Total parenteral nutrition in malnourished infants with intractable diarrhea

Thirty-four infants (25 Inuit and 9 Caucasians) with protein-energy malnutrition and intractable diarrhea were treated with total parenteral nutrition (TNP) consisting of a casein hydrolysate, a soybean emulsion and dextrose. Initially peripheral veins were used in all the infants, and 22 were treated successfully without resort to a central venous catheter. The mean duration of treatment by the peripheral route was 29 days. Although mean energy intake and protein intake were high, weight gain was poor and growth continued at the prehospitalization percentiles. There were two deaths, both from complications of the use of central lines. Specific diagnoses were established for 7 of the 9 Caucasian infants but only 2 of the 25 Inuit infants. Concentrations of serum glutamic oxaloacetic transaminase (SGOT) were elevated in 80% of the patients at the time of admission, increased further in 82% when TPN was begun, but decreased towards normal before discharge in all patients. Eosinophilia was common during TPN. Liver biopsy in seven patients with elevated SGOT values showed eosinophilia, increased pigment in the Kupffer cells and slight lymphocytosis in the portal tract. Intercurrent infections occurred frequently and were often preceded by a short period of lipid intolerance or neutropenia, or both. Tolerance to lipids returned after the infections resolved. Thus, peripheral TPN is a safe and relatively simple method of providing adequate nutrition during episodes of diarrhea in malnourished infants.