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A recent study underscores the critical role of parenteral nutrition (PN) in paediatric patients. Although PN is crucial for the growth and development of preterm infants, it often involves considerable variability and risk, which can lead to complications. Advances such as Multi-Chamber Bags (MCB) have shown potential for improving precision, safety, and efficiency, but challenges persist in meeting paediatric needs. The findings stress the importance of standardising practices and adopting evidence-based guidelines to improve PN outcomes in paediatric care.
Overview of parenteral nutrition
PN is a high-risk therapy involving intravenous feeding, bypassing normal eating and digestion. It is crucial when oral or enteral nutrition is impossible or insufficient. PN is often lifesaving for paediatric patients, especially preterm infants, who have higher nutritional needs for growth and development but often cannot yet digest food properly because of their immature digestive system. Their increased requirements for energy, amino acids, and calcium compared to other patients make PN an essential treatment option for this patient group. However, PN practices vary widely, and standardised, evidence-based guidelines are needed to optimise patient care.
Challenges and process of parenteral nutrition
PN is a complex medication as it involves assessing the patient’s individual needs, prescribing the dosage and form of PN, compounding, labelling, administering, and monitoring. Effective communication among healthcare professionals is crucial, as inconsistent practices can directly impact patient outcomes. Adverse drug events are common, highlighting the need for skilled pharmacists and error minimisation.
Venous access and complications
Reliable venous access is critical in PN. Central lines are used for long-term PN but carry risks like infections and thromboses, requiring skilled placement. Peripheral lines are easier to manage but can lead to complications like extravasation and are suited for short-term therapy only. Diluted PN can reduce risks by peripheral access but provides lower nutrient density compared to concentrated PN.
Parenteral nutrition in neonates
Central line PN is recommended for neonates due to high nutritional needs. Peripheral PN is used only under certain conditions like avoiding delay or short-term use. Intravenous lipid emulsion (ILE) is essential to meet the patient’s energy and fatty acids requirements. The authors found that administering the ILE as all-in-one PN is preferrable as it is safer when compared to separate PN.
Different types of parenteral nutrition
PN is generally distinguished into individualised PN (IPN) and standardised PN (SPN). IPN offers flexibility but requires more resources and carries higher risks. While SPN is generally safer, more cost-effective, and adequate for most infants, it is not tailored to meet specific individual needs. Vitamins, which degrade quickly, should be added just before use. Multi-chamber bags (MCB) are licensed for SPN and manufactured by industry. The chambers separate the macronutrients. MCBs are safe, cost-effective, and reduce preparation time. They improve protein and energy intake in very low birth weight infants but may not meet all paediatric needs.
The authors conclude that translating recommendations into PN practice remains challenging. Adhering to evidence-based guidelines is essential to improving PN safety and efficacy in paediatric patients.
Paper available at: ClinicalNutrition Journal (Safe and efficient practice of parenteral nutrition in neonates and children aged 0–18 years)
Full list of authors: Senterre, T., van den Akker C. H. P., Domellof, M., Saenz de Pipaon, M., Arnell, H., Tabbers, M., Valla, F. V., Tomlin, S., Paulsson, M., Wackernagel, D., Haiden N., Luukkainen, P., Orfeo, L., Carnielli, V. P. & Rigo, J.
