Isosmolar coma during parenteral alimentation with protein hydrolysate in excess of 4 gm/kg/day

Intravenous nitrogen and energy intakes required to duplicate in utero nitrogen accretion in prematurely born human infants

In order to determine the intravenous energy and nitrogen intakes required to achieve intrauterine rates of nitrogen accretion and growth, 30 studies were completed in 22 premature infants who were provided with various intakes of amino acids and energy (glucose +/- lipid) by peripheral vein infusion. At constant nitrogen intake, increasing energy intake (as lipid) from 50 to 80 nonprotein kcal/kg/day resulted in significant increases in nitrogen retention and weight gain. Increasing nitrogen intake from 494 to 655 mg/kg/day at constant low energy intake (mean = 53 kcal/kg/day) had no effect on nitrogen retention or weight change; however, at higher energy intakes (mean = 81 kcal/kg/day) increasing nitrogen intake correlated significantly with increasing nitrogen retention. At energy intakes greater than 70 kcal/kg/day the major determinant of nitrogen retention was nitrogen intake. When energy intake was greater than 70 kcal/kg/day, the infusion of nitrogen providing 430 to 560 mg/kg/day (2.7 to 3.5 gm protein/kg/day) resulted in the duplication of intrauterine nitrogen accretion rates.

Metabolic complications of parenteral nutrition in infants and children

Metabolic complications of TPN in infants and children are numerous and frequent. Properly designed nutrient solutions, careful monitoring, knowledge of potential problems, and appropriate management are essential to avoid serious complications. Hepatic dysfunction is most likely to prevent achievement of adequate nutrient intake. Better delineation of trace metal, essential fatty acid, and vitamin deficiencies is necessary, particularly in patients who require long-term TPN.

Parenteral nutrition in paediatric practice: a review

The special problems associated with parenteral nutrition in childhood are reviewed. A regime for administration is outlined and specific areas for further research are suggested.

Prospective controlled study of parenteral nutrition-associated cholestatic jaundice: effect of protein intake

The development of transient cholestatic jaundice is a well-recognized complication of prolonged parenteral nutrition. The etiology and long-term significance have not been established. This report describes a prospective controlled study designed to compare the hepatic effects of two different parenteral protein intakes, a lower protein regimen of 2.3 gm/kg/day and a higher protein regimen of 3.6 gm/kg/day. The minimum criterion for ChJ was a direct bilrubin greater than or equal to 2.0 mg/dl. Eighty-two consecutive infants completed the study. No ChJ occurred in the 39 infants who received PN for less than two weeks. In 43 infants requiring PN for at least two weeks, the incidence of ChJ was similar in the two groups, six infants in the LP and seven in the HP group. However, infants prospectively assigned to the HP group developed ChJ earlier than the LP group, 27 +/- 6 days (P less than 0.01), and achieved a significantly greater peak direct bilrubin level, 8.4 +/- 1.6 versus 3.2 +/- 0.3 mg/dl (P less than 0.001). Retrospective comparison of the 13 ChJ infants to the 30 long-term PN infants without ChJ revealed a significantly greater daily dextrose intake in those developing ChJ, 16.2 +/- 1.1 gm/kg/day versus 13.4 +/- 0.9 in the group without ChJ (P = 0.025). Our results indicate that an increased parenteral protein intake is associated with an earlier and increased magnitude of ChJ and suggest than an increased dextrose intake may be associated with an increased frequency of ChJ.

Total parenteral alimentation via indwelling umbilical catheters in the newborn period

Total parenteral alimentation (TPA) was delivered to 80 infants via indwelling umbilical artery and to 9 via indwelling umbilical venous catheters. The primary indication for catheter placement and maintenance was monitoring of arterial blood gases (umbilical venous catheter tip in left atrium) in a group of sick neonates requiring increased inspired oxygen or assisted ventilation. Results were compared with those from 23 infants who had tunnelled jugular catheters for a variety of chronic medical and surgical problems preventing gastric or intestinal feeding. A mean weight gain was achieved in both groups. Mortality and morbidity rates were similar in both groups. The most common complications were infection and thrombotic phenomena. Metabolic complications were few. It is concluded that infusing TPA solutions via indwelling umbilical catheters presents no greater risk than infusion via tunnelled jugular catheters, and provides a method for supplying adequate caloric intake for growth during the acute stage of illness.