The Indian Journal of Pediatrics

, Volume 50, Issue 2, pp 195–208 | Cite as

Parenteral nutrition in the neonate

  • J. Bhatia
Perinatal Medicine


Parenteral nutrition has become an integral part of the support of the neonate who is either unable to receive or tolerate enteral feeding. The nutrient requirements for basal metabolism and growth can be provided by the infusion of a mixture of amino acids, glucose, lipids and other additives. By these means, growth can be promoted in infants who would otherwise be susceptible to problems associated with malnutrition. Careful assessment for the need for parenteral nutrition and monitoring during its administration may reduce the incidence of various complications associated with its use. Requirements of various nutrients, modes of delivery and suggested monitoring schedules are discussed.

Key words

Parenteral nutrition 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Helfrick FW, Abelson NM: Intravenous feeding of a complete diet in a child: Report of a case. J Pediatr 25:400, 1944CrossRefGoogle Scholar
  2. 2.
    Dudrick SJ, Wilmore DW, Vars HM et al: Long-term parenteral nutrition with growth, development, and positive nitrogen balance. Surgery 64:134, 1968PubMedGoogle Scholar
  3. 3.
    Dudrick SJ, Wilmore DW, Vars HM et al: Can intravenous feeding as the sole means of nutrition support growth in the child and restore weight loss, in an adult: An affirmative answer. Ann Surg 169:974, 1969PubMedCrossRefGoogle Scholar
  4. 4.
    American Academy of Pediatrics Committee on Nutrition: Pediatric Nutrition Handbook, 1979Google Scholar
  5. 5.
    Oh W: Fluid and electrolyte management. In Avery GB (ed):Neonatology, pathophysiology and management of the newborn. 2nd ed. JB Lippincott Co., Philadelphia 1981, p 649Google Scholar
  6. 6.
    Bell FF, Oh W: Fluid and electrolyte balance in very low birth weight infants. Clin Perinatol 6:139, 1979PubMedGoogle Scholar
  7. 7.
    Bell EF, Warburton D, Stonestreet BS et al: Effect of fluid administration on the development of symptomatic patent, ductus arteriosus and congestive heart failure in premature infants. N Engl J Med 302:598, 1980PubMedCrossRefGoogle Scholar
  8. 8.
    Bell EF, Warburton D, Stonestreet BS et al: High-volume fluid intake predisposes premature infants to necrotising enterocolitis (Letter). Lancet ii (8133):90, 1979CrossRefGoogle Scholar
  9. 9.
    Brown ER, Stark A, Sosenko I et al.: Bronchopulmonary dysplasia: Possible relationship to pulmonary edema. J Pediatr 92:982, 1978PubMedCrossRefGoogle Scholar
  10. 10.
    Hooper JMD, Evans IWJ and Stapleton T: Resting pulmonary water loss in the newborn infant. Pediatrics 13:206, 1954PubMedGoogle Scholar
  11. 11.
    Hey EN, Katz G: Evaporative water loss in the newborn bady. J Physiol (Lond) 200:605, 1969Google Scholar
  12. 12.
    Bell EF, Neidich GA, Cashore WJ et al.: Combined effect of radiant warmer and phototherapy on insensible water loss in low-birth-weight infants. J Pediatr 94:810, 1979PubMedCrossRefGoogle Scholar
  13. 13.
    Wu PYK, Hodgman JE: Insensible water loss in preterm infants: Changes with postnatal development and non-ionizing rediant energy. Pediatrics 54:704, 1974PubMedGoogle Scholar
  14. 14.
    Williams PR, Oh W: Effects of radiant warmer on insensible water loss in newborn infants. Am J Dis Child 128:511, 1974PubMedGoogle Scholar
  15. 15.
    Oh W, Karecki H: Phototherapy and insensible water loss in the newborn infant. Am J Dis Child 124:230, 1972PubMedGoogle Scholar
  16. 16.
    Zweymuller E, Preining O: The insensible water loss in the newborn infant. Acta Pediatr Scand (Suppl) 205, 1970Google Scholar
  17. 17.
    Sladen A, Laver MB, Pontoppidan H: Pulmonary complications and water retention in prolonged mechanical ventilation. New Engl J Med 279;448, 1968PubMedCrossRefGoogle Scholar
