Parenteral Nutrition in the NICU

Summary:

Infants in the NICU often require nutrition support, particularly premature infants. Parenteral nutrition, the delivery of nutrients directly into the bloodstream, is used in the first days of life to maximize energy intake while oral feedings or enteral feedings (or a combination of the two) is established. If an infant cannot receive enteral feedings for two or three days, PN should be initiated. Determining energy requirements is crucial to feeding infants because they have a higher metabolic rate and energy requirement per unit of body weight than children and adults. The WHO has developed guidelines for calculating energy and nutrient needs in infants. In addition to energy needs, fluid and electrolyte balance must be closely monitored. The medical team should closely monitor vitamins and trace elements and be aware of compounding agents that contain aluminum, which are dangerous to infants.    

Objectives:

• List the indications for parenteral nutrition in the preterm infant.
• Estimate protein and calories required by a preterm infant to support appropriate fetal weight gain.
• Determine appropriate fluid and electrolyte needs of preterm infants.
• Discuss the types of access that can be used for parenteral nutrition in the preterm infant.
• Determine an appropriate parenteral solution that contains dextrose, amino acids and lipids for a preterm infant.
• Explain the best way to provide preterm infants vitamins and minerals that meet their specific needs.
• Develop a monitoring schedule of the preterm infant on parenteral nutrition.
• Discuss the calcium and phosphorus needs of preterm infants.