National Institute for Health and Care Excellence Draft for consultation Neonatal parenteral nutrition [D3] Lipids NICE guideline tbc Evidence reviews September 2019 Draft for Consultation These evidence reviews were developed by the National Guideline Alliance which is part of the Royal College of Obstetricians and Gynaecologists DRAFT FOR CONSULTATION 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. 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ISBN: DRAFT FOR CONSULTATION Individual constituents in parenteral nutrition for preterm and term babies - lipids Contents Intravenous lipids ................................................................................................................ 6 Review questions ........................................................................................................... 6 Introduction ........................................................................................................... 6 Summary of the protocol ....................................................................................... 6 Clinical evidence ................................................................................................... 7 Summary of clinical studies included in the evidence review ................................. 7 Quality assessment of clinical outcomes included in the evidence review ........... 16 Economic evidence ............................................................................................. 16 Summary of studies included in the economic evidence review ........................... 17 Economic model .................................................................................................. 17 Evidence statements ........................................................................................... 17 The committee’s discussion of the evidence ........................................................ 25 References .......................................................................................................... 27 Appendices ........................................................................................................................ 30 Appendix A – Review protocols .................................................................................... 30 Review protocol for review question: What is the optimal target for lipid dosage in preterm and term babies who are receiving parenteral nutrition and neonatal care? and What is the optimal way (starting dose and approach to increment, if employed) to achieve that? .............................. 30 Appendix B – Literature search strategies .................................................................... 36 Literature search strategies for review question: What is the optimal target for lipid dosage in preterm and term babies who are receiving parenteral nutrition and neonatal care? and What is the optimal way (starting dose and approach to increment, if employed) to achieve that? ....................... 36 Appendix C – Clinical evidence study selection ............................................................ 47 Clinical study selection for review question: What is the optimal target for lipid dosage in preterm and term babies who are receiving parenteral nutrition and neonatal care? and What is the optimal way (starting dose and approach to increment, if employed) to achieve that? ....................... 47 Appendix D – Clinical evidence tables .......................................................................... 48 Clinical evidence tables for review question: What is the optimal target for lipid dosage in preterm and term babies who are receiving parenteral nutrition and neonatal care? and What is the optimal way (starting dose and approach to increment, if employed) to achieve that? ....................... 48 Appendix E – Forest plots............................................................................................. 86 Forest plots for review question: What is the optimal target for lipid dosage in preterm and term babies who are receiving parenteral nutrition and neonatal care? and What is the optimal way (starting dose and approach to increment, if employed) to achieve that? .............................. 86 Appendix F – GRADE tables ........................................................................................ 89 GRADE tables for review question: What is the optimal target for lipid dosage in preterm and term babies who are receiving parenteral nutrition and neonatal care? and What is the optimal way (starting dose and approach to increment, if employed) to achieve that? .............................. 89 4 DRAFT FOR CONSULTATION Individual constituents in parenteral nutrition for preterm and term babies - lipids Appendix G – Economic evidence study selection ...................................................... 103 Economic evidence study selection for review questions: What is the optimal target for lipid dosage in preterm and term babies who are receiving parenteral nutrition and neonatal care? and What is the optimal way (starting dose and approach to increment, if employed) to achieve that? ....................................................................................................... 103 Appendix H – Economic evidence tables .................................................................... 104 Economic evidence tables for review questions: What is the optimal target for lipid dosage in preterm and term babies who are receiving parenteral nutrition and neonatal care? and What is the optimal way (starting dose and approach to increment, if employed) to achieve that? ..................... 104 Appendix I – Health economic evidence profiles ......................................................... 105 Economic evidence study selection for review questions: What is the optimal target for lipid dosage in preterm and term babies who are receiving parenteral nutrition and neonatal care? and What is the optimal way (starting dose and approach to increment, if employed) to achieve that? ....................................................................................................... 105 Appendix J – Health economic analysis ...................................................................... 107 Economic analysis for review questions: What is the optimal target for lipid dosage in preterm and term babies who are receiving parenteral nutrition and neonatal care? and What is the optimal way (starting dose and approach to increment, if employed) to achieve that? ..................... 107 Appendix K – Excluded studies .................................................................................. 108 Excluded studies for review question: What is the optimal target for lipid dosage in preterm and term babies who are receiving parenteral nutrition and neonatal care? and What is the optimal way (starting dose and approach to increment, if employed) to achieve that? ..................... 108 Clinical studies .................................................................................................. 108 Economic studies .............................................................................................. 138 Appendix L – Research recommendations ................................................................. 139 Research recommendations for review question: What is the optimal target for lipid dosage in preterm and term babies who are receiving parenteral nutrition and neonatal care? and What is the optimal way (starting dose and approach to increment, if employed) to achieve that? ..................... 139 5 DRAFT FOR CONSULTATION Individual constituents in parenteral nutrition for preterm and term babies - lipids 1 Intravenous lipids 2 Review questions 3 This evidence report contains information on two questions conducted as one review relating 4 to the individual constituents (lipids) in parenteral nutrition for preterm and term babies. 5 D3a. What is the optimal target for lipid dosage in preterm and term babies who are 6 receiving parenteral