Evidence map›Paper›PMID 40133525›Full record

ArticleNature medicine2025

AI-guided precision parenteral nutrition for neonatal intensive care units.

Thanaphong Phongpreecha, Marc Ghanem, Jonathan D Reiss, Tomiko T Oskotsky, Samson J Mataraso, Davide De Francesco, S Momsen Reincke, Camilo Espinosa, Philip Chung, Taryn Ng and 36 more

Erratum issued Registry-linked trialAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Nature medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. It is linked to trial NCT07712198 (Artificial Intelligence-Based Prediction of Sarcopenia Risk in Intensive Care Unit Patients With Intracranial Pathology), which is not on this map. Cited by 18 papers.

0numbers the graph read from it
0cells of the map it votes in
18citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT07712198 recruitingnot on this mapstarted 2026, after this paper: background citation

Artificial Intelligence-Based Prediction of Sarcopenia Risk in Intensive Care Unit Patients With Intracranial Pathology

TypeobservationalSponsorTrabzon Kanuni Education and Research HospitalRan2026 to 2026Enrolled100ConditionsIntracerebral Hemorrhage, Subarachnoid Hemorrhage, Subdural Hematoma, Epidural Hematoma, Ischemic Stroke, Brain NeoplasmsArmsProspective Observational Assessment
3 · Its place in the literature

Who cites it

18 citing papers in PubMed.

  1. Analysis of factors driving variations in neonatal parenteral nutrition over a decade: A retrospective study.Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition · 2026
    Article
  2. Article
  3. Review
  4. Article
  5. A lesson from the past and the future of artificial intelligence in medical decision-making.Journal of perinatology : official journal of the California Perinatal Association · 2026
    Review
  6. Article
  7. Article
  8. Review
  9. Article
  10. Review
  11. Artificial intelligence-guided nutritional therapy in the ICU.Current opinion in clinical nutrition and metabolic care · 2026
    Review
  12. Review
  13. Article
  14. Review
  15. Review
  16. Article
  17. Article
  18. Review
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

46 authors.

