Neonatal parenteral nutrition provides fluids and nutrients intravenously for infants who cannot eat or maintain adequate nutrition. It can be partial or total, but carries risks such as infection and liver complications. Premature babies are more likely to require it due to immature gastrointestinal tracts. Other medical conditions may also require it.
Neonatal parenteral nutrition supplies need the necessary fluids and nutrients for babies who cannot eat or maintain adequate nutrition in other ways. Partial parenteral nutrition (PPN) supplements oral intake, and total parenteral nutrition (TPN) provides all the daily nutritional needs of an infant. Neonatal parenteral nutrition feeds a newborn baby intravenously, through an intravenous (IV) line that delivers nutrition directly through the bloodstream rather than through the baby’s gastrointestinal tract.
The total parenteral nutrition solution includes water, amino acids, energy, fatty acids, and minerals and vitamins. The nutritional solution is modified based on the baby’s laboratory results, hypermetabolism, or diagnosed disorder. The solution is infused intravenously and continues for several hours each day.
Neonatal parenteral nutrition is often prescribed in a neonatal intensive care unit, but it can also be used at home or in another medical center setting. Solutions used for parenteral nutrition are concentrated, so treatment usually requires a central venous catheter. When a baby’s gastrointestinal (GI) tract is immature, intravenous feeding may be necessary to maintain neonatal health. Parenteral nutrition is generally not recommended for infants, or even adults, with an intact and functional gastrointestinal tract. Medical complications are more likely with intravenous nutrition, but it is often the only feasible option for babies with conditions that require complete bowel rest.
Although neonatal parenteral nutrition provides the nutrition a baby needs to grow and thrive, complications are a risk. The IV line increases the possibility of infection; Babies treated with partial or full parenteral nutrition are carefully monitored and often treated with antibiotics if an infection is detected or even suspected. Premature babies are sometimes at risk of hyperglycemia, elevated blood sugar, or may experience elevated triglyceride levels if their liver functions are not optimal. Prolonged treatment with total parenteral nutrition also risks cholestasis, which affects the flow of bile from the baby’s liver. Without treatment, cholestasis can lead to jaundice.
Partial parenteral nutrition is sometimes used to supplement the normal feeding of a baby with health problems. Small enteral feedings can be used in conjunction with parenteral nutrition treatment to stimulate metabolic function in the baby’s system. The combination of treatments is carefully prescribed, monitored and adjusted, depending on the progress of the baby.
Babies born prematurely are more likely than full-term babies to require neonatal parenteral nutrition, because the gastrointestinal tract of a premature baby is immature. The gastrointestinal tract is fully formed at 20 weeks pregnant, but is not yet fully functional. The normal intestinal contractions, known as peristalsis, that move food through the digestive system are not functional until about week 29, and the enzymes necessary for milk digestion are often not adequately produced by a premature baby. The physical coordination a baby needs to suck and swallow usually doesn’t develop until the 34th week of pregnancy.
Other situations or medical conditions may indicate the need for neonatal parenteral nutrition. A baby breathing with the help of a ventilator, for example, cannot be breastfed or bottle-fed. A baby with ulcerative colitis, Crohn’s disease, or an obstructed intestine may require parenteral nutrition to rest the intestines and allow the digestive system to heal. Some gastrointestinal disorders in infants, such as prolonged diarrhea or certain abnormalities in the gastrointestinal tract, may also require the use of parenteral nutrition.
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