterm infants: commentary from European Society of Paediatgric Gastroenterology, Hepatology and Nutrition Committee on Nutrition. Journal of Pediatric Gastroenterology and Nutrition 2010; 50: 85-91. https://doi.org/10.1097/MPG.0b013e3181adaee0
  16. Marie A. Chisholm-burns. US pharmacists' effect as team members on patient care. Systematic review and metaanalyses. Medical Care 2010; 48(10): 923-33. https://doi.org/10.1097/MLR.0b013e3181e57962
  17. Smith WE. Role of a pharmacist in improving rational drug therapy as part of the patient care team. Annals of Pharmacother 2007; 41(2): 330-5. https://doi.org/10.1345/aph.140055
  18. Koretz RL, Lipman TO, Klein S, et al., AGA technical review on parenteral nutrition. Gastroenterology 2001; 121: 970-1001. https://doi.org/10.1016/S0016-5085(01)92000-1
  19. Torun B, Chew F. Protein-energy malnutrition. In: Shils M, Shike M, Olson J, et al., Modern nutrition in health and disease. Baltimore: Williams & Wilkins, Media, PA. 1999; 963-988.
  20. Sheldon GF, Peterson SR, Sanders R. Hepatic dysfunction during hyperalimentation. Archives of Surgery 1978; 113: 504-8. https://doi.org/10.1001/archsurg.1978.01370160162028
  21. Slicker J, Vermilyea S. Pediatric Parenteral Nutrition: Putting the microscope on macronutrients and micronutrients. Nutritional Clinical Practice 2009; 24(4): 481-6. https://doi.org/10.1177/0884533609339073
  22. Lobas NH, Armitstead JA, Ivey MF. Expanding staff pharmacist responsibilities to maintain pharmacy services in a neonatal intensive care unit. American Journal of Healthsystem Pharmacy 1991; 48(8): 1708-11.
  23. Lehmann CU, Kim G, Conner and Jeanne M. Preventing Provider Errors: Online total parenteral nutrition calculator. Pediatrics 2004; 113(4): 748-53. https://doi.org/10.1542/peds.113.4.748
  24. Rochow N, Fusch G, Nuhlinghaus A, et al., A nutritional program to improve outcome of very low birth weight infants. Clinical Nutrition 2012; 31: 124-31. https://doi.org/10.1016/j.clnu.2011.07.004
  25. O'Reilly BK, MAHE, Maria L, et al., Evaluation, Development, and Implementation of Potentially Better Practices in Neonatal Intensive Care Nutrition. Pediatrics 2003; 111 (4Pt2): E461-470. https://doi.org/10.1542/peds.111.3.461
  26. Dice JE, Burckart GJ, Woo JT, et al., Standardized versus pharmacist-monitored individualized parenteral nutrition in low-birth-weight infants. American Journal of Health-System Pharmacy 1981; 38(10): 1487-9.
  27. Kochevar M, Guenter P.A.S.P.E.N. Statement on parenteral nutrition standardization. Journal of Parenteral Enteral Nutrition 2007; 31(5): 441-8. https://doi.org/10.1177/0148607107031005441
  28. Lehmann CU, Kim G. Conner and Jeanne M. Preventing Provider Errors: Online total parenteral nutrition calculator. Pediatrics 2004; 113(4): 748-53. https://doi.org/10.1542/peds.113.4.748
  29. Rochow N, Fusch G, Nuhlinghaus A, et al., A nutritional program to improve outcome of very low birth weight infants. Clinical Nutrition 2012; 31: 124-131. https://doi.org/10.1016/j.clnu.2011.07.004
  30. Grover A, Khashu M, Mukherjee A, et al., Iatrogenic malnutrition in neonatal intensive care units: urgent need to modify practice. Journal of Parenteral Enteral Nutrition 2008; 32(2): 140-4. https://doi.org/10.1177/0148607108314373
  31. Hay WW Jr. Strategies for feeding the preterm infant. Neonatology 2008; 94(4): 245-54. https://doi.org/10.1159/000151643