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Description:
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The interactive support system VIE-PNN (Vienna Expert System for Parenteral Nutrition of Neonates) has been developed for calculating the composition of parenteral nutrition solutions (PNS) for neonates at intensive care units.
The planning of an adequate nutrition support for meeting the metabolic requirements of sick neonates is a tedious time consuming calculation, needs practical expert knowledge and involves the risk of introducing possibly fatal errors. The aims of VIE-PNN are to avoid errors within certain limits, to save time, and to keep data for further statistical analysis. The daily fluids, electrolytes, vitamins, and nutritional requirements are calculated according to the estimated needs, the patients body weight, the age, and its clinical conditions (e.g. specific diseases, past and present day blood analysis). The requirements are also corrected according to the daily measurement of serum electrolytes, triglycerides and proteins if available. Glucose supply is adjusted depending on the type of venous access used (peripheral or central line), on the glucose tolerance and on the total fluid allowance. In the absence of real values, the system uses default values and estimation strategies. The physician has the option of accepting or adjusting proposed values on the screen. Finally, the PNS may be reduced according to the proportion of oral feedings. The final output is a PNS schedule form, which can be used directly in the case history of neonates. A knowledge acquisition module supports the input of new bypasses and new oral feeding products.
VIE-PNN is in routine clinical use at the Neonatal Intensive Care Unit (NICU) of the Department of Pediatrics of the University of Vienna, Austria since 1996.
Evaluation: a technical, empirical and subjective evaluation of the system was performed.
Results: the mean time needed for calculating a PNS was 2.4 (VIE-PNN) vs. 7.1 minutes (Human). Expert review detected errors or omissions in 22 % (VIE-PNN) vs. 56% (human) of the PNS prescription. All errors in the VIE-PNN based PNS were related to interactively changed values. Analyzing the 5539 stored PNS, 4 out of 16 parameters were interactively changed by the physician.
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