An Expert System for Parenteral Nutrition Composition of Newborn Infants

The Project
The System
The Team

The Project

The aim of the project was to develop an expert system representing the clinical and theoretical knowledge about the composition of parenteral nutrition solutions for newborn infants treated at neonatal intensive care units (NICUs).

Planning of an adequate nutritional support for maintaining the metabolic needs of sick newborn infants is time consuming, needs experts' knowledge and involves the risk of introducing possibly fatal errors. Recent systems used for composing parenteral nutrition solutions mainly support the calculation and the documentation process and cannot easily be adapted for neonates. Computerized expert system technology may help to develop time saving solutions to a given problem and to avoid errors within certain limits. We therefore developed an interactive expert system for calculating the composition of parenteral nutrition solutions (PNS) for newborn infants.

The knowledge base of the expert system consists of the rules for composing the PNS according to heuristic rules used at the cooperating NICU. Applying these rules, the daily fluids, electrolytes, vitamins, and nutritional requirements were calculated according to the estimated needs, the patient's body weight, the age, and the individual tolerance. The requirements were also corrected according to the daily measurements of serum electrolytes, triglycerides and protein if available. Glucose supply was adjusted depending on the type of venous access used (peripheral or central venous line), on the glucose tolerance and on the total fluid allowances. Finally, the PNS was reduced according to the proportion of oral feedings. The program works interactively asking for relevant data, calculating the PNS, and displaying the results. The physician has the choice to adjust calculated values according to special clinical requirements. The final output is a PNS schedule that can be used directly in the case history of neonates. Possible input and dosage errors are eliminated by methods of data validation using body weight and age dependent thresholds.

A knowledge acquisition module supports updating of thresholds, input of medication of new bypasses and new oral feeding products. Further, it allows neonatologists to keep VIE-PNN consistent with the prescription rules used at their clinic.

The System

The current version of VIE-PNN is 5.2. This version is implemented as a client/server application for clinical intranets and for the internet. The system uses an http-server (running cgi-scripts in Perl) and a standard browser (Netscape) on the client side. VIE-PNN 5.2 is used in the daily routine at two neonatological intensive care units at the Vienna University Hospital. During the last year of operation more than 2000 PNS sheets have been composed by VIE-PNN. These sheets are an integral part of the clinical patient record.

Versions 1 to 4 of VIE-PNN have been developed on an IBM compatible PC using different languages (expert system shells, C++). None of these previous versions got the required user acceptance. In contrast, the redesign as an HTML-application was highly accepted by the clinicians.

The following two demonstration pages show the resulting PNS of VIE-PNN 5.1 (in German):
Sample parenteral nutrition composition sheet
Overview of all PNS sheets of one patient

The Project Team

The project is a joint cooperation of the Department of Medical Cybernetics and Artificial Intelligence (IMKAI), the Austrian Research Institute for Artificial Intelligence (ÖFAI), and the Neonatal Intensive Care Unit (NICU) of the Department of Pediatrics of the University of Vienna:



Werner Horn (email:
WH, 22-Apr-2002