Parenteral Nutrition in Infants and Children

Abstract

Parenteral nutrition (PN) enables patients with intestinal failure to receive their nutritional requirements even when they are unable to ingest and absorb sufficient fluid and nutrients via the gastrointestinal tract for normal growth and development. PN is a sterile mixture of nutrients formulated to remain stable in solution for a sufficient period of time for infusion into the bloodstream. PN can be provided as “off the shelf” standard bags that can be stored for several weeks or even months, often at room temperature or as individually formulated regimes that may be compounded with a 48–72 h expiry or in certain specialist pharmacies with a 2–3 week expiry that enables a patient to be discharged home on treatment.

PN may be used for a few days in an acutely unwell hospitalized patient, for example, after gastrointestinal surgery, during chemotherapy or for many months, years, or throughout childhood in the child with chronic irreversible intestinal failure. Complications include fluid and electrolyte imbalances, other metabolic disorders , bloodstream infections, liver damage, and thromboembolic problems. Complications are minimized when PN treatment is managed by a multidisciplinary nutrition team that includes a dietitian, pharmacist specialist nurses, and doctor.

Over the past 10 years, the prognosis for patients treated with PN has hugely improved with a reduction in complications related to the PN itself. Prognosis is related to the underlying disease causing the intestinal failure .

Newer practices that have improved outcomes include, interventional radiological techniques that minimize damage to blood vessels when inserting the central venous catheters to administer the PN, improvements in the PN composition and in particular the use of a variety of lipid sources and reduction in infection rates with the use of 2 % chlorhexidene for cleaning the catheter connection sites as well as taurolidine CVC locks to help prevent septicemia.

Outcomes of treatment are as follows: (1) recovery of intestinal functions with successful reintroduction of enteral nutrition and, if at all possible, a normal diet, (2) survival on treatment: (a) long-term PN or, (b) after intestinal transplant, or (3) death on PN either due to the underlying disease or less commonly, PN itself.

In summary, PN is life-saving hi-tech treatment with potentially life-threatening complications that should be managed by a specialist multidisciplinary team to enable the best chance of a good outcome and long-term health for patient. The outcome is continuing to improve.