Enhancing Parenteral Nutrition Therapy for the Neonate

Abstract

The neonate receiving parenteral nutrition (PN) therapy requires a physiologically appropriate solution in quantity and quality given according to a timely, cost-effective strategy. Maintaining tissue integrity, metabolism, and growth in a neonate is challenging. To support infant growth and influence subsequent development requires critical timing for nutrition assessment and intervention. Providing amino acids to neonates has been shown to improve nitrogen balance, glucose metabolism, and amino acid profiles. In contrast, supplying the lipid emulsions (currently available in the United States) to provide essential fatty acids is not the optimal composition to help attenuate inflammation. Recent investigations with an omega-3 fish oil IV emulsion are promising, but there is need for further research and development. Complications from PN, however, remain problematic and include infection, hepatic dysfunction, and cholestasis. These complications in the neonate can affect morbidity and mortality, thus emphasizing the preference to provide early enteral feedings, as well as medication therapy to improve liver health and outcome. Potential strategies aimed at enhancing PN therapy in the neonate are highlighted in this review, and a summary of guidelines for practical management is included.

A double-blind, randomized clinical trial of the effect of ω-3 fatty acids on the oxidative stress of preterm neonates fed through parenteral nutrition

“…Enteral feeding was initiated as soon as possible, as it is considered extremely important for the preterm neonates (Valentine and Puthoff, 2007). However, the energy provided through oral feedings was o20% of the total energy intake for the trial period.…”

Prácticas de prescripción de nutrición parenteral neonatal en Portugal

“…En estas circunstancias, el 18-31% de las unidades británicas e irlandesas reducen la dosis de lípidos o la suspenden 5 . Hay varios nutrientes supuestamente implicados en la colestasis asociada a la NP, especialmente las dosis excesivas de glucosa 36 , ciertos aminoácidos aromáticos 37 y fitoesteroles contenidos en las emulsiones lipídicas de origen vegetal 38 . En caso de colestasis, el 70% de las unidades portuguesas opta por reducir la dosis de aminoácidos, el 17% reduce la glucosa y el 68% reduce la dosis de lípidos.…”

“…La mayoría de las unidades portuguesas calcula la osmolaridad de la solución hidrosoluble, usando la ecuación validada para soluciones de NP neonatal 39 recomendada por el Consenso Nacional 6 y por otros autores 15,18,36 . Cuando este estudio fue realizado todavía no había comercializadas bolsas standard de NP neonatal 40 , motivo por el que todas las unidades portuguesas prescribían NP individualizada.…”

Parenteral Nutrition in the Newborn: Associated Disorders and Nutritional Aspects

“…On should, however, to consider the use of NP as an emergency feature, which imposes significant side effects to the neonate and also involves significant hospital costs. PN standardized solutions usually consist of dextrose, as a source of carbohydrate; essential and non-essential amino acids, thus mimicking protein intake orally; fat emulsions, providing essential polyunsaturated lipids and fatty acids as an energy source; carnitine to promote the oxidation of long chain fatty acids; sodium, calcium and phosphorus, essential electrolytes; vitamins and trace elements, which can vary according to symptoms or procedures to which the infant is subjected [64]. Table 3 presents a brief example of neonate progression through PN and possible modifications according to specific needs and disorders.…”

“…Table 3 presents a brief example of neonate progression through PN and possible modifications according to specific needs and disorders. [30], [46], [47], [63] and [64] One of the main complications related to the use of PN are those associated with the liver, about 40-60% of infant patients undergoing PN for long periods develop PNALD. Among the common liver onsets are: hepatic steatosis, cholestasis, deficiency of nutrients and diseases associated with the gallbladder.…”