TOTAL PARENTERAL NUTRITION
INDICATIONS
- Extremely low birth weight, <1000 g
- Very low birth weight (<1500 g)
- Clinically unstable
- Absent/reversed end-diastolic flow
- Full enteral feeds unachievable by day 5
- Any baby on inotropic support
- Necrotising enterocolitis (10-14 days)
- Temporary feeding intolerance
Peripheral PN
• Limited by glucose concentration (<12%)
• Indicated if full enteral feeds likely to be obtained relatively soon
• Short episodes of feeding intolerance or suspected NEC
Central TPN
• By a central catheter (tip in superior vena cava or inferior vena cava)
TABLE 2
TABLE 3
EVERYDAY ELECTROLYTE REQUIREMENT
Glucose – maximum concentration:
• Peripheral PN 10-12%
• Central PN up to 20-25%
COMPLICATIONS
Catheter-related:
- Peripheral catheters: extravasations
- Septicaemia
Metabolic
- Hyper/hypoglycaemia, osmotic diuresis
- Metabolic bone disease
- Hyperlipidaemia and hypercholesterolemia
- Conjugated hyperbilirubinaemia
PN-associated cholestatic hepatitis
- Prolonged TPN (>10-14 days)
- High serum bilirubin ( direct component) and elevated transaminases.
- Small enteral feeds will limit this problem
- Add trace minerals
- If stools alcoholic or very pale, refer urgently