Ratio of Phosphate to Amino Acids
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National Institute for Health and Care Excellence Final Neonatal parenteral nutrition [D10] Ratio of phosphate to amino acids NICE guideline NG154 Evidence reviews February 2020 Final These evidence reviews were developed by the National Guideline Alliance which is part of the Royal College of Obstetricians and Gynaecologists FINAL Error! No text of specified style in document. Disclaimer The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian. Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties. NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the Welsh Government, Scottish Government, and Northern Ireland Executive. All NICE guidance is subject to regular review and may be updated or withdrawn. Copyright © NICE 2020. All rights reserved. Subject to Notice of Rights. ISBN: 978-1-4731-3673-1 FINAL IV minerals for preterm and term babies Contents IV minerals for preterm and term babies ........................................................................... 6 Review question ............................................................................................................. 6 Introduction ........................................................................................................... 6 Summary of protocol ............................................................................................. 6 Clinical evidence ................................................................................................... 7 Summary of clinical studies included in the evidence review ................................. 8 Quality assessment of clinical outcomes included in the evidence review ........... 11 Economic evidence ............................................................................................. 11 Summary of studies included in the economic evidence review ........................... 11 Economic model .................................................................................................. 11 Evidence statements ........................................................................................... 11 The committee’s discussion of the evidence ........................................................ 13 References ................................................................................................................... 15 Appendices ........................................................................................................................ 15 Appendix A – Review protocols .................................................................................... 16 Review protocol for review question: What is the optimal ratio of phosphate to amino acid in preterm and term babies who are receiving parenteral nutrition and neonatal care? ..................................................................... 16 Appendix B – Literature search strategies .................................................................... 20 Literature search strategies for review question: What is the optimal ratio of phosphate to amino acid in preterm and term babies who are receiving parenteral nutrition and neonatal care? .................................................... 20 Databases: Medline; Medline EPub Ahead of Print; and Medline In-Process & Other Non-Indexed Citations .................................................................... 20 Databases: Embase; and Embase Classic .......................................................... 21 Databases: Cochrane Central Register of Controlled Trials; Cochrane Database of Systematic Reviews; Database of Abstracts of Reviews of Effects; and Health Technology Assessment ........................................... 23 Appendix C – Clinical evidence study selection ............................................................ 26 Clinical study selection for review question: What is the optimal ratio of phosphate to amino acid in preterm and term babies who are receiving parenteral nutrition and neonatal care? .................................................... 26 Appendix D – Clinical evidence tables .......................................................................... 27 Clinical evidence tables for review question: What is the optimal ratio of phosphate to amino acid in preterm and term babies who are receiving parenteral nutrition and neonatal care? .................................................... 27 Appendix E – Forest plots............................................................................................. 33 Forest plots for review question: What is the optimal ratio of phosphate to amino acid in preterm and term babies who are receiving parenteral nutrition and neonatal care? ..................................................................... 33 Appendix F – GRADE tables ........................................................................................ 34 Neonatal parenteral nutrition: evidence review for intravenous minerals DRAFT (February 2020) 4 FINAL IV minerals for preterm and term babies Appendix G – Economic evidence study selection ........................................................ 41 Economic evidence study selection for review question: What is the optimal ratio of phosphate to amino acid in preterm and term babies who are receiving parenteral nutrition and neonatal care? ..................................... 41 Appendix H – Economic evidence tables ...................................................................... 42 Economic evidence tables for review question: What is the optimal ratio of phosphate to amino acid in preterm and term babies who are receiving parenteral nutrition and neonatal care? .................................................... 42 Appendix I – Economic evidence profiles ..................................................................... 43 Health economic evidence profiles for review question: What is the optimal ratio of phosphate to amino acid in preterm and term babies who are receiving parenteral nutrition and neonatal care? ..................................... 43 Appendix J – Economic analysis .................................................................................. 44 Health economic analysis for review question: What is the optimal ratio of phosphate to amino acid in preterm and term babies who are receiving parenteral nutrition and neonatal care? .................................................... 44 Appendix K – Excluded studies .................................................................................... 45 Excluded clinical studies list for review question: What is the optimal ratio of phosphate to amino acid in preterm and term babies who are receiving parenteral nutrition and neonatal care? .................................................... 45 Clinical studies .................................................................................................... 45 Economic studies ................................................................................................ 55 Appendix L – Research recommendations ................................................................... 56 Research recommendations for review question: What is the optimal ratio of phosphate to amino acid in preterm and term babies who are receiving parenteral nutrition and neonatal care? .................................................... 56 Neonatal parenteral nutrition: evidence review for intravenous minerals DRAFT (February 2020) 5 FINAL IV minerals for preterm and term babies Intravenous minerals for preterm and term babies Review question What is the optimal ratio of phosphate to amino acid in preterm and term babies who are receiving parenteral nutrition and neonatal care? Introduction Babies who are receiving parenteral nutrition (PN) require an amino acid intake of at least 1.5 g/kg/day, in order to be in positive nitrogen balance. A greater intake of amino acids is recommended in order to allow for growth and tissue accretion. Phosphate is a key substrate for growth. If not supplied in sufficient quantities in an anabolic growth environment, bone will be utilised as a source of phosphate. The release of phosphate from bone results in release of calcium. Provision of amino acids without sufficient provision of phosphate may lead to hypophosphataemia and hypercalcaemia. It is therefore important to give babies receiving recommended intakes of amino acids in PN sufficient phosphate to allow for growth and to