Parenteral nutrition in infants and children

Amy Thompson MD (

Dr. Thompson of Children’s Hospital of Georgia, Augusta University, has no relevant financial relationships to disclose.

)
Pinkal Patel MD (Dr. Patel of Children’s Hospital of Georgia has no relevant financial relationships to disclose.)
Jatinder Bhatia MD (Dr. Bhatia, Division Chief of Neonatology at the Medical College of Georgia, Augusta University Medical Center, has no relevant financial relationships to disclose.)
Bernard L Maria MD, editor. (Dr. Maria of Thomas Jefferson University has no relevant financial relationships to disclose.)
Originally released July 25, 2003; last updated September 21, 2018; expires September 21, 2021

Overview

In this article, the authors categorize types of parenteral nutrition, summarize and update currently recognized metabolic and nutrient requirements, and review complications that are associated with parenteral nutrition. Research updates in the field are also presented.

Key points

 

• Providing optimal nutrition is of foremost important in the immediate newborn period and throughout infancy, as undernutrition is associated with poor growth and adverse neurodevelopmental outcome.

 

• Studies now demonstrate that the use of amino acids up to 3 to 3.5 g/kg per day from the first day of life is both safe and effective.

 

• Fish oil emulsions (rich in long chain omega-3 fatty acids) providing n-3 and n-6 fatty acids show great promise over soybean oil in promoting brain development, modulating immune and inflammatory response, and protecting the liver once parenteral nutrition-associated liver disease (PNALD) sets in with a recent pediatric study showing significant decreases in total bile acids, transaminases and both total and direct bilirubin in addition to decreases in inflammatory indicators such as tumor necrosis factor-alpha, C-reactive protein, and white blood cell counts (Zhang et al 2018). However, providing enteral feeding, if possible, is the most effective strategy for prevention and treatment of parenteral nutrition-associated liver disease.

 

• A multidisciplinary team approach is crucial in providing optimal and safe parenteral nutrition while decreasing time to full enteral feeds and also to prevent CLABSI (central line associated blood stream infection) as prompt removal of central lines has been recognized and recommended as a major contributing factor in reducing CLABSI rates in NICUs (Mobley and Bizzarro 2017).

Historical note and terminology

Parenteral nutrition entails providing nutrients via an intravenous route when some or all nutrition cannot be provided via the intestinal tract. As the sole source of nutrition, parenteral nutrition is called total parenteral nutrition. This label has been generally overused to mean any parenteral nutrition; however, depending on the severity of disease, parenteral nutrition can be supplemented by enteral nutrition to varying degrees—this should be called partial (or supplemental) parenteral nutrition.

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