Method for analysing individualised parenteral nutrition prescriptions for substitution with a market authorised or standardised parenteral nutrition formula

OBJECTIVE: This study aims to develop a method and a tool to determine whether an individualised parenteral nutrition (PN) prescription for premature newborns can be replaced by a market authorised or standardised PN formula. METHODS: We reviewed available PN formulas in France for premature newborns, including market authorised drugs and standardised formulas from our hospital and those proposed for the French national formulary. We collected data on 280 individualised PN prescriptions produced in our hospital over a 4 month period. Critical nutritional parameters for premature newborns-administered volume, amino acids, carbohydrates, sodium, potassium, calcium, and phosphorus-were identified based on European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) guidelines. RESULTS: An algorithm was created to compare individualised PN prescriptions to available formulas, proposing an alternative if all critical nutritional intakes did not deviate by more than 15% from the prescribed intakes. The algorithm was then applied to the extracted prescriptions. Out of 280 individualised PN prescriptions, only 23 (5%) concerning six patients had a suitable alternative. The formulas most frequently identified as alternatives were Prem2C (17 occurrences) and Premend (seven occurrences). CONCLUSION: The developed algorithm can be used to audit prescription practices or as a routine tool for pharmaceutical validation. Integrating such a tool into prescription software could provide real-time support for prescribers and pharmacists. The results confirm that while some individualised PN prescriptions can be substituted, individualised PN remains essential for meeting the complex and specific nutritional needs of premature newborns in paediatric intensive care units.