INFANT PARENTAL NUTRITION

INFANT PARENTAL NUTRITION

It may become mandatory to resort to parental nutrition in the following life-threatening situations in which enteral feeding has failed to establish or central feeding is not possible for prolonged periods:

1. ELBW babies (<1000g).
2. LBW babies unlikely to attain full enteral nutrition by day 5 for some associated problem such as intractable diarrhea, necrotizing enterocolitis, surgically correctable GI anomaly (omphalocele, gastroschisis, tracheoesophageal fistula, malrotation with volvus, diaphragmatic hernia, etc.), extensive bowel resection.

This regimen provides adequate fluids and electrolytes, energy (from glucose, protein and lipids), amino acids and vitamins and micronutrients for sustained growth of the LBW babies. With this method, providing  around 100kcal/kg/24 hours, a weight gain of 15 g/kg/24 hours is likely to be attained in the first week.

Parenteral nutrition may be carried out employing an indwelling central venous catheter (per cutaneous or surgically-placed) or through a peripheral vein.

Complication of Parenteral nutrition and remedial measures

Complication                                            Action Recommended

Catheter-related Complications                  Aseptic preparation of the infusate                

Sepsis/septicemia(usually from                    Appropriate antibiotics Removal

Coagulasenegative staphylococcus)            of line if sepsis persists

Thrombosis

Extravasation of fluid

Accidental dislodgement of catheter

Metabolic Complications                            Biochemical and physiologic monitoring

Hyperglycemia

Azotemia

Nephrocalcinosis

Hyperlipidemia

Hypoxemia

Hyperammonemia

Cholestatic jaundice

Liver disease

Metabolic bone disease