Observational Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Pediatr. Aug 8, 2016; 5(3): 325-329
Published online Aug 8, 2016. doi: 10.5409/wjcp.v5.i3.325
Significant variations in nutritional supplementation amongst neonates in the United Kingdom
Morris Gordon, Sahira Isaji, Fiona Tyacke
Morris Gordon, Sahira Isaji, Fiona Tyacke, Department of Paediatric, Blackpool Victoria Hospital, Preston FY3 8NR, United Kingdom
Morris Gordon, School of Medicine and Dentistry, University of Central Lancashire, Preston PR1 2HE, United Kingdom
Author contributions: Gordon M conceived the study, supported the analysis and led the write up; Isaji S and Tyacke F jointly performed the data collection, analysis and added to the write up; all authors approved the final manuscript.
Institutional review board statement: The study was reviewed by the local Research and Development/audit Department.
Informed consent statement: Obtained by all participants before telephone participation, all information recorded was anonymous.
Conflict-of-interest statement: Isaji S and Tyacke F have none to declare; Gordon M has received travel grants and educational grants from various companies to attend scientific and educational meetings, including Danone/nutricia, Abbott, Ferring, Casen Fleet, Vifor, Clinova, Tillots, Warner Chiclott, Norgine and Biogaia. They had no involvement in this or any other study.
Data sharing statement: Data is available on request from the author morris@betterprescribing.com.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Morris Gordon, School of Medicine and Dentistry, University of Central Lancashire, HA118, Harrington building, Preston PR1 2HE, United Kingdom. morris@betterprescribing.com
Telephone: +44-7816-687791
Received: January 20, 2016
Peer-review started: January 20, 2016
First decision: April 18, 2016
Revised: May 8, 2016
Accepted: June 27, 2016
Article in press: June 29, 2016
Published online: August 8, 2016
Abstract

AIM: To ascertain United Kingdom adherence to European society of Paediatric Gastroenterology, Hepatology and Nutrition guidance (ESPGHAN).

METHODS: A national cross sectional questionnaire study of neonatal units across England was completed between January and March 2014. All 174 units in the country were attempted to be contacted to complete a telephone survey. This included all level 1, 2 and 3 units. They were initially contacted by phone and asking any senior member of the team about their current practice and procedures. The first ten telephone interviews were completed with two researchers present to ensure consistency of approach. If no response was received or no details were available, one further attempt was made to contact the unit. The results were recorded in a proforma and then collated and entered into a spreadsheet for analysis. Comparison to United Kingdom adherence to ESPGHAN guidance was completed.

RESULTS: Response rate was 53%. There was variation in use of all supplements. The survey collected data from 91 neonatal units (53% response rate). It was found that 10% of neonatal units had no fixed policy on supplements. The protocols regarding supplementation involved predominantly folic acid, vitamin A, vitamin D and iron, with much variation in doses and regimens. The criteria for prescribing supplements was largely based on age (47%) with only 7% using a weight targets to initiate supplements. Summary data regarding the appropriateness of each nutritional supplement for a variety of different weights are presented, as well as comparison to ESPGHAN guidance which suggests issues with both underdoing of Breast Fed infants and overdosing of infants on several artificial formulas which already contain significant amounts of these nutritional elements.

CONCLUSION: There is significant heterogeneity in neonatal policies when prescribing supplements to neonates. National policies which take international guidance into account are recommended.

Keywords: Neonatal, Nutritional additives, Preterm nutrition, Term nutrition, Iron

Core tip: Nutritional supplementation in neonates is common in neonatal units, but there is no clear United Kingdom guidance. This study set out to ascertain United Kingdom practice with a national cross-sectional study with reference to European society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) nutritional guidance. Fifty-five percent of the 174 units in the country were contacted. There was variation in use of all supplements. Comparison to ESPGHAN guidance suggests issues with both underdoing of Breast Fed infants and overdosing of preterm infants on several artificial formulas which already contain significant amounts of nutritional elements. National policies which take international guidance into account are recommended, with similar research needed in other countries.