Parenteral Protein Decision Support System Improves Protein Delivery in Preterm Infants: A Randomized Clinical Trial

Mhd Wael Alrifai, David P. Mulherin, Stuart T. Weinberg, Li Wang, Christoph U. Lehmann

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Background: Management of neonatal parenteral protein intake for preterm infants is challenging and requires daily modifications of the dose to account for the infant's postnatal age, birth weight, current weight, and the volume and protein concentration of concurrent enteral nutrition. The objective of this study was to create and evaluate the Parenteral Protein Calculator (PPC), a clinical decision support system to improve the accuracy of protein intake for preterm infants who require parenteral nutrition (PN). Materials and Methods: We integrated the PPC into the computerized provider order entry system and tested it in a randomized controlled trial (routine or PPC). Infants were eligible if they were ≤3 days old, had a birth weight ≤1500 g, and had no inborn error of metabolism. The primary outcome was the appropriate total protein intake, defined as target protein dose ±0.5 g/kg. Results: We randomly allocated 42 infants for 221 PN days in the control group and 211 in the PPC group. Total protein intake in the PPC group was more accurate as compared with the control group (appropriate protein dosing: odds ratio = 5.8; 95% CI, 2.7–12.4). Absolute deviation from protein target was 0.41 g/kg (0.24–0.58) lower in the PPC group. Conclusion: The PPC improved appropriate protein dosing for premature infants receiving PN. Further studies are needed to test whether clinical decision support systems will reduce uremia and improve growth and to replicate similar findings in the cases of other PN nutrients.

Original languageEnglish (US)
Pages (from-to)219-224
Number of pages6
JournalJournal of Parenteral and Enteral Nutrition
Issue number1
StatePublished - Jan 2018
Externally publishedYes


  • clinical decision support system
  • medication dosing
  • parenteral nutrition
  • protein intake
  • uremia

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Nutrition and Dietetics


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