Am J Perinatol 2001; 18(2): 059-072
DOI: 10.1055/s-2001-13640
REVIEW ARTICLE

Copyright © 2001 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

From TPN to Breast Feeding-Feeding the Premature Infant-2000: Part I. Parenteral Nutrition

Dawn Pinchasik
  • Weill Medical College of Cornell University, New York and Presbyterian Hospital, New York
Further Information

Publication History

Publication Date:
31 December 2001 (online)

ABSTRACT

Advancements in medical technology have allowed for the survival of smaller, more premature infants, during the past several years. Infants as immature as 23 weeks gestational age and as small as 500 g, or even less, are now common sights in Neonatal Intensive Care Units throughout the United States. These infants present a unique challenge to neonatologists and registered dietitians, who must provide them with the nutrients needed for normal growth and development. With mounting evidence of a direct link between early nutrition and later outcome, the need for a better understanding of fetal and neonatal nutrition is critical. From admission to discharge, most infants will transition from a dependence on parenteral feeding, to a dependence on tube feeding, and finally, the ability to orally feed. In the early days of postnatal life, decisions must be made about when to initiate TPN, what type of intravenous access will be required, and to what extent and at what rate parenteral nutrients should be advanced. Similar decisions are made about the introduction and advancement of enteral nutrition. The following is a review of the available literature on the parenteral feeding of premature infants, with an emphasis on how our practice in the year 2000 was evolved over time. A similar review of enteral feeding practices will be presented in a future installment.

