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Parenteral nutrition in infants and children

Authors
Robert D Baker, MD, PhD
Susan S Baker, MD, PhD
Jessica Briggs, RD
Georgina Bojczuk, RD, CSP
Section Editor
Kathleen J Motil, MD, PhD
Deputy Editor
Alison G Hoppin, MD

INTRODUCTION

Safe, long-term parenteral nutrition (PN) was first described in infants in 1972 [1]. Since that time, it has contributed to the survival of many children. Soon after the development of PN, however, it became clear that serious problems were commonly associated with its use. Changes in the gastrointestinal luminal contents, gastrointestinal function, metabolic abnormalities, cholestasis, liver compromise, and blood stream infections were reported. This dampened enthusiasm and led, in some instances, to recommendations against its use [2]. The indication for pediatric PN is limited to those children whose gastrointestinal tract is inadequate to support normal growth and development.

Enteral nutrition should be used instead of or in addition to PN whenever possible. PN should be used only when it is not possible to meet nutritional requirements via the gastrointestinal tract or when there is bowel dysfunction resulting in inability to tolerate enteral nutrition for a prolonged time: 1 to 3 days in infants, 4 to 5 days for children and adolescents, and 7 to 10 days in adults. Enteral nutrition has several physiological advantages as compared with PN and generally has fewer complications. Indications and management of enteral nutrition for infants and children are discussed in a separate topic review. (See "Overview of enteral nutrition in infants and children".)

Premature infants have a number of unique characteristics that affect the implementation and safety of PN. These considerations are discussed in a separate topic review. (See "Parenteral nutrition in premature infants".)

PHYSIOLOGY

Parenteral nutrition (PN) is inherently nonphysiological because nutrients are delivered directly to the systemic circulation, bypassing the gastrointestinal (GI) tract and the portal circulation, which are the usual routes of nutrient entry. Nutrients delivered intravenously through PN avoid the "first pass" effect of passage through the liver. The targets for nutrient intake administered via PN are designed to approximate the nutrient content that reaches the systemic circulation in enterally fed patients.

The effect of PN on physiology can be placed into three broad categories:

                        

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Literature review current through: Nov 2016. | This topic last updated: Thu Apr 28 00:00:00 GMT+00:00 2016.
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