Vietnam National Survey on Parenteral Nutrition Practice in Preterm Neonates: Status, Barriers, and Implications

Abstract

ABSTRACTBackgroundDue to high risks of feeding intolerance, preterm infants often receive parenteral nutrition (PN) to ensure sufficient nutrition and energy intake. However, there is a lack of data on the status of clinical PN practice and barriers among neonatal care units in low to middle-income countries like Vietnam. This extensive survey explores the status and barriers of PN practice for preterm infants in neonatal units across Vietnam and identifies the practical implications of enhancing nutritional outcomes in preterm infants.MethodsA multicenter nationwide web-based survey on PN practice in preterm infants was conducted across 114 neonatal units from 61 provinces in Vietnam.ResultsAmong 114 neonatal units receiving a request for surveys, 104 units (91.2%) from 55 provinces participated. Neonatal units were categorized as level I (2/104, 1.9%), II (39/104, 37.5%), III (56/104, 53.8%), and IV (7/104, 6.8%). We showed that the initiations of PN within the first hour and the first two hours of life occurred in 80.8% (84/104) and 95.2% (99/104) of the units, respectively. The early provision of amino acids (within the first day of life) and lipids (within two days of life) were documented by 85% (89/104) and 82% (84/104) of the respondents, respectively. The initial dose of amino acids ranged from 0.5 to 3 g/kg/day; the dose of amino acids less than 1 g/kg/day was 7.7% (8/104) of respondents; the maximum dose of amino acids ranged from 2 to over 4.5 g/kg/day, with 4 g/kg/day in 47.1% (49/104) of the respondents. The initial dose of lipids was between 0.5 and 2 g/kg/day, frequently 1 g/kg/day, in 51.9% (54/104) of the respondents; the target lipid dose ranged from 3 to 4 g/kg/day in 93.3% (97/104); the maximum target dose for lipid was 4 g/kg/day in 36.5% (38/104) of the respondents. The initial glucose dose was distributed as follows: 46.2% of respondents (48/104) administered 04 mg/kg/minute, 21.2% (22/104) used 05 mg/kg/minute, 28.8% (30/104) used 06 mg/kg/minute, and 3.8% (4/104) used 03 mg/kg/minute. Additionally, 48.1% of respondents (50/104) reported a maximum glucose infusion rate above 13 mg/kg/min and 19.2% (20/104) above 15 mg/kg/min. Nineteen percent (20/104) of the respondents reported lacking micronutrients. Barriers to PN initiation included difficulty in establishing intravenous lines, the absence of standardized protocols, the lack of lipids and micronutrients, infections, and unavailable software supporting neonatologists in calculating nutrition paradigms.ConclusionsThis study’s findings highlight the highly variable PN practice across neonatal units in Vietnam. Deviations from current practical guidelines can be explained by various barriers, most of which are modifiable. A monitoring network for nutritional practice status and a database to track the nutritional outcomes of preterm infants in Vietnam are needed.Key messagesWhat’s known?Recent clinical trials have suggested that parenteral nutrition (PN) is an important factor contributing to both short- and long-term clinical outcomes, including mortality and neurodevelopment, in preterm infants.There are existing well-developed PN guidelines for preterm infants in high-income countries.What’s new?PN practice varies across neonatal units in Vietnam, particularly in amino acids, lipids, and micronutrient provision.Deviations from the current practical guidelines are related to various barriers. Common barriers include difficulty in establishing intravenous lines, the absence of standardized protocols, the unavailability of lipids and particularly micronutrients, and the lack of software supporting neonatologists in calculating nutritional paradigms. Fortunately, most of these barriers are modifiable.Establishing a monitoring network for nutritional practice status and developing a database to track the nutritional outcomes of preterm infants in Vietnam is necessary.