Parenteral nutrition in infants and children

Quyen Pham MD (

Dr. Pham 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, 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 August 1, 2019; expires August 1, 2022

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 goal of optimal nutrition in the newborn period for premature infants, especially very low birth weight infants, is to achieve intrauterine growth rate.

 

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

 

• Full parenteral nutrition, including optimal fat intake, is needed for overall growth and maturation. Suboptimal fat intake during the postnatal period significantly affects brain growth (Bin-Nun et al 2019). 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. Total parenteral nutrition consists of water, dextrose, amino acids, intravenous fat, and micro- and macronutrients. 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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