PARENTERAL NUTRITION PRACTICES AND OUTCOMES OF NEONATAL AND PRETERM INFANTS IN FOUR PUBLIC HOSPITALS IN QUITO, ECUADOR FROM 2012- 2017

ABSTRACT Background: Parenteral nutrition (PN) is a treatment provided to very low birth weight neonates during their hospital stay. PN is comprised of the essential nutrients, minerals, fluids, and electrolytes required for sustenance. If healthcare personnel follow the current published infant PN guidelines of an internationally recognized nutritional organization (e.g., American Society for Parenteral and Enteral Nutrition), they can improve the efficacy of their PN treatment. While a host of PN practices in developed countries have been described in scientific literature, there is a lack of knowledge about the PN practices in developing countries (Katoue, Al-Taweel, Matar, & Kombian, 2016). This lack of evidence also applies to the PN practices employed in Ecuador. Ecuadorian PN practices have not been well studied and, therefore, relevant literature is unavailable. Objectives: Describe the current PN practices and resources in public hospital neonatal wards (n=4) in Quito, Ecuador. Furthermore, identify whether current PN practices are standardised and examine the prevalence of the most common side effects associated with PN. Design: Survey of health professionals delivering PN treatment at four neonatal intensive care unit (NICU)s. Furthermore, a retrospective chart review of neonates who received PN treatment from June 2016 to June 2017. Setting: Four public neonatal wards in Quito, Ecuador Results: Our study showed that thirteen out of sixteen interviewees follow PN protocols or consensus developed by their units or by the Ecuadorian Ministry of Health or published guidelines. Furthermore, all of the NICUs developed an Excel conversion spreadsheet to help professionals automate the ordering PN solutions to avoid potential errors during the prescription of this treatment. Other findings noted that the lack of a formal and functional nutritional support team was common in the observed NICUs and that there is little participation from dietitians in PN treatment. Finally, our study found that during week one to week four of PN treatment, the mean levels of amino acids, lipids, energy intake, the glucose infusion rates, and conjugated bilirubin differed significantly between Hospital Gineco-Obstetrico Isidro Ayora’s and Hospital Gineco-Obstetrico Nueva Aurora’s NICUs. Conclusions: The participants at the public NICUs in Quito endeavoured to meet the recommendations of published guidelines, despite the observed challenges and limitations. Our study found that there are opportunities for safety and quality improvement. Awareness of these opportunities will allow NICUs to fill gaps in their procedures to ensure better practices and, therefore, safer PN treatment