{
  "abstract": "Aim Supplemented regimens of multi-chamber bags (MCBs) are useful in managing paediatric patients who require parenteral nutrition (PN). Standardised PN formulations are recommended to reduce cost, compounding errors and microbial contamination. Four MCBs, supplemented with adult micronutrient preparations, are available within The Trust for patients weighing more than 10kg. The adult micronutrient preparation currently used has a higher vitamin A content than paediatric preparations and does not contain vitamin K. The recommended daily intake of vitamin A is significantly higher for adults than for children. This audit assesses micronutrient intakes in paediatric patients receiving supplemented MCB PN against recommended intakes in the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) 2018 PN guidelines. 1 2 Methods Children managed by the paediatric intestinal failure team who received supplemented MCBs between September 2023 and September 2024 were included in this audit. Prescriptions were reviewed at the point when the maximal macronutrient requirement was achieved. Intake of vitamins A, D, E, zinc, selenium, copper, and manganese were calculated and compared to individual recommended intakes. This project received local audit approval and did not require any ethical approval.Results Fifty-six patients (ages ranging from 1 to 16 years) were reviewed. For each patient, the daily intake of micronutrients was calculated as a percentage of each individual’s recommended intake.Analysis of median intake for each micronutrient showed that, on average, patients received 438% of their recommended daily intake of vitamin A, consistently in excess of the target range. Zinc often exceeded the recommended intake at 420% median and frequently exceeded the maximum recommended daily intake among all stock bags. Vitamin D and Copper presented as consistently low among all patients, with medians of 34% and 28% respectively. Vitamin E (17-134%), selenium (18-149%) and manganese (0-213%) were delivered in wide ranges of the recommended intake, with no identifiable pattern for meeting patient needs.With consideration of the results, The Trust has reviewed different options with the aim to more consistently meeting the recommended intakes. Use of an alternative adult stock bag enables supplementation with paediatric micronutrient preparations. Comparing the nutritional intake the audited patients would’ve received from this new regimen to the original supplementation, presents a feasible option with improvements in multiple micronutrient intakes. Analysis of median intake shows reductions in recommended daily intake of vitamin A (232%) and zinc (150%), with an increase intake in vitamin D (50%), significantly closer to recommended intakes. This also resulted in a reduced intake of manganese (30%), selenium (30%) and vitamin E (29%), whilst copper (30%) remained consistent. Whilst this is not a perfect solution, it allows for safer levels of several micronutrients and the additional delivery on vitamin K.Conclusion The audit suggests that the use of adult micronutrient preparations is unsuitable for children of all ages as no micronutrient intake was met consistently. Moving forward, the micronutrient status of paediatric patients receiving supplemented MCBs should be monitored regularly, particularly in use exceeding 14 days. Exploration of options that allow more consistent delivery of micronutrients is still required.References Bronsky J, Campoy C, Braegger C, et al. ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: vitamins. Clinical Nutrition 2018;37(6):2366–2378. Domellöf M, Szitányi P, Simchowitz V, et al. ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: iron and trace minerals. Clinical Nutrition 2018;37(6):2354–2359.",
  "authors": [
    {
      "affiliations": [
        "Southampton Children’s Hospital, UK"
      ],
      "name": "Rosie Glyde"
    },
    {
      "affiliations": [
        "Southampton Children’s Hospital, UK"
      ],
      "name": "Melody Chan"
    },
    {
      "affiliations": [
        "Southampton Children’s Hospital, UK"
      ],
      "name": "Akshay Batra"
    }
  ],
  "title": "P62 Micronutrient intake in children receiving supplemented parenteral nutrition multi-chamber bags",
  "uid": "e719e36b-f2b3-5923-938f-ae05ce17205d"
}