Total parenteral nutrition in low-birth-weight neonates with complicated surgical disorders; effects and difficulties

Twenty low-birth-weight, surgical neonates were given total parenteral nutrition (TPN). They were divided into two groups according to birth-weights. Group A consisted of 8 patients weighing less than 2,000 gm, and group B consisted of 12 patients weight between 2,000 and 2,500 gm. The infusate of TPN consisted of 15% glucose and 3% amino acids solution, and 10% fat emulsion. The dosage administered was usually 120 ml/kg/day in the amino acid glucose solution and 15 ml/kg/day in the fat emulsion, but varied depending on the clinical condition of the patients. The duration of parenteral nutrition was from 3 to 76 days with an average of 34.3 days. Four patients in group A survived. Three of the four who died had already been in severe septicemia due to the original disease before the initiation of parenteral nutrition. Ten in group B survived. The intake of 500 mg/kg/day of nitrogen as crystalline amino acids and calories of more than 80 Cal./dg/day produced a gain of body weight and a positive nitrogen balance. However, the weight gain in the patients in group A lagged behind. Furthermore, severe hepatic dysfunction was induced in four in group A. We conclude that TPN will improve the general condition, weight gain and positive nitrogen balance, even in low-birth-weight neonates with complicated surgical disorders.