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Principles and practice of parenteral nutrition in the neonatal period
1Serviço de Pediatria, Universidade de Monash, Melburne, Austrália.
Insights
Parenteral nutrition is vital for critically ill infants, providing essential nutrients intravenously. Early enteral feeding complements parenteral nutrition, supporting gastrointestinal development and infant growth.
Area of Science:
- Neonatal intensive care
- Pediatric nutrition
- Clinical nutrition
Background:
- Parenteral nutrition (PN) is crucial for extremely preterm or critically ill infants before enteral feeding is established.
- Fluid intake, nitrogen, glucose, and fat requirements vary based on infant maturity and metabolic needs.
- Accurate delivery of minerals, trace elements, and multivitamins is essential.
Purpose of the Study:
- To outline the fundamental aspects of parenteral nutrition in neonatal intensive care.
- To detail the specific nutritional requirements for fluid, energy, and macronutrients.
- To highlight the importance of minimizing complications and integrating early enteral feeding.
Main Methods:
- Review of established guidelines and practices for parenteral nutrition in neonates.
- Calculation of fluid, energy, and nutrient requirements based on infant characteristics.
- Emphasis on monitoring and management to prevent complications.
Main Results:
- Specific ranges for fluid intake (60-150 ml/kg/d), nitrogen (30-35 mmol/kg/d), glucose (starting 6-8 g/kg/d, increasing to 18-20 g/kg/d), and fat (starting 1 g/kg/d, increasing to 3 g/kg/d) are defined.
- Energy intake recommendations are provided for maintenance (50 kcal/kg/d) and optimal growth (70 kcal/kg/d).
- Improved techniques have reduced catheter-related and metabolic complications.
Conclusions:
- Parenteral nutrition is a cornerstone of neonatal intensive care, with benefits outweighing risks when managed by expert teams.
- Careful administration of fluids, macronutrients, micronutrients, and energy is critical for infant outcomes.
- Early initiation of supplemental enteral feeding is vital for promoting gastrointestinal tract growth and development.
Abstract:
In extremely preterm or critically ill infants, the parenteral route for maintaining nutritional integrity has to be relied upon before successful transition to the enteral route of feeding is achieved. Parenteral nutrition is now a fundamental part of neonatal intensive care. Fluid intake volumes vary from 60-150 ml/kg/d, depending on maturity of the infant and environmental conditions influencing insensible water loss from the skin. Parenteral nitrogen requirements are 30-35 mmol/kg/d, equivalent to 3.0-3.5 mg/kg/d of amino acids. Hyperglycaemia during parenteral nutrition can be minimised by starting glucose infusion at a rate of 6-8 g/kg/d with progressive increase to 18-20 g/kg/d by 2-3 weeks after birth. Parenteral fat is introduced at 1 g/kg/d, gradually increasing to 3 g/kg/d, given as a continuous infusion. An energy intake of 50 kcal/kg/d is adequate to match ongoing expenditure but an additional energy intake of 70 kcal/kg/d is required to achieve optimal growth. Minerals and trace elements delivered with parenteral nutrition are calculated to meet in-utero accretion rates. Multivitamins available for parenteral use should also be included. Improved techniques for the preparation, administration and monitoring of parenteral nutrition have helped minimise catheter-related and metabolic complications. In neonatal intensive care units where appropriate medical, nursing, pharmacy and laboratory expertise are available, the potential benefits of parenteral nutrition outweigh its hazards. Nevertheless, early initiation of enteral feeding in small subnutritional quantities to supplement parenteral nutrition is of major importance to enhance the growth and development of the gastrointestinal tract.