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Standard parenteral nutrition (PN) is an integral part of neonatal intensive care in the UK. 1 However, there are variations in their utilisation, especially in extremely premature neonates. At our level 3 surgical unit in London, standardised, concentrated, additional macronutrients PN (SCAMP) is the standard PN of choice, but due to the constituents, a rapid increase in SCAMP administration may lead to hyperglycaemia and metabolic acidosis.2 Locally, the first incrementation for extremely premature neonates is recommended at least 96 hours post-initiation in order to reduce the instances of hyperglycaemia and metabolic acidosis.Aim The primary outcome of this audit was to assess if 100% of extremely premature neonates born at less than 25 weeks’ gestation received their first incrementation after 96 hours. The secondary outcomes were to determine the instances of hyperglycaemia and metabolic acidosis associated with the incrementation of SCAMP.Method Data was retrospectively collected from the electronic prescribing and medicines administration (EPMA) system over a 12-month period, from 01/07/2024 to 30/06/2025. Ethics approval was not required for this audit. Eligible patients included those born within the Trust, extremely premature, and received SCAMP during this period. Patients who met the inclusion criteria, but died in the first 96 hours of life or switched to bespoke PN were excluded. Data for secondary outcomes were obtained by reviewing results on EPMA records to determine whether local criteria for hyperglycaemia and metabolic acidosis were met.Results 181 patients received SCAMP during the data collection period. 15/181 (8.3%) met the criteria for inclusion in the audit. The mean gestational age at birth was 24+3/40 (range 23+1/40 to 24+6/40). SCAMP was incremented after 96 hours for 9/15 patients (60%) in accordance with local protocol, 6/15 patients (40%) incrementation occurred more rapidly within 48 hours of initiation.In secondary outcomes, 4/6 (67%) of rapidly incremented patients and 8/9 (89%) of protocol aligned incremented patients were hyperglycaemic (defined as two consecutive blood glucose measurements above 12mmol/L in the first 96 hours of life). 4/6 (67%) of rapidly incremented patients and 5/9 (55%) of protocol aligned incremented patients had significant metabolic acidosis (defined as a blood gas with a pH of less than 7.15 and a base excess of <-10 in the first 96 hours of life).Conclusion Whilst the majority of patients were incremented according to protocol, a significant number were rapidly increased, further teaching is required for the neonatal team to ensure that all extremely premature neonates receive SCAMP according to local protocol. Hyperglycaemia and metabolic acidosis can result from various factors in extreme prematurity, 3 but it is important to note that the majority of extremely premature neonates receiving SCAMP experienced hyperglycaemia. Lower rates of metabolic acidosis were observed among patients who received SCAMP incrementation in accordance with local protocol. The high rates of hyperglycaemia in all patients requires revision of local protocol to reduce glucose load in extremely premature neonates receiving SCAMP, and there should be discussion across the regional network to consider reducing the amount of glucose in SCAMP bags across London.References Burgess-Shannon J, Chehrazi M, Lanoue J, et al. Outcomes following the adoption of standard parenteral nutrition in preterm infants: a whole-population non-concurrent control study. Arch Dis Child Fetal Neonatal Ed 2024;109(6):616–621.Tertiary NICU Guideline, Prescribing and Monitoring Parenteral Nutrition (PN); [cited 2025 Jul 04]. Available from: http://www.clinibee.comLissauer T, Carroll W. Illustrated Textbook of Paediatrics, Chapter 11: Neonatal medicine; Sixth Ed. [2022]