Thanaphong Phongpreecha *Department of Anesthesiology, Pain and Perioperative Medicine, Stanford University, Stanford, CA, USA.ORCID http://orcid.org/0000-0001-9245-6686
Marc Ghanem *Department of Anesthesiology, Pain and Perioperative Medicine, Stanford University, Stanford, CA, USA.ORCID http://orcid.org/0000-0002-7479-7994
Jonathan D Reiss *Department of Pediatrics, Stanford University, Stanford, CA, USA.ORCID http://orcid.org/0000-0003-1460-8570
Tomiko T Oskotsky *Bakar Computational Health Sciences Institute, University of California, San Francisco, CA, USA.ORCID http://orcid.org/0000-0001-7393-5120
Samson J MatarasoDepartment of Anesthesiology, Pain and Perioperative Medicine, Stanford University, Stanford, CA, USA.
Davide De FrancescoDepartment of Anesthesiology, Pain and Perioperative Medicine, Stanford University, Stanford, CA, USA.
S Momsen ReinckeDepartment of Anesthesiology, Pain and Perioperative Medicine, Stanford University, Stanford, CA, USA.ORCID http://orcid.org/0000-0002-8132-3527
Camilo EspinosaDepartment of Anesthesiology, Pain and Perioperative Medicine, Stanford University, Stanford, CA, USA.ORCID http://orcid.org/0000-0003-1630-1564
Philip ChungDepartment of Anesthesiology, Pain and Perioperative Medicine, Stanford University, Stanford, CA, USA.ORCID http://orcid.org/0000-0002-1194-7510
Taryn NgDepartment of Pharmacy, Lucile Packard Children's Hospital, Palo Alto, CA, USA.
Jean M CostelloBakar Computational Health Sciences Institute, University of California, San Francisco, CA, USA.
Jennifer A SequoiaDepartment of Pediatrics, Stanford University, Stanford, CA, USA.ORCID http://orcid.org/0000-0002-5354-6870
Sheila RazdanDepartment of Pediatrics, Stanford University, Stanford, CA, USA.ORCID http://orcid.org/0000-0002-4137-7635
Feng XieDepartment of Anesthesiology, Pain and Perioperative Medicine, Stanford University, Stanford, CA, USA.
Eloise BersonDepartment of Anesthesiology, Pain and Perioperative Medicine, Stanford University, Stanford, CA, USA.ORCID http://orcid.org/0000-0003-1046-125X
Yeasul KimDepartment of Anesthesiology, Pain and Perioperative Medicine, Stanford University, Stanford, CA, USA.
David SeongDepartment of Anesthesiology, Pain and Perioperative Medicine, Stanford University, Stanford, CA, USA.ORCID http://orcid.org/0000-0002-8980-5731
May Y SzetoDepartment of Pediatrics, Stanford University, Stanford, CA, USA.
Faith MyersDepartment of Pediatrics, Stanford University, Stanford, CA, USA.ORCID http://orcid.org/0000-0002-5073-5465
Hannah GuDepartment of Pediatrics, Stanford University, Stanford, CA, USA.
John FeisterDepartment of Pediatrics, Stanford University, Stanford, CA, USA.
Courtney P VerscajDepartment of Pediatrics, Stanford University, Stanford, CA, USA.
Laura A RoseDepartment of Pediatrics, Stanford University, Stanford, CA, USA.
Lucas W Y SinDepartment of Anesthesiology, Pain and Perioperative Medicine, Stanford University, Stanford, CA, USA.
Boris OskotskyBakar Computational Health Sciences Institute, University of California, San Francisco, CA, USA.ORCID http://orcid.org/0000-0002-9364-7051
Jacquelyn RogerBakar Computational Health Sciences Institute, University of California, San Francisco, CA, USA.ORCID http://orcid.org/0000-0003-1823-0421
Chi-Hung ShuDepartment of Anesthesiology, Pain and Perioperative Medicine, Stanford University, Stanford, CA, USA.ORCID http://orcid.org/0009-0009-3486-8856
Sayane ShomeDepartment of Anesthesiology, Pain and Perioperative Medicine, Stanford University, Stanford, CA, USA.
Liu K YangDepartment of Anesthesiology, Pain and Perioperative Medicine, Stanford University, Stanford, CA, USA.ORCID http://orcid.org/0000-0002-3205-3663
Yuqi TanDepartment of Pathology, Stanford University, Stanford, CA, USA.
Steven LevitteDivision of Pediatric Gastroenterology, Hepatology and Nutrition, Stanford University, Stanford, CA, USA.
Ronald J WongDepartment of Pediatrics, Stanford University, Stanford, CA, USA.ORCID http://orcid.org/0000-0003-1205-6936
Brice GaudillièreDepartment of Anesthesiology, Pain and Perioperative Medicine, Stanford University, Stanford, CA, USA.ORCID http://orcid.org/0000-0002-3475-5706
Martin S AngstDepartment of Anesthesiology, Pain and Perioperative Medicine, Stanford University, Stanford, CA, USA.ORCID http://orcid.org/0000-0002-1550-8136
Thomas J MontineDepartment of Pathology, Stanford University, Stanford, CA, USA.ORCID http://orcid.org/0000-0002-1346-2728
John A KernerDepartment of Pediatrics, Stanford University, Stanford, CA, USA.ORCID http://orcid.org/0000-0002-0380-6048
Roberta L KellerDepartment of Pediatrics, University of California, San Francisco, CA, USA.ORCID http://orcid.org/0000-0003-0743-8470
Gary M ShawDepartment of Pediatrics, Stanford University, Stanford, CA, USA.
Karl G SylvesterDepartment of Pediatrics, Stanford University, Stanford, CA, USA.
Janene FuerchDepartment of Pediatrics, Stanford University, Stanford, CA, USA.
Valerie ChockDepartment of Pediatrics, Stanford University, Stanford, CA, USA.
Shabnam GaskariDepartment of Pharmacy, Lucile Packard Children's Hospital, Palo Alto, CA, USA.
David K StevensonDepartment of Pediatrics, Stanford University, Stanford, CA, USA.
Marina SirotaBakar Computational Health Sciences Institute, University of California, San Francisco, CA, USA.ORCID http://orcid.org/0000-0002-7246-6083
Lawrence S PrinceDepartment of Pediatrics, Stanford University, Stanford, CA, USA.ORCID http://orcid.org/0000-0002-7010-4548
Nima AghaeepourDepartment of Anesthesiology, Pain and Perioperative Medicine, Stanford University, Stanford, CA, USA. naghaeep@stanford.edu.ORCID http://orcid.org/0000-0002-6117-8764

