[Current status of parenteral feeding with fat emulsions. Clinical experience in children]

Area of Science:

• Pediatric Gastroenterology
• Nutritional Support
• Metabolic Disorders

Context:

• Total parenteral nutrition (TPN) with lipid emulsions has been a standard regimen in Europe for over a decade for treating pediatric diseases.
• Childhood necessitates high energy intake, which can be adequately met through the administration of fat emulsions.
• Intravenous (IV) administration of lipid emulsions requires continuous infusion and a dosage of up to 2 g/kg/day.

Purpose:

• To highlight the established role and essential considerations for using lipid emulsions in pediatric parenteral nutrition.
• To emphasize the importance of continuous infusion and appropriate dosage for effective energy delivery.
• To outline monitoring parameters and contraindications for safe administration.

Summary:

• Lipid emulsions are vital for providing adequate energy in pediatric TPN.
• Continuous IV infusion, up to 2 g/kg/day, is recommended.
• Daily serum triglyceride monitoring (target <150-200 mg/dl) is essential for assessing fat elimination.
• Contraindications include severe shock, coagulation issues, and specific lipid metabolism disorders like Apolipoprotein-C-II-deficiency.
• When administered with strict adherence to protocols and sterile precautions, TPN with fat emulsions is a safe and effective therapeutic tool in pediatrics, aside from potential catheter-related issues.

Impact:

• Ensures adequate energy delivery for growth and development in pediatric patients requiring TPN.
• Provides a well-established and experienced therapeutic option for managing pediatric diseases.
• Minimizes risks associated with TPN by defining clear indications, contraindications, and monitoring guidelines.