Abstract

Neonates admitted to a Neonatal Intensive Care Unit (NICU) often need parenteral nutrition (PN) in combination with multiple intravenous medications. Typically, they have limited venous access points, increasing the risk of incompatibility reactions at Y-sites. These reactions, driven by physicochemical differences, can cause serious complications such as emboli and organ damage. Despite clinical importance, compatibility data specific to neonates remain limited, with most evidence derived from adult populations. This commentary critically appraises a systematic review by Gostyńska et al. (2024) (1). The review explores evidence on Y-site compatibility of PN and intravenous drugs in neonatal and pediatric patients, highlighting methodological limitations and variable study quality. The review’s authors found 56% compatibility among tested drugs, but stressed caution due to heterogeneous PN formulations and lipid emulsions impacting stability. The findings from the review should not be solely used for clinical decisions. There is a significant need for more comprehensive and systematic research to support safe clinical decision-making and reduce the risk of adverse events related to co-administration of PN and intravenous medications in neonates in NICU.