  18. 18.
    Gett PM, Jones ES, Shepherd GF: Pulmonary edema associated with sodium retention during ventilator treatment. Br J Anaesth 42:460, 1971CrossRefGoogle Scholar
  19. 19.
    Edelman CM, Jr., Spitzer A: The maturing kidney. J Pediatr 75:509, 1969CrossRefGoogle Scholar
  20. 20.
    Arant BS Jr: Development patterns of renal functional maturation compared in the human neonate. J Pediatr 92:705, 1978PubMedCrossRefGoogle Scholar
  21. 21.
    Edelman CM, Jr, Barnett HL, Stark H et al: A standardized test of renal concentrating capacity in children. Am J Dis Child 114:639, 1967Google Scholar
  22. 22.
    Ziegler EE, Biga RL, Fomon SJ: Nutritional requirements of the premature infant. In Susking RM (ed).Textbook of Pediatric Nutrition. Raven Press, New York, 1981, p 29Google Scholar
  23. 23.
    Cashore WJ, Sedaghtian MR, Usher RH: Nutritional supplements with intravenously administered lipid, protein hydrolysate, and glucose in small premature infants. Pediatrics 36:8, 1975Google Scholar
  24. 24.
    Coran AG: The long-term total intravenous feeding of infants using peripheral veins. J Pediatr Surg 8:801, 1973PubMedCrossRefGoogle Scholar
  25. 25.
    Coran AG: Total intravenous feeding of infants and children without the use of a central venous catheter. Am Surg 179:445, 1974Google Scholar
  26. 26.
    Sinclair J, Driscolt J, Jr, Heird W et al.: Supportive management of the sick neonate: Parenteral calories, water electrolytes. Pediatr Clin North Am 17:863, 1970PubMedGoogle Scholar
  27. 27.
    Shils ME: Guidelines for total parenteral nutrition. JAMA 220:1721, 1972PubMedCrossRefGoogle Scholar
  28. 28.
    Christensen HM, Lynch EL, Powers JH: The conjugated, non-protein amino acids of plasma. III. Peptidemia and hyperpeptiduria as a result of the intravenous administration of partially hydrolyzed casein (Amigen). J Biol Chem 156:649, 1946Google Scholar
  29. 29.
    Quinby GE, Nowak MM, Andrews BF: Parenteral nutrition in the neonate. Clin Perinatol 2:59, 1975PubMedGoogle Scholar
  30. 30.
    Raiha N: Biochemical basis for nutritional management of pretern infants. Pediatrics 53:147, 1974PubMedGoogle Scholar
  31. 31.
    Sturman JA, Gaull G, Raina NCR: Absence of cystathionase in human fetal liver: Is cystine essential? Science 169:74, 1970PubMedCrossRefGoogle Scholar
  32. 32.
    Synderman SE, Prose PH, Holt LE: Histidine essential aminoacid for infant. Am J Dis Child 98:459, 1959Google Scholar
  33. 33.
    Synderman SE: Amino acid requirements. In Winters RW and Hasselmeyer EG (eds).Intravenous nutrition in the high risk infant. John Wiley and Sons, New York, 1875. p 205Google Scholar
  34. 34.
    Jurgens P, Dolif D: Experimental results of parenteral nutrition with amino acids.In Parenteral Nutrition (ed), Wilkinson AW. Edinburg Churchill, Livingstone, p 77, 1972Google Scholar
  35. 35.
    Gaull GE, Rassin DK, Niels CR et al: Milk protein qnantity and quality in low-birth-weight infants. J Pediatr 90:348, 1977PubMedCrossRefGoogle Scholar
  36. 36.
    Zlotkin SH, Bryan HM, Anderson GH: Cysteine supplementation to cysteine free intravenous feeding regimens in newborn infants. Am J Clin Nutr 34:914, 1911Google Scholar
  37. 37.
    Alvear D, Somers L: Parenteral nutrition in seriously ill neonates. Am J Surg 127:696, 1974PubMedCrossRefGoogle Scholar
  38. 38.
    Anderson GH, Patel DG, Jeejeebhoy KN: Design and evaluation by nitrogen and blood aminograms of an amino acid mixture for total parenteral nutrition of adults with gastrointestinal disease. J Clin Invest 53:904, 1974PubMedCrossRefGoogle Scholar
  39. 39.
    Heird WC, Anderson TL: Nutrition, body fluids, and acid-base homeostasis. In:Neonatal-Perinatal Medicine. Diseases of the Fetus and Infant. (eds), Fanaroff AA and Martin RJ 3rd ed., CV Mosby Company, St. Louis, Toronto, London, 1983, p 302Google Scholar