Funding

Clinical and Translational Science InstituteUL1TR001872 · NCATS · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI COLLARD, HAROLD R, JACOBY, VANESSA · 2016 to 2025
$112.1M
Research in Anesthesia Training Program (ReAP)T32GM089626 · NIGMS · STANFORD UNIVERSITY · PI Vivianne L Tawfik · 2010 to 2026
$5.2M
An AI-driven total parenteral nutrition platform for cost-effective and scientifically personalized nutrition for premature newbornsR42HD115517 · NICHD · TAKEOFF41, INC. · PI Nima Aghaeepour, Thanaphong Phongpreecha · 2024 to 2026
$2.3M
Machine Learning for Integrative Modeling of the Immune System in Clinical SettingsR35GM138353 · NIGMS · STANFORD UNIVERSITY · PI AGHAEEPOUR, NIMA · 2020 to 2024
$2.2M
Mechanisms Regulating Inflammatory Phenotypes in Fetal MacrophagesR01HD113215 · NICHD · STANFORD UNIVERSITY · PI PRINCE, LAWRENCE S · 2023 to 2025
$1.2M
NCATS NIH HHS UL1 TR001872NICHD NIH HHS R01 HD113215NICHD NIH HHS R42 HD115517NIGMS NIH HHS R35 GM138353NIGMS NIH HHS T32 GM089626U.S. Department of Health & Human Services | NIH | Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) R42HD115517U.S. Department of Health & Human Services | NIH | National Center for Advancing Translational Sciences (NCATS) UL1TR001872U.S. Department of Health & Human Services | NIH | National Institute of General Medical Sciences (NIGMS) R35GM138353
6 · The paper itself

Abstract

One in ten neonates are admitted to neonatal intensive care units, highlighting the need for precise interventions. However, the application of artificial intelligence (AI) in guiding neonatal care remains underexplored. Total parenteral nutrition (TPN) is a life-saving treatment for preterm neonates; however, implementation of the therapy in its current form is subjective, error-prone and resource-consuming. Here, we developed TPN2.0-a data-driven approach that optimizes and standardizes TPN using information collected routinely in electronic health records. We assembled a decade of TPN compositions (79,790 orders; 5,913 patients) at Stanford to train TPN2.0. In addition to internal validation, we also validated our model in an external cohort (63,273 orders; 3,417 patients) from a second hospital. Our algorithm identified 15 TPN formulas that can enable a precision-medicine approach (Pearson's R = 0.94 compared to experts), increasing safety and potentially reducing cost. A blinded study (n = 192) revealed that physicians rated TPN2.0 higher than current best practice. In patients with high disagreement between the actual prescriptions and TPN2.0, standard prescriptions were associated with increased morbidities (for example, odds ratio = 3.33; P value = 0.0007 for necrotizing enterocolitis), while TPN2.0 recommendations were linked to reduced risk. Finally, we demonstrated that TPN2.0 employing a transformer architecture enabled guideline-adhering, physician-in-the-loop recommendations that allow collaboration between the care team and AI.

Indexed as

Artificial IntelligenceIntensive Care Units, NeonatalParenteral NutritionParenteral Nutrition, TotalPrecision MedicineAlgorithmsElectronic Health RecordsFemaleHumansInfant, NewbornInfant, PrematureMale

Identifiers

PMID40133525
PMCPMC12176641

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.