REFERENCES

  • 1 Lucas A, Morley R, Cole T J. Early diet in preterm babies and developmental status in infancy.  Arch Dis Child . 1989;  64 1570-1578
  • 2 Lucas A, Morley R, Cole T J. Early diet in preterm babies and developmental status at 18 months.  Lancet . 1990;  335 1477-1481
  • 3 Skuse D, Pickles A, Wolke D, Reilly S. Postnatal growth and mental development: evidence for a sensitive period.  J Child Psychol Psychiatry . 1994;  35 521-545
  • 4 Lucas A, Morley R, Cole T J, Gore S M. A randomized multicentre study of human milk versus formula and later developme in preterm infants.  Atch Dis Child . 1994;  70 F141-146
  • 5 Saini J, MacMahon P, Morgan J B, Kovar I Z. Early parenteral feeding of amino acids.  Arch Dis Child . 1989;  64 1362-1366
  • 6 Rivera A, Bell E F, Bier D M. Effect of intravenous amino acids on protein metabolism of preterm infants during the first three days of life.  Pediatr Res . 1993;  33 106-111
  • 7 Wilson D C, Cairns P, Halliday H L. Randomised controlled trial of an aggressive nutritional regimen in sick very low birthweight infants.  . 1977;  77 F4-11
  • 8 Stegink L D. Amino acids in pediatric parenteral nutrition: solutions infused-lessons learned.  Am J Dis Child . 1836;  137 1008-1016
  • 9 Dudrick S J, Rhoads J E, Vars H M. Growth of puppies receiving all nutritional requirements by vein.  Fortschr Parenteral Ernahr . 1967;  216-218
  • 10 Filler R M, Erakis A J. Care of the critically ill child: intravenous alimentation.  Pediatrics . 1970;  46 456-461
  • 11 Stegink L D, Baker G L. Infusion of protein hydrolysates in the newborn infant: plasma amino acid concentrations.  J Pediatr . 1971;  78 595-602
  • 12 Walker F S. Ammonia in fibrin hydrolysates.  N Engl J Med . 1971;  235 1324-1325
  • 13 Stegink L D. Response to Larkin, VD. Hyperamminemia: another hazard of parenteral alimentation.  Pediatrics . 1973;  51 584-585
  • 14 Committee on Nutrition. Parenteral nutrition: a note of caution.  Pediatrics . 1971;  46 775
  • 15 Johnson J D, Albritton W L, Sunshine P. Hyperamminemia accompanying parenteral nutrition in newborn infants.  J Pediatr . 1972;  81 154-161
  • 16 Shohl A T, Blackfan K D. The intravenous administration of crystalline amino acids to infants.  J Nutr . 1940;  20 305-316
  • 17 Heird W C, Nicholson J F, Driscoll Jr M J. Hyperammonemia resulting from intravenous alimentation using a mixture of synthetic L-amino acids: a preliminary report.  J Pediatr . 1972;  81 162-165
  • 18 Seashore J H, Seashore M R, Reily C. Hyperammonemia during total parenteral nutrition in children.  J Parenter Enteral Nutr . 1982;  6 114-118
  • 19 Heird W C, Dell R B, Driscoll Jr M J. Metabolic acidosis resulting from intravenous alimentation with synthetic amino acids.  N Engl J Med . 1972;  287 943-948
  • 20 Perez V J, Olney J W. Accumulation of glutamic acid in the arcuate nucleus of the hypothalamus of the infant mouse following subcutaneous administration of monosodium glutamate.  J Neurochem . 1972;  19 1777-1782
  • 21 Filer Jr J L, Stegink L D. Safety of hydrolysates in parenteral nutrition.  N Engl J Med . 1973;  289 426-427
  • 22 Chan J C. The influence of synthetic amino acid and casein hydrolysate on the endogenous production and urinary excretion of acid in total intravenous alimentation.  Pediatr Res . 1972;  6 789-796
  • 23 Meng H C, Stahlman M T, Otten A. The use of a crystalline amino acid mixture for parenteral nutrition in low-birth-weight infants.  Pediatrics . 1977;  59 699-709
  • 24 Driscoll Jr M J, Heird W C, Schullinger J N. Total intravenous alimentation in low-birth-weight infants: a preliminary report.  J Pediatr . 1972;  81 145-153
  • 25 Raiha N C. Biochemical basis for nutritional management of preterm infants.  Pediatrics . 1974;  53 147-155
  • 26 Zlotkin S H, Bryan M J, Anderson G H. Cysteine supplementation to cysteine-free intravenous regimens in newborn infants.  Am J Clin Nutr . 1981;  34 914-923
  • 27 Malloy M H, Rassin D K, Richardson C J. Total parenteral nutrition to sick preterm infants: effects of cysteine supplementation with nitrogen intakes of 240 and 400 mg/kg/day.  J Pediatr Gastroenterol Nutr . 1984;  3 239-244
  • 28 Watkins J B. Role of bile acids in the development of the enterohepatic circulation. In: Lebenthal E, ed. Textbook of Gastroenterology and Nutrition in Infancy New York: Raven Press Books 1981: 167-176
  • 29 Rassin D K, Raiha N C, Gaull G E. Protein and taurine nutrition in infants. In: Lebenthal E, ed. Textbook of Gastroenterology and Nutrition in Infancy New York: Raven Press Books 1984: 391-401
  • 30 Cooke R J, Whitington P F, Keits D. Effect of taurine supplementation on hepatic function during short-term parenteral nutrition in premature infants.  J Pediatr Gastroenterol Nutr . 1874;  3 234-238
