Browsing by Author "Flint, Cristen Sarah"

Now showing 1 - 1 of 1
  • Thumbnail Image
    Item
    Neonatal and paediatric parenteral nutrition prescription practices in South Africa : a cross-sectional survey
    (Stellenbosch : Stellenbosch University, 2018-03) Flint, Cristen Sarah; Blaauw, Renee; Van Niekerk, Evette; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Human Nutrition.
    ENGLISH SUMMARY : Objectives: The objective of this study was to describe the current parenteral nutrition (PN) prescription practices and knowledge of prescribers (paediatric doctors and dietitians) for their neonatal and paediatric patients, in South Africa, and to establish the factors which influence usage and adherence to the available guidelines. Methods: A descriptive cross-sectional survey was conducted from November 2016 to March 2017 through a self-administered online questionnaire. PN prescription factors were assessed in terms of timing, patient type and diagnosis, use of macronutrients, and fluid allocations. Prescriber knowledge of the ESPGHAN international guidelines was assessed, as well as access to information. Knowledge and practice score competency levels were set, a priori, at 60% and 80% respectively. Respondents were stratified according to work sector (state / private) or professional group (dietitian / paediatric doctor) for statistical comparison. Summary statistics, chi-squared tests and correlation coefficients were used to describe and analyse the data. Results: A total of 72 survey respondents were included, 58% dietitians and 42% paediatric doctors; 47% private sector and 53% state sector based. The primary indications for PN use were gut abnormalities and intolerances, prematurity and critical illness. Doctors prioritised fluid calculation in determining their PN prescription. Dietitians were significantly more likely to calculate the patient-specific protein requirements (p < 0.001). Only 36% of prescribers commenced PN feeding within the first 24 hours of admission, but the majority (67%) introduced intravenous lipid emulsion (IVLE) from day 1 of PN. The main reasons given for IVLE delay were habit, liver function concerns, and PN bag availability. The mean practice score was 75% (SD ± 17). There was no significant difference in mean score between the work sector subgroups (75 ± 20% state versus 76 ± 15% private; p = 0.82). The dietitians, however, scored significantly higher for practice outcomes compared with the doctors (82 ± 12% versus 65 ± 19 %; p < 0.001). The main potential factors that influenced the delay or non-use of PN when it was indicated included concerns regarding infectious complications and financial resource constraints. Inadequate access to PN, and a lack of trained staff to administer the PN, also impacted on its use. Only 64 of the respondents completed the knowledge section of the questionnaire. The mean knowledge score was 74% (SD ± 12), range 50 – 100%. There was no significant difference in mean score between the work sector subgroups (73 ± 13% for state versus 76 ± 12 % for private; p = 0.32). The mean knowledge score for the dietitians (77 ± 13%) was however significantly higher than that of the doctors (71 ± 11%); (p = 0.04). Conclusion: PN prescribing practices in South Africa for neonatal and paediatric patients are not yet optimal in many respects. Prescribers require access to clear PN therapy guidelines, as well as guidance on how to implement these recommendations effectively in daily clinical practice. A multidisciplinary approach to PN feeding is paramount. Our findings emphasise the role of the dietitian as part of the multidisciplinary team in achieving optimal feeding. Additional research is warranted to further assess the PN feeding practices in this vulnerable patient group.