New software enhances neonatal TPN

"Independent surveys show our manual is used in 97% of the na-tion's neonatal intensive care units [NICUs] and has been translated into Spanish, German, Polish, Portuguese, and Chinese," said Barry Mangum, Pharm.D., clinical pharmacist, cofounder of the Raleigh, N.C., company, and an author of the manual. "Our software program offers consistency in infant drug and fluid nutrients dosing by practitioners, including pharmacists," he said.

According to Mangum and others, neonatal drug dosing and parenteral nutrition ordering are among the most complex and error-prone in hospital care. Stressing the need for accuracy and informed decision support, he noted that in the United States commercially available drugs and nutrition products are not tested on babies. Thus, as many as 98% of drugs prescribed to babies are off-label. And doses are extremely small, so special concentrations are needed for accurate measurement. The type of medication, as well as the baby's weight, gestational age, and postnatal age, all play a role in determining the proper dose.

Total parenteral nutrition (TPN) ordering includes nutrient, energy, osmolarity, aluminum calculations, and archives order history. A patient-specific drug dosage calculator gauges dosing intervals using gestational and postnatal ages, along with a built-in interface for Baxa Corp.'s and Baxter Healthcare's automatic TPN compounders, said Mangum.

The company makes available default values, warning ranges, and compounding instructions, but data are usually customized by individual health systems, Mangum explained. "We provide clinical consultation to administrative groups of clinical pharmacists, nurses, and neonatologists to define their own parameters," he said. Twenty-two health systems are using the software; about eight more systems-including one in Russia-are considering it. The software is licensed on an annual basis, and support is available through hotline.

Each of the two primary TPN compounder vendors, Baxa Corp. and Baxter Healthcare Corp., offer Windows-based software order entry products that compare computerized TPN prescription input to preset formulary and guidelines algorithms. And researchers at Johns Hopkins Children's Center in Baltimore recently released an on-line, stand-alone product that computes dosage requirements based on weight and other critical data for TPN solutions for neonatal and pediatric patients.