  • 31 Adamkin D D, Radmacher P, Rosen P. Comparison of a neonatal cersus general-purpose amino acid formulation in preterm neonates.  J Perinatol . 1995;  15 108-113
  • 32 Innis S M. Fat. In: Tsang RC, Lucas A, Uauy R, Zlotkin S, eds. Nutritional Needs of the Preterm Infant: Scientific Background and Practical Guidelines Pawling, NY: Caduceus Medical Publishing 1993: 65-86
  • 33 Koo W W, McLaughlin K, Saba M. Nutrition support for the preterm infant. In: Christensen ML, Merritt RJ, eds. The A.S.P.E.N. Nutrition Support Practice Manual Silver Springs, MD: The American Society for Parenteral and Enteral Nutrition 1998: 26-1-26-15
  • 34 Anderson T L, Muttart C R, Bieber M A. A controlled trial of glucose versus glucose and amino acids in premature infants.  J Pediatr . 1979;  94 947-951
  • 35 Heird W C. Early use of parenteral amino acids. In: Ziegler EE, Lucas A, Moro GE, eds. Nutrition of the Very Low Birthweight Infant Vevey, Switzerland: Nestec 1999: 53-69
  • 36 Zlotkin S H, Bryan M H, Anderson G H. Intravenous nitrogen and energy intakes required to deplicate in utero nitrogen accretion in prematurely born human infants.  J Pediatr . 1981;  599 115-120
  • 37 Touloukian F J. Isosmolar coma during parenteral alimentation with protein hydrolysate in excess of 4 gm/kg/day.  J Pediatr . 1975;  86 270-273
  • 38 Micheli J L, Fawer C L, Schutz Y. Protein requirement of the extremely low-birthweight preterm infant. In: Ziegler EE, Lucas A, Moro GE, eds. Nutrition of the Very Low Birthweight Infant Vevey, Switzerland: Nestec 1999: 155-177
  • 39 Heird W C, Hay W, Helms R A. Pediatric parenteral amino acid mixture in low birth weight infants.  Pediatrics . 1988;  81 41-50
  • 40 Adamkin D D, Radmacher P, Rosen P. Comparison of a neonatal versus general-purpose amino acid formulation in preterm neonates.  J Perinatol . 1995;  15 108-113
  • 41 Cowett R M, Oh W, Schwartz R. Persistent glucose production during glucose infusion in neonates.  J Clin Invest . 1983;  71 467-475
  • 42 Sunehag A, Gustafsson J, Ewald U. Very immature infants (< or = 30 Wk) respond to glucose infusion with incomplete suppression of glucose production.  Pediatr Res . 1994;  36 550-555
  • 43 Van Goudoever B J, Sulkers E J, Chapman T E. Glucose kinetics and glucoregulatory hormone levels in ventilated preterm infants on the first day of like.  Pediatr Res . 1993;  33 583-589
  • 44 Ostertag S G, Jovanovic L, Lewis B, Auld P A. Insulin pump therapy in the very low birth weight infant.  Pediatrics . 1986;  78 625-630
  • 45 Vaucher Y E, Walson P D, Morrow G. Continuous insulin infusion in hyperglycemic, very low birth weight infants.  J Pediatr Gastroenterol Nutr . 1982;  1 211-217
  • 46 Heron P, Bourchier D. Insulin infusions in infants of birthweight less than 1250 g and with glucose intolerance.  Aust Pediatr J . 1988;  24 362-365
  • 47 Kanarek K S, Santeiro M L, Malone J I. Continuous infusion of insulin in hyperglycemic low-birth weight infants receiving parenteral nutrition with and without lipid emulsion.  J Parenter and Enteral Nutr . 1991;  15 417-420
  • 48 Binder N D, Raschko P K, Benda G I, Reynolds J W. Insulin infusion with parenteral nutrition in extremely low birth weight infants with hyperglycemia.  J Pediatr . 1989;  114 273-280
  • 49 Cornblath M, Hawdon J M, Williams A F. Controversies regarding definition of neonatal hypoglycemia: suggested operational thresholds.  Pediatrics . 2000;  105 1141-1145
  • 50 Friedman Z, Damon A, Stahlman M T, Oates J A. Rapid onset of essential fatty acid deficiency in the newborn.  Pediatrics . 1976;  58 640-649
  • 51 Cook R J, Zee P, Yeh Y Y. Essential fatty acid status of the premature infant during short-term fat-free parenteral nutrition.  J Pediatr Gastroenterol Nutr . 1984;  3 446-449
  • 52 Farrell P M, Gutcher G R, Palta M, DeMets D. Essential fatty acid deficiency in premature infants.  Am J Clin Nutr . 1988;  48 220-229
  • 53 Lee E J, Simmer K, Gibson R A. Essential fatty acid deficiency in parenterally fed preterm infants.  J Pediatr Child Health . 1993;  29 51-55
  • 54 Barson A J, Chistwick M L, Doig C M. Fat embolism in infancy after intravenous fat infusions.  Arch Dis Child . 1978;  53 218-223
  • 55 Levene M K, Batiist O, Wigglesworth J S. A prospective study of intrapulmonary fat accumulation in the newborn lung following intralipid infusion.  Acta Pediatr Scand . 1984;  73 454-460
  • 56 Shulman R J, Langston C, Schanler R J. Pulmonary vascular deposition after administration of intravenous fat to infants.  Pediatrics . 1987;  79 99-102
  • 57 Brans Y W, Dutton E B, Andrew D S. Fat emulsion tolerance in very low birth weight neonates: effect on diffusion of oxygen in the lungs and on blood pH.  Pediatrics . 1986;  78 79-84
  • 58 Gilbertson N, Dovar I Z, Cox D J. Introduction of intravenous lipid administration on the first day of life in the very low birth weight neonate.  J Pediatr . 1991;  119 615-623
