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Parenteral nutrition in premature infants

Richard J Schanler, MD
Section Editor
Steven A Abrams, MD
Deputy Editor
Alison G Hoppin, MD


The nutritional needs of premature infants are usually dependent upon parenteral nutrition (PN) during early postnatal life, especially for very low birth weight (VLBW) infants (birth weight of less than 1500 g). In these infants, full enteral feedings are generally delayed because of the severity of medical problems associated with prematurity, such as immature lung function (which often requires endotracheal intubation and mechanical ventilation), hypothermia, infections, and hypotension. In addition, early enteral feeds are also delayed because of concerns that aggressive feeding may lead to complications, such as feeding intolerance or necrotizing enterocolitis. As a result, the nutritional requirements of VLBW infants are rarely met by enteral feeds in the first two weeks after birth [1]. (See "Short-term complications of the preterm infant".)

PN (sometimes referred to as hyperalimentation) in the premature infant, including its composition, will be reviewed here. The approach to enteral nutrition in premature infants is discussed separately. (See "Approach to enteral nutrition in the premature infant".)


There is growing evidence that inadequate nutrition in the first weeks of life of premature infants results in growth failure that is often difficult to correct and may lead to permanent detrimental effects [2-4]. There are also potential risks and complications from PN so this should be used judiciously. PN is essential for the very low birth weight (VLBW) infant, but more mature, and larger, premature infants may not require PN, because these infants usually tolerate early enteral nutrition. (See "Growth management in preterm infants".)

The early use of adequate PN minimizes weight loss [5,6], improves growth and neurodevelopmental outcome, and appears to reduce the risk of mortality and later adverse outcomes, such as necrotizing enterocolitis and bronchopulmonary dysplasia [7,8]. Increased protein and energy intakes in the first week of life also are associated with improved neurodevelopmental outcome. In one study of 148 extremely low birth weight (ELBW) survivors (birth weight below 1000 g), increasing caloric and protein intakes during the first week of life were associated with increases in the Bayley Mental Development Index (MDI) scores at 18 months of corrected age [9].  

Infants born at the beginning of the third trimester of pregnancy often are growth-restricted because of decreased intrauterine nutrient deposition [10].


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Literature review current through: Sep 2016. | This topic last updated: Aug 30, 2016.
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