Pharmacy World and Science

, Volume 27, Issue 4, pp 305–310 | Cite as

Computer Assisted Total Parenteral Nutrition for Pre-term and Sick Term Neonates

  • Maria SkouroliakouEmail author
  • Dimitris Konstantinou
  • Petros Papasarantopoulos
  • Chrysoula Matthaiou
Research Article


Introduction: Over the past few years, the use of total parenteral nutrition (TPN) has been established for pre-term and sick term neonates. At ‘IASO’ Hospital, a series of protocols implemented through the use of a computer programme has been developed to assist in the time consuming task of prescribing and preparing TPN in neonates. The algorithms used for neonates of a different gestational age are based on the protocols created through screening of literature and personal experience. This is important because it heralds a uniformity of the prescription of TPN at IASO and other hospitals where these protocols have been implemented.

Objective: The objective is to determine the extent of error occurrence of the manual method as opposed to the new computerized procedure of TPN formulation, and to assess the immediate benefits stemming from the computer programme’s use, in terms of personnel time reduction. Furthermore, the usefulness of the automated compounder in the computer driven process of TPN solution formulation was also assessed.

Setting: Gynaecology Hospital ‘IASO’.

Method: For a period of 6 months, sick and prematurely born babies were included in the study. Calculations regarding the composition of TPN solutions were conducted both by computer and manually.

Main outcome measure: The time needed to complete the procedure and the results’ accuracy were measured and compared.

Results: Implementation of the protocols into practice via this computer programme has been found to reduce the time spent by the physician and the pharmacist on TPN solution preparation, but the most important contribution is the virtual elimination (no errors in computerized calculation) of errors in the complex task of prescribing and formulating TPN solutions. For example, the average time taken to prepare the individual TPN solutions was 5.2 min while the computerized procedure took 15.4 min.

Conclusion: Use of this system can optimize pharmacists’ and physicians’ work and help prevent prescription and preparation errors.