  40. 40.
    Seashore JH, Seashore MR: Protein requirements of infants receiving total parenteral nutrition. J Pediatr Surg 11:645, 1976PubMedCrossRefGoogle Scholar
  41. 41.
    Dale G: Biochemical consequences of intravenous nutrition in the newborn. Adv Clin Chem 19:207, 1977PubMedGoogle Scholar
  42. 42.
    Heird WC, Anderson TL: Nutritional requirements and methods of feeding low birth weight infants. Curr Probl Pediatr 7:1, 1977PubMedCrossRefGoogle Scholar
  43. 43.
    Ghadimi H, Abaci F, Kumar S et al: Biochemical aspects of intravenous alimentation. Pediatrics 48:955, 1971PubMedGoogle Scholar
  44. 44.
    Johnson JR, Albuitton WL, Sunshine P: Hyperammonemia accompanying parenteral nutrition in newborn infants. J Pediatr 81:154, 1972PubMedCrossRefGoogle Scholar
  45. 45.
    Heird WC, Dell RB, Driscoll JM et al: Metabolic acidosis resulting from intravenous alimentation mixtures containing synthetic amino acids. N Engl J Med 287: 943, 1972PubMedCrossRefGoogle Scholar
  46. 46.
    Dudrick SJ, MacFady BV, VanBuren CT et al: Parenteral hyperalimentation: Metabolic problems and solutions. Ann Surg 176: 259, 1972PubMedCrossRefGoogle Scholar
  47. 47.
    Dak G, Pander-Brick M, Wagget J et al: Plasma amino acid changes in the postsurgical newborn during intravenous nutrition with a synthetic amino acid solution, J Pediatr Surg 11: 17, 1976CrossRefGoogle Scholar
  48. 48.
    Vileisis RA, Inwood RJ, Hunt CE: Prospective controlled study of parenteral nutrition associated with cholestatic jaundice: Effect of protein intake. J Pediatr 96: 893, 1980PubMedCrossRefGoogle Scholar
  49. 49.
    Goldman HI, Liebman OB, Freudenthal R et al: Effects of early dietary protein in low-birth-weight infants: Evaluation at 3 years of age. J Pediatr 78: 126, 1971PubMedCrossRefGoogle Scholar
  50. 50.
    Heird WC, Nicholson JF, Driscoll JM Jr, et al: Hyperammonemia resulting from intravenous alimentation using a mixture of synthetic L-amino acids: A preliminary report. J pediatr 81: 162; 1972PubMedCrossRefGoogle Scholar
  51. 51.
    Fahey JL, Nathans D, Rairigh D: Effect of L-arginine on elevated blood ammonia in man. Am J Med 23: 860, 1957PubMedCrossRefGoogle Scholar
  52. 52.
    Schoefl, GI: The ultrastructure of chylomicra and of particles in an artificial fat emulsion. Proc Royal Soc 169: 147, 1968.Google Scholar
  53. 53.
    Lorch VL, Lay SA: Parenteral alimentation in the neonate. Pediatr Clin North Am 24: 547, 1977PubMedGoogle Scholar
  54. 54.
    Rossner S: Studies on an intravenous fat tolerance test. Acta Medica Scand (Suppl) 564: 1, 1973Google Scholar
  55. 55.
    Bryan H, Shennan A, Griffin E et al: Intralipid—Its rational use in parenteral nutrition of the newb. Ern: Pediatrics 58: 787, 1976Google Scholar
  56. 56.
    Eiller RM, Takada Y, Carreras T et al: Serum intralipid levels in neonates during parenteral nutrition: The relationship to gestational age. J Pediatr Surg 15: 405, 1980CrossRefGoogle Scholar
  57. 57.
    Andrew G, Chan G, Schiff D: Lipid metabolism in the neonate. I. The effect of intralipid infusion on plasma triglyceride and free fatty acid concentration in the neonate. J Pediatr 88: 273, 1976PubMedCrossRefGoogle Scholar
  58. 58.
    Gustavsson A, Kjelimer I, Olegard R et al: Nutrition in low birth weight infants. Acta Pediatr Scand 61: 149, 1972CrossRefGoogle Scholar
  59. 59.
    Kwiterovick PO: Neonatal screening for hyperlipidemia. Pediatrics 53: 455, 1974Google Scholar
  60. 60.
    Oreene HL, Hazlett D, Demaree R: Relationship between intralipid induced hyperlipidemia and pulmonary function. Am J Clin Nutr 29: 127, 1976Google Scholar
  61. 61.
    Sundstrom G, Zauner CW, Arborelius M: Decrease in pulmonary diffusing capacity during lipid infusion in healthy men. J Appl Physiol 34: 816, 1973PubMedGoogle Scholar