  • 59 Bell E F, Weinstein E R, Oh W. Effect of intravenously administered safflower oil emulsion of respiratory gas exchange of low-birth-weight infants.  J Pediatr Gastroenterol Nutr . 1983;  2 517-520
  • 60 Wu P Y. Nutritional aspects of bilirubin metabolism and phototherapy. In: Lebenthal E, ed. Textbook of Gastroenterology and Nutrition in Infancy New York: Raven Press Books 1981: 731-742
  • 61 Putet G. Early administration of intravenous lipids: still under debate. In: Ziegler EE, Luca A, Moro FE, eds. Nutrition of the Very Low Birthweight Infant Vevey, Switzerland: Nestec 1999: 69-79
  • 62 Thaler M M, Weinberg R P. Influence of intravenous nutrients on bilirubin transport. Emulsified lipid solutions.  Pediatr Res . 1977;  11 167-171
  • 63 Wheeler J G, Boyle R J, Abramson J S. Intralipid infusion in neonates: effects on polymorphonuclear leukocyte function.  J Gastroenterol Nutr . 1985;  4 453-456
  • 64 Friedman Z, Lambert Jr L E, Stahlman M T, Oates J A. Platelet dysfunction in the neonate with essential fatty acid deficiency.  J Pediatr . 1977;  90 439-443
  • 65 Fox G F, Wilson D C, Ohlsson A. Effects of early versus late introduction of intravenous lipid to preterm infants on death chronic lung disease: results of meta-analysis [abstract].  Pediatr Res . 1988;  43 214A
  • 66 Bresson J L, Bader B, Rocchiccioli F. Protein-metabolism kinetics and energy-substrate utilization in infants fed with parenteral solutions with different glucose-fat ratios.  Am J Clin Nutr . 1991;  54 370-376
  • 67 Putet G. Energy. In: Tsang RC, Lucas A, Uauy R, Zlotkin S, eds. Nutritional Needs of the Preterm Infant Pawling, NY: Caduceus Medical Publishers 1993: 15-28
  • 68 American Academy of Pediatrics. Nutritional needs of preterm infants. In: Kleinman RE, ed. Pediatric Nutrition Handbook, 4th ed. Elk Grove Village, IL: American Academy of Pediatrics 1998: 55-87
  • 69 Greene H L, Hambidge K M, Schanler R, Tsang R C. Guidelines for the use of vitamins, trace elements, calcium, magnesium, and phosphorus in infants and children receiving total parenteral nutrition: report of the Subcommittee on Pediatric Parenteral Nutrient Requirements from the Committee on Clinical Practice Issues of The American Society for Clinical Nutrition.  Am J Clin Nutr . 1988;  48 1324-1343
  • 70 Arant Jr B S. Sodium, chloride, and potassium. In: Tsang RC, Lucas A, Uauy R, Moro GE, eds. Nutritional Needs of the Preterm Infant Pawling, NY: Caduceus Medical Publishers 1993: 157-175
  • 71 Koo W W, Tsange R C. Calcium, magnesium, phosphorus, and vitamin D. In: Tsang RC, Lucas A, Uauy R, Moro GE, eds. Nutritional Needs of the Preterm Infant Pawling, NY: Caduceus Medical Publishers 1993: 135-155
  • 72 Hansen J W. Appendix. In: Tsang RC, Lucas A, Uauy R, Moro GE, eds. Nutritional Needs of the Preterm Infant Pawling, NY: Caduceus Medical Publishers 1993: 287-301
  • 73 Adal K A, Farr B M. Central venous catheter-related sepsis: a review.  Nutrition . 1996;  12 208-213
  • 74 Vasilikis A, Apelgen K M. Answering the fat emulsions question: three in one admixture versus conventional total parenteral nutrition in a clinical setting.  J Parenter Eternal Nutr . 1988;  12 356-359
  • 75 Hap J M, Mangus I, Perez J L. Staphylococcus suprophyticus sepsis related to total parenteral nutrition admixtures contamination.  J Parenter Enterl Nutr . 1993;  17 575-577
  • 76 Wolf A, Pohlandt F. Bacterial infection: the main cause of acute cholestasis in newborn infants receiving short-term parenteral nutrition.  J Parenter Enteral Nutr . 1989;  8 297-303
  • 77 Balistreri W F. Neonatal cholestasis. In: Textbook of Gastroenterology and Nutrition in Infancy New York: Raven Press Books 1981: 1081-1107
  • 78 Bos A P, Tibboel D, Hazebroek F W. Total parenteral nutrition associated cholestasis: a predisposing factor for sepsis in surgical neonates?.  Eur J Pediatr . 1990;  149 331-333
  • 79 Merritt R J. Cholestasis associated with total parenteral nutrition.  J Pediatr Gastroenterol Nutr . 1986;  5 9-22
  • 80 Moss R L, Amili L A. New approaches to understanding the etiology and treatment of total parenteral nutrition-associated cholestasis.  Semin Pediatr Surg . 1999;  8 140-147
  • 81 Levine A, Maayan A, Shamir R. Parenteral nutrition-associated cholestasis in preterm neonates: evaluation of ursodeoxycholic acid treatment.  J Pediatr Endocrinol Met . 1999;  12 549-553
  • 82 Laborie S, Lavoie J L, Pineault M, Chessex P. Protecting emulsions of parenteral nutrition from peroxidation.  J Parenter Enteral Nutr . 1999;  23 104-108
  • 83 Klang M G, Hayes E M, Bloss C S. Drug-nutrient considerations: parenteral nutrition. In: Mueller C, ed. A.S.P.E.N. Standards of Practice Manual Siler Springs, MD: American Society for Parenteral and Enteral Nutrition 1998: 10-1-10-11
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