Pediatric Nutrition in Practice

3 Nutritional Challenges in Special Conditions and Diseases

Key Words

Parenteral feeding · Intravenous alimentation ·

Substrate requirements, parenteral · Infant · Child

Key Messages

• Parenteral nutrition (PN) is indicated when ade-
  quate nutrition cannot be provided orally or enter-
  ally


• PN is not indicated in patients with adequate small
  intestinal function who can be enterally (tube) fed


• Ordering and monitoring of PN should follow
  agreed algorithms to improve the quality of care


• Patients receiving PN should be evaluated 2–3
  times/week (e.g. clinical examination, weight, an-
  thropometry, laboratory values and dietary intake
  as appropriate)


• The available evidence-based guidelines on paedi-
  atric PN should guide practice, including the dos-
  age of substrate supply © 2015 S. Karger AG, Basel

Introduction

Parenteral nutrition (PN) is generally indicated
when adequate nutrition cannot be provided
orally or enterally, to prevent or correct malnutri-
tion, and to sustain appropriate growth. It should
be avoided whenever possible by use of adequate
care, specialized enteral nutrition (EN) and artifi-

cial feeding devices as appropriate, because PN is

more costly and carries higher risks than oral nu-

trition or EN. PN is not indicated in patients with

adequate small intestinal function in whom oral

tube or gastrostomy feeding can be used. The

time when PN should be initiated depends both

on individual circumstances and the patient’s age

and size. In small preterm infants, starvation for

just 1 day may be detrimental, and PN must be

instituted shortly after birth if it is obvious that

adequate amounts of EN will not be tolerated

soon. In older children and in adolescence, longer

periods of inadequate nutrition (up to 7 days)

may be tolerated, depending on the age, nutri-

tional status and disease of the patient as well as

on the type of intervention (surgery or medical).

Whenever possible, PN should be combined with

some (at least minimal) EN. Establishing a multi-

disciplinary paediatric nutrition support team for

the supervision of PN can improve the quality of

care and save costs; hence, it is highly recom-

mended [1]. Ordering and monitoring PN should

follow agreed algorithms to improve the quality

of care. Patients receiving PN should be evaluated

2–3 times/week (e.g. clinical examination, weight,

anthropometry, laboratory values and dietary in-

take as appropriate). The recommendations pro-

vided here are based on the recent evidence-based

guidelines for paediatric PN [2, 3].

Koletzko B, et al. (eds): Pediatric Nutrition in Practice. World Rev Nutr Diet. Basel, Karger, 2015, vol 113, pp 158–162
DOI: 10.1159/000375190

3.4 Parenteral Nutritional Support

Berthold Koletzko