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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
Practice of parenteral nutrition in VLBW and ELBW infants
Nicholas D Embleton1, Karen Simmer
1Newcastle Neonatal Service, Newcastle Hospitals NHS Foundation Trust, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.
Insights
Parenteral nutrition (PN) supports preterm infants lacking nutrients but lacks long-term benefit evidence. Careful administration and monitoring are crucial to mitigate risks like sepsis and metabolic issues.
Area of Science:
- Neonatalogy
- Pediatric Nutrition
- Intensive Care Medicine
Background:
- Preterm infants have limited nutrient stores and poor growth, risking neurodevelopmental outcomes.
- Parenteral nutrition (PN) is essential for neonates unable to tolerate enteral feeding, such as those with necrotizing enterocolitis (NEC).
- While PN offers short-term benefits, long-term evidence in neonates is limited.
Purpose of the Study:
- To review the compositional, practical, and risk aspects of neonatal parenteral nutrition.
- To highlight recommended nutrient intakes for preterm infants receiving PN.
- To discuss the administration, complications, and quality control measures for PN in neonates.
Main Methods:
- Review of current literature and guidelines on neonatal parenteral nutrition.
- Analysis of recommended nutrient compositions (protein, lipids, carbohydrates, micronutrients).
- Discussion of PN administration routes (peripheral vs. central venous access) and associated risks.
Main Results:
- Recommended intakes: 3.5-4 g/kg/day protein, 3-4 g/kg/day lipids, 90-110 kcal/kg/day energy.
- Standardized PN may be inadequate due to fluid restrictions, especially for amino acids.
- PN is associated with increased sepsis, mechanical complications, metabolic derangements, and aluminum toxicity.
Conclusions:
- Neonatal PN requires careful attention to micronutrients and administration.
- Effective PN necessitates strict quality control, asepsis, and multidisciplinary teams.
- Further controlled trials are needed to establish long-term benefits of PN in neonates.
Abstract:
Preterm infants have limited nutrient stores at birth, take time to establish enteral feeding, are at risk of accumulating significant nutrient deficits, and frequently suffer poor growth - all risks which are associated with poorer neurodevelopmental outcome. Parenteral nutrition (PN) provides a relatively safe means of meeting nutrient intakes, and is widely used in preterm infants in the initial period after birth. PN is also important for infants who may not tolerate enteral feeds such as those with congenital or acquired gut disorders such as necrotizing enterocolitis (NEC). PN is associated with several short-term benefits, but clear evidence of long-term benefit from controlled trials in neonates is lacking. There are many compositional, practical and risk aspects involved in neonatal PN. In most preterm infants, authorities recommend amino acid intakes approximating to 3.5-4 g/kg/day of protein, lipid intakes of 3-4 g/kg/day and sufficient carbohydrate to meet a total energy intake of 90-110 kcal/kg/day. Where PN is the sole source of nutrition, careful attention to micronutrient requirements is necessary. PN may be administered via peripheral venous access if the osmolality allows, but in many cases requires central venous access. Standardized PN bags may meet the nutrient needs of many preterm infants over the first few days, although restricted fluid intakes mean that many receive inadequate amounts especially of amino acids. PN can be associated with increased rates of bacterial and fungal sepsis, mechanical complications related to venous line placement and miscalculations and errors in manufacture, supply and administration. PN is also associated with metabolic derangements, hepatic dysfunction, and risks contamination with toxins such as aluminum, which enter the solutions during manufacturing. PN must only be administered in units with good quality control, strict asepsis in manufacture and administration and multidisciplinary teams focused on nutrient needs and intakes.
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