  62. 62.
    Wilmore DW, Moylan JA, Helmkamp GM, et al: Clinical evaluation of a 10 per cent intravenous fat emulsion for parental nutrition in thermally injured patients. Ann Surg 178: 503, 1973PubMedCrossRefGoogle Scholar
  63. 63.
    Pereira GR, Fox WW, Stanley CA et al: Decreased oxygenation and hyperlipemia during fat infusions in premature infants. Pediatrics 66: 26, 1980Google Scholar
  64. 64.
    Andrew G, Chan G, Schiff D: Lipid metabolism in the neonate. II. The effect of intralipid on bilirubin binding in vitro and in vivo. J Pediatr 88: 279, 1976PubMedCrossRefGoogle Scholar
  65. 65.
    Thiessen H, Jacobson J, Broderson TL: Displacement of albumin bound bilirubin by fatty acids. Acta Pediatr Scand 61: 285, 1972CrossRefGoogle Scholar
  66. 66.
    Schreiner RL, Glick MR, Nordschow GD et al: An evaluation of methods to monitor infants receiving intravenous lipids. J Pediatr 94: 197, 1979PubMedCrossRefGoogle Scholar
  67. 67.
    Recammended Daily Allowances, ed 9. Food and Nutrition Board of the National Research Council, National Academy of Sciences, 1980Google Scholar
  68. 68.
    Holman RT: Function and biologic activities of essential fatty acids in man. In Meng HC. Wilmore DW (eds): Fat Emulsions in Parenteral Nutrition. American Medical Association, Chicago, p 5, 1976Google Scholar
  69. 69.
    Sanders TAB, Naismith DJ: Conflicting roles of polyunsaturated fatty acids. Lancet i: 654, 1980CrossRefGoogle Scholar
  70. 70.
    Friedman Z, Dannon A, Stahlman MT et al: Rapid onset of essential fatty acid deficiency in the newborn. Pediatr 58: 640, 1976Google Scholar
  71. 71.
    Postuma R, Pease PWB, Watts R et al: Essential fatty acid deficiency in infants receiving parenteral nutrition. J Pediatr Surg 13: 393, 1978PubMedGoogle Scholar
  72. 72.
    Tashiro T, Ogata H, Yokoyama H et al: The effect of fat emulsion (Intralipid)on essential fatty acid deficiency in infants receiving intravenous alimentation. J Pediatr Surg 11: 505, 1976PubMedCrossRefGoogle Scholar
  73. 73.
    O'Neill JA: Jr, Meng HC, Caldwell MD et al: Metabolic evaluation of a synthetic amino acid mixture for parenteral nutrition in infants and children. J Pediatr Surg 11: 979, 1976PubMedCrossRefGoogle Scholar
  74. 74.
    Goodgame JT, Lowry SF, Brennan MF: Essential fatty-acid deficiency in total parenteral nutrition: Time course of development and suggestions for therapy. Surg 84: 271, 1978Google Scholar
  75. 75.
    Bhatia J, Mims LC, Roesel RA: The effect of phototherapy on amino acid solutions containing multivitamins. J Pediatr 96: 284, 1980PubMedCrossRefGoogle Scholar
  76. 76.
    Bhatia J, Stegink LD, Ziegler EE: Riboflavin enhances photooxidation of amino acids, JPEN (In press)Google Scholar
  77. 77.
    Sheldon GF, Petersen SR, Sanders R: Hepatic dysfunction during hyperalimentation. Arch Surg 113: 504, 1978PubMedGoogle Scholar
  78. 78.
    Grant JP, Cox CE, Kleinman LM et al: Serum hepatic enzyme and bilirubin elevations during parenteral nutrition. Surg Gynecol Obstet 145: 573, 1970Google Scholar
  79. 79.
    Richardson TJ, Sgoutas D: Essential fatty acid deficiency in four adult patients during total parenteral nutrition. Am J Clin Nutr 28: 258, 1975PubMedGoogle Scholar
  80. 80.
    Hooper R: Hpdrocephalus and obstruction of the superior vena cava in infancy. Pediatrics 28: 792, 1961PubMedGoogle Scholar
  81. 81.
    Stewart DR, Johnson DG, Myers GG: Hydrocephalus as a complication of jugular catheterization during total parenteral nutrition. J Pediatr Surg 10: 771, 1975PubMedCrossRefGoogle Scholar

Copyright information

© Dr. K C Chaudhuri Foundation 1983

Authors and Affiliations

  • J. Bhatia
    • 1
  1. 1.Department of Pediatrics. Division of Perinatal PediatricsUniversity of Taxes Medical BranchGalveston

Personalised recommendations