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[Parenteral nutrition in critically ill newborns]
Insights
Parenteral nutrition using amino acids and glucose safely supported critically ill newborns when oral feeding was not possible. While risks like sepsis exist, metabolic changes were minimal, suggesting its utility in infant care.
Area of Science:
- Neonatalogy
- Pediatric critical care
- Clinical nutrition
Background:
- Critically ill newborns often require nutritional support when oral feeding is impossible.
- Intractable diarrhea and surgical conditions present significant nutritional challenges in neonates.
Purpose of the Study:
- To evaluate the safety and efficacy of parenteral alimentation in critically ill newborns.
- To assess metabolic alterations and complications associated with parenteral nutrition in this population.
Main Methods:
- Administered a 5% crystalline amino acids (AA) and glucose solution to nine critically ill newborns.
- Provided 120 kcal/kg/24 hours of parenteral nutrition for 3 to 15 days.
- Monitored metabolic status, acid-base balance, and serum electrolytes (sodium, potassium).
Main Results:
- Six out of nine infants recovered, gained weight, and were discharged.
- Three infants died due to septicemia, pneumonia, and pulmonary infarcts.
- Minimal metabolic alterations observed; acid-base status and electrolytes remained stable or normalized.
Conclusions:
- Parenteral alimentation is a useful intervention for critically ill newborns unable to feed orally, despite potential risks like septicemia.
- Metabolic complications are generally minimal, but long-term studies are needed.
- Current parenteral nutrition solutions may require optimization for neonatal physiology.
Abstract:
In nine critically ill newborns, five of them with intractable diarrhea and four surgical patients, we administered a 5% crystalline aminoacids solution (AA) and glucose in sufficient amount to provide 120 cal times kg. in 24 hours. Six of them recovered after receiving parenteral alimentation for 3 to 15 days, gained weight during or after treatment and were discharged from the hospital in good conditions. Three died, one of them presented septicemia and two pneumonia and pulmonary infarcts. The solution used generated few metabolic alterations, the acid-base status remained within normal range and there were not important changes in the sodium and potassium serum concentrations. On the contrary, children with hyponatremia and hypokalemia at the beginning of the treatment, normalized these constants within the first hours, as diarrhea ceased. The most frequent complications were infiltrations and reaction of the surrounding tissue of the catheterized vein and local skin infection. Only one patient died of septicemia, possibly caused by this proceeding. In summary, parenteral alimentation though not free from risk, seems to be a useful proceeding when oral feeding is impossible or inadvisable. The utmost danger is septicemia. Metabolic changes are minimal and they do not mean a risk for child's life; nevertheless, there is a need for long term studies to bring up definite conclusions. The solutions in actual use are probably not the most physiological for the newborn. It is necessary to adequate them according to the new advances made on child nourishment during his first days of life.