Parenteral nutrition in infants and children

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.)
Pinkal Patel MD (Dr. Patel of Children’s Hospital of Georgia 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 August 15, 2017; expires August 15, 2020

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 has shown poor growth and adverse neurodevelopmental outcome.

 

• Studies now support that the use of amino acids intake of 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 acid) 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. 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 prevent CLABSI (central line associated blood stream infection.

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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