Key words

Greece Neonates Pre-term neonates Protocols Total parenteral nutrition TPN TPN compounding 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Zoltkin, SH, Bryan, MH, Anderson, GH. 1981Intravenous nitrogen and energy intakes required to duplicate in utero nitrogen accretion in prematurely born human infantsJ Pediatr99115PubMedGoogle Scholar
  2. 2.
    Dechert, R, Wesley, J, Schafer, L,  et al. 1985Comparison of oxygen consumption, carbon dioxide production, and resting energy expenditure in premature and full-term infantsJ Pediatr Surg20792PubMedGoogle Scholar
  3. 3.
    Groh-Wargo, S. 1987Prematurity/low birth weightLang, CE eds. Nutritional Support in Critical CareAspen RockvilleMD287313Google Scholar
  4. 4.
    Vaucher, YE, Walson, PD, Morrow, G.,III 1982Continuous insulin infusion in hyperglycemic, very low birth weight infantsJ Pediatr Gastroenterol Nutr1211PubMedGoogle Scholar
  5. 5.
    American Academy of Pediatrics Commitee on nutrition. Parenteral nutrition. In: Barness LA, editor. Pediatric Nutrition Handbook, 3rd ed. American Academy of Pediatrics, Elk Grove Village, IL, 1993; 154–66.Google Scholar
  6. 6.
    Rivera, A, Bell, EF, Bier, DM. 1993Effect of intravenous amino acids on protein metabolism of pre-term infants during the first three days of lifePediatr Res33106PubMedGoogle Scholar
  7. 7.
    Sapsford, AL. 1994Energy carobhydrate, protein and fatGroh-Wargo, SThomson, MCox, J eds. Nutritional Care for High Risk NewbornsPrecept PressChicago712ISBN: 1566251338Google Scholar
  8. 8.
    Systemic Disease and the Liver In: Suehy FJ, Sokol RJ and Balistreri WF editors. Liver Disease in Children. 2nd ed. Philadelphia: Lippincott Williams and Wilkins, 2001, p. 884. ISBN: 0781720982.Google Scholar
  9. 9.
    A.S.P.E.N Board of Directors. Nutrition support for low birth weight infants. In: Guidelines for the use of of parenteral and enteral nutrition in adult and pediatric patients. Suppl. to JPEN 1993; 17(4):33SA–8SA.Google Scholar
  10. 10.
    Fletcher, A. 1994Neonatology: pathophysiology and management of the newborn 4th edNutrition243478Google Scholar
  11. 11.
    Lebenthal E. Total parenteral nutrition. Kerner Jr J. Monitoring of pediatric parenteral nutrition in the hospital and home, p 232. William Jr VH. Justification for TPN in the premature and compromised newborn, pp. 278–279. Adamkin DH. TPN in Hyaline membrane disease p 311. Raven Press, 1986.Google Scholar
  12. 12.
    Hartnoll, G, Betremieux, P, Modi, N. 2000Randomised controlled trial of postnatal sodium supplementation on body composition in 25–30-week gestational age infantsArch Dis Child Fetal Neonatal Ed82F248CrossRefPubMedGoogle Scholar
  13. 13.
    Rubin, H, Carlson, S, DeMeo, M, Ganger, D, Craig, RM. 1997Randomized, double-blind study of intravenous human albumin in hypoalbuminemic patients receiving total parenteral nutritionCrit Care Med2524952CrossRefPubMedGoogle Scholar
  14. 14.
    Hartnoll, G, Betremieux, P, Modi, N. 2000Effect of postnatal sodium on oxygen dependency and body weight in preterm infantsArch Dis Child Fetal Neonatal Ed82F1923CrossRefPubMedGoogle Scholar
  15. 15.
    Eggert, LD, Rusho, WJ, Maclay, MW, Chan, GM. 1982Calcium and phosphorus compatibility in parenteral nutrition solution for neonatesAm J Hosp Pharm394953PubMedGoogle Scholar
  16. 16.
    Ziegler, EE, Thuzeen, PJ, Gaelson, JC. 2002Aggressive nutrition of the very low birth weight infant in recent advances in neonatal nutritionClin Perinatol2922545CrossRefPubMedGoogle Scholar
  17. 17.
    Greene, HL, Hambidge, KM, Schanler, R,  et al. 1988Guidelines for the use of vitamins, trace elements, calcium, magnesium, and phosphorous in infants and children receiving total parenteral nutrition: report of the subcommittee on pediatric parenteral nutrient requirements from the committee on clinical practice issues of the american society for clinical nutritionAm J Clin Nutr48132442PubMedGoogle Scholar
  18. 18.
    Park, W, Paust, H, Brosicke, H,  et al. 1986Impaired fat utilization in parenterally fed low-birth weight infants suffering from sepsisJ Parenter Enter Nutr10627Google Scholar
  19. 19.
    Driscoll, D. 1996Delivery of nutritional therapy: quality assurance of automated compounding devicesNutrition126512CrossRefPubMedGoogle Scholar
  20. 20.
    Ritzer, G. 1966The McDonaldization of SocietySage PublicationsPine ForgeGoogle Scholar
  21. 21.
    Allwod, MC, Kearney, MCJ. 1998Compatibility and stability of additives in parenteral nutrition admixturesNutrition14697706CrossRefPubMedGoogle Scholar
  22. 22.
    Enhancing The Safety of Parenteral and Enteral Nutrition. Harvard Medical School. Dept. of Continuing Education. Division of Nutrition. Blackburn G, Bistrian B, Driscoll D Records kept on the proceedings of the seminar held on November 3–5 2002.Google Scholar
  23. 23.
    A.S.P.E.N. Board of Directors: Nutrition support for low birth weight infants. In: Guidelines for the Use of Parenteral and Enteral Nutrition in Adult and Pediatric Infants. Suppl. to JPEN 1993; 17 (4) 33SA–8SA.Google Scholar
  24. 24.
    National Advisory Group on Standards and Practice Guidelines for Parenteral Nutrition. Safe practices for parenteral nutrition formulations, JPEN 1997; 22(2):49–66.Google Scholar
  25. 25.
    Rey, GB, Nouaille-Degorce, B, Combeau, D, Brion, F. 2000Cost-effectiveness of the BAXA MM23 automated compounder for the preparation of pediatric parenteral nutrition solutionsEHP6425Google Scholar
  26. 26.
    Paul, R. 2000Schloerb, Electronic parenteral and enteral nutritionJ Parenter Enter Nutr242330Google Scholar
  27. 27.
    Hilmas, E, Partyka, CM. 2004Implementaion of computerized parenteral nutrition orders in a community paediatric hospitalAm J Health Syst Pharm6127377PubMedGoogle Scholar
  28. 28.
    Puangco, MA, Nguycn, HL, Sheridan, MJ. 1995Computerized TPN ordering saves time and optimizes nutritional therapyJ Am Diet Assoc95A28CrossRefGoogle Scholar

Copyright information

© Springer 2005

Authors and Affiliations

  • Maria Skouroliakou
    • 1
    Email author
  • Dimitris Konstantinou
    • 2
  • Petros Papasarantopoulos
    • 3
  • Chrysoula Matthaiou
    • 1
  1. 1.Harokopio University, IASO Maternity HospitalKifissiaGreece
  2. 2.Diagnostic, Therapeutic, Research Centre, Obstetrics and Maternity Hospital “IASO”AthensGreece
  3. 3.Business Information Support (BIS)Greece

Personalised recommendations