Parenteral nutrition in infants and children

Ann Simonin MD (Dr. Simonin of Children’s Hospital of Georgia 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, Georgia Regents University, has no relevant financial relationships to disclose.)
Bernard Maria MD, editor. (Dr. Maria of Icahn School of Medicine at Mount Sinai and Director of Pediatric Neurology and Developmental Medicine at Goryeb Children)
Originally released July 25, 2003; last updated October 10, 2016; expires October 10, 2019

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

 

• The ultimate goal in nutrition for premature infants is to provide optimal nutrition throughout the hospitalization and beyond, including aggressive parenteral and enteral nutrition.

 

• Contrary to previous recommendations and some current practice, starting amino acids at 2.5 to 3.5 g/kg/day as early as day 1 has been shown to prevent negative nitrogen balance and is safe and efficacious.

 

• Fish oil emulsions (rich in long chain omega-3 fatty acid) providing n-3 and n-6 fatty acids show great promise over safflower or soybean oil in promoting brain development, modulating immune and inflammatory response, and protecting the liver once parenteral nutrition-associated liver disease (PNALD) sets in. Providing enteral feeding, if possible, is 1 of the most effective treatments of parenteral nutrition-associated liver disease.

 

• A specialized team of physicians (including the surgical team), dieticians, nurses, pharmacists, and ancillary staff trained in parenteral nutrition are of paramount importance to providing optimal and safe parenteral nutrition while decreasing time to full enteral feeds.

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. Nutrition tailored to each patient reduces the effects of metabolic demands and improves response to medical and surgical therapy (Kleinman 2009).

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