Neonatal Parenteral Nutrition
Neonatal Parenteral Nutrition
Key Concepts
- Parenteral nutrition (PN) is vital for providing nutrients to neonates who cannot receive adequate enteral nutrition
- Essential for preventing protein-energy malnutrition and promoting growth in premature infants
- Must be initiated within 24-48 hours of birth in very low birth weight infants
- Requires careful monitoring and adjustment based on individual needs
Pathophysiological Basis
Premature infants have:
- Limited energy reserves
- High metabolic demands
- Immature gastrointestinal systems
- Increased risk of necrotizing enterocolitis
Primary Indications
- Prematurity (≤32 weeks gestation)
- Very low birth weight (<1500g)
- Gastrointestinal anomalies
- Respiratory distress requiring ventilation
- Hemodynamic instability
Nutritional Assessment
- Daily weight measurements
- Length and head circumference weekly
- Serum proteins (albumin, prealbumin)
- Nitrogen balance studies
- Growth velocity monitoring
Essential Components
Protein (Amino Acids)
- Initial dose: 2-3 g/kg/day
- Target: 3.5-4 g/kg/day
- Start within first 24 hours
- Essential for preventing catabolism
Carbohydrates (Dextrose)
- Initial: 4-6 mg/kg/min
- Maximum: 12-14 mg/kg/min
- Monitor blood glucose q4-6h
- Target glucose: 80-150 mg/dL
Lipids
- Start: 0.5-1 g/kg/day
- Advance by 0.5-1 g/kg/day
- Maximum: 3-4 g/kg/day
- Essential fatty acids required within 72h
Electrolytes & Minerals
- Sodium: 2-4 mEq/kg/day
- Potassium: 2-3 mEq/kg/day
- Calcium: 40-50 mg/kg/day
- Phosphorus: 40-50 mg/kg/day
- Magnesium: 3-7 mg/kg/day
Trace Elements
- Zinc: 400 μg/kg/day
- Copper: 20 μg/kg/day
- Selenium: 2 μg/kg/day
- Chromium: 0.2 μg/kg/day
Vitamins
- Fat-soluble (A, D, E, K)
- Water-soluble (B complex, C)
- Start within first 24-48 hours
Monitoring Parameters
Daily Monitoring
- Fluid balance
- Blood glucose
- Vital signs
- Weight
- Urine output
Laboratory Monitoring
- Electrolytes, BUN, Creatinine (2-3x/week)
- Calcium, Phosphorus, Magnesium (2x/week)
- Liver function tests (weekly)
- Triglycerides (2x/week while advancing lipids)
- Blood gases (as needed)
Complications
Metabolic
- Hyperglycemia
- Hypoglycemia
- Electrolyte imbalances
- Metabolic bone disease
- Cholestasis
Technical
- Central line infections
- Catheter thrombosis
- Extravasation injuries
- Air embolism
Clinical Practice Guidelines
Initiation
- Start within 24h of birth in VLBW infants
- Begin with amino acids 2-3 g/kg/day
- Start lipids at 0.5-1 g/kg/day
- Initial glucose infusion rate 4-6 mg/kg/min
Advancement
- Increase amino acids by 0.5-1 g/kg/day
- Advance lipids by 0.5-1 g/kg/day
- Increase glucose by 1-2 mg/kg/min daily
Transition to Enteral Feeds
- Begin trophic feeds when clinically stable
- Advance feeds based on tolerance
- Reduce PN as enteral feeds increase
- Consider discontinuing PN when enteral feeds reach 120 mL/kg/day
Disclaimer
The notes provided on Pediatime are generated from online resources and AI sources and have been carefully checked for accuracy. However, these notes are not intended to replace standard textbooks. They are designed to serve as a quick review and revision tool for medical students and professionals, and to aid in theory exam preparation. For comprehensive learning, please refer to recommended textbooks and guidelines.
