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Intravenous nutrition for the pediatric patient
1Division of Pediatric Surgery, Mayo Clinic, Rochester, MN 55905.
Insights
Parenteral nutrition (PN) is vital for children unable to eat but carries risks. Careful management by a specialized team ensures safe and effective nutritional support for pediatric patients.
Area of Science:
- Pediatric Nutrition
- Clinical Nutrition
- Intensive Care Medicine
Background:
- Pediatric nutritional needs differ from adults due to growth and immaturity.
- Parenteral nutrition (PN) is a critical therapy for pediatric patients with gastrointestinal dysfunction.
- PN is associated with significant metabolic, mechanical, and infectious complications.
Purpose of the Study:
- To outline the indications, requirements, and protocols for pediatric parenteral nutrition.
- To emphasize the importance of a multidisciplinary team in managing PN.
- To highlight the role of technological advancements in home PN.
Main Methods:
- Selection of PN candidates based on defined indications and nutritional assessment.
- Calculation of fluid, electrolyte, vitamin, trace element, and caloric requirements.
- Administration of total calories with a nonprotein-calorie to gram-nitrogen ratio of 150-250:1.
- Utilizing central venous access for long-term PN and peripheral veins for short-term support.
- Adherence to established protocols for PN initiation and monitoring.
Main Results:
- Optimized PN management minimizes complications and maximizes cost-effectiveness.
- An interdisciplinary team approach is crucial for successful PN outcomes.
- Advancements in intravenous pumps enable safe and effective home parenteral nutrition for select pediatric patients.
Conclusions:
- Pediatric parenteral nutrition requires specialized knowledge and careful management.
- A multidisciplinary team approach is essential for safe and effective PN.
- Home parenteral nutrition is a viable option for selected pediatric patients due to technological progress.
Abstract:
Nutritional management of infants and children differs from that of adults because of the extra requirements for growth and the limitations of physiological immaturity. Although parenteral nutrition (PN) is an accepted practice and a potentially life-saving therapy for pediatric patients who cannot be fed through their gastrointestinal tract, it is associated with the risk of serious metabolic, mechanical, and infectious complications. Candidates for PN should be selected according to well-defined indications, with initial nutritional assessment and with careful attention given to fluid, electrolyte, vitamin, trace element, and caloric requirements. Total calories should be administered so that the nonprotein-calorie to gram-nitrogen ratio is in the range of 150 to 250:1. Although short-term supplemental nutritional support can be administered through a peripheral vein, long-term total PN is best delivered by central venous access. PN should be initiated and monitored in accordance with well-established protocols. The lowest complication rate and highest cost-effectiveness are achieved by an interdisciplinary team that includes one or more nurses, dietitians, pharmacists, and physicians. The development of safe, reliable, and miniaturized intravenous pumps with built-in monitors has made home parenteral nutrition possible and desirable in selected patients.