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A Clinical Trial Assessing the Safety, Efficacy, and Delivery of Olive-Oil-Based Three-Chamber Bags for Parenteral Nutrition
Published on: September 20, 2019
Neonatology/Paediatrics - Guidelines on Parenteral Nutrition, Chapter 13
1Dept. of Pediatrics, McMaster University, Hamilton, Canada.
Insights
Parenteral nutrition (PN) in children presents unique challenges due to diverse patient needs and metabolic changes. Careful calculation and timely transition to enteral nutrition are crucial to prevent long-term health issues.
Area of Science:
- Pediatric Gastroenterology
- Clinical Nutrition
- Neonatology
Background:
- Parenteral nutrition (PN) implementation in pediatric patients is complex due to a wide age and weight range, from premature infants to adolescents.
- Metabolic and nutritional requirements vary significantly with age, maturity, and clinical condition, differing substantially from adult PN practices.
Purpose of the Study:
- To highlight the specialized challenges and considerations for administering parenteral nutrition in pediatric populations.
- To emphasize the importance of accurate calculation and timely enteral nutrition introduction in pediatric patients receiving PN.
Main Methods:
- Review of existing literature and clinical guidelines on pediatric parenteral nutrition.
- Analysis of age-specific fluid, nutrient, and energy requirements in neonates, infants, children, and adolescents.
Main Results:
- Pediatric patients, especially premature infants and neonates, have significantly higher fluid, nutrient, and energy needs per kg body weight compared to older children and adults.
- Accurate calculation of PN in neonates is essential, and gradual introduction of enteral nutrition is recommended to minimize PN-related side effects.
- Inadequate substrate intake during early infancy can lead to long-term metabolic programming and increased risk of illness later in life.
Conclusions:
- Parenteral nutrition in children requires tailored approaches considering age-related metabolic changes and specific clinical situations.
- Early and appropriate initiation of enteral nutrition is vital to mitigate risks associated with prolonged PN.
- Failure to meet energy and nutrient demands in children and adolescents necessitates timely consideration of PN within a week.
Abstract:
There are special challenges in implementing parenteral nutrition (PN) in paediatric patients, which arises from the wide range of patients, ranging from extremely premature infants up to teenagers weighing up to and over 100 kg, and their varying substrate requirements. Age and maturity-related changes of the metabolism and fluid and nutrient requirements must be taken into consideration along with the clinical situation during which PN is applied. The indication, the procedure as well as the intake of fluid and substrates are very different to that known in PN-practice in adult patients, e.g. the fluid, nutrient and energy needs of premature infants and newborns per kg body weight are markedly higher than of older paediatric and adult patients. Premature infants <35 weeks of pregnancy and most sick term infants usually require full or partial PN. In neonates the actual amount of PN administered must be calculated (not estimated). Enteral nutrition should be gradually introduced and should replace PN as quickly as possible in order to minimise any side-effects from exposure to PN. Inadequate substrate intake in early infancy can cause long-term detrimental effects in terms of metabolic programming of the risk of illness in later life. If energy and nutrient demands in children and adolescents cannot be met through enteral nutrition, partial or total PN should be considered within 7 days or less depending on the nutritional state and clinical conditions.
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