Nutrition plays a life-saving role in our lives. The fetus also requires nutrients for its complete growth and development in the intrauterine environment. These nutrients come from the mother’s womb inside a secured environment. Premature birth creates possible risks for nutritional deficiency in the baby.

 

As the preemies do not complete their full gestation time, they are more likely to have nutritional deficiencies. Premature babies with low birth weight (<1500gm) rely entirely on parenteral nutrition. 

 

What Is Total Parenteral Nutrition (TPN)?

The intravenous (IV) administration of essential nutrients in the baby, bypassing the gastrointestinal tract (GI), is called total parenteral nutrition (TPN). Essential nutrients include vitamins, iron, proteins, minerals, and lipids, which the baby cannot receive by mouth and absorb nutrients in the gastrointestinal tract (GI) [1].

TPN is a life-saving feeding method for premature and sick babies to provide them with essential nutrients through an intravenous (IV) line. An intravenous line is placed in the baby’s hand, scalp or navel to give TPN.

Regular feeding methods are also used for feeding babies, but they only facilitate salts and sugar.

 

Common Components Of TPN: 

1. Carbohydrates: For a healthy childhood and infancy, carbohydrates, in the form of glucose, are the main energy sources. Dextrose monohydrate solution is administered in babies as TPN. It provides 1500-2000 calories/day. 

2. Minerals: Infants that are regularly receiving TPN also require minerals, such as calcium and phosphorus. Post-natal bone mineralization and skeletal development are regulated by minerals. 

3. Lipids: For the healthy development of an infant, lipid emulsions are administered intravenously. Lipids are essential for neural tissues, the central nervous system, and retinal development [2].

4. Proteins: For TPN, an amino acid solution is given to the baby for healthy bones, muscles, and tissues. Normally, TPN includes branched-chain amino acid solution [3].

 

Nutritional Monitoring:

During total parenteral nutrition, the following parameters are necessary to be measured:

• Urine sugar estimation every 8 hours

• Bodyweight estimation

• Calcium & chloride estimation

• Bicarbonate estimation

• Intake-output chart every 12 hours

•  LFT (liver function test)

• Urea and serum creatinine estimation

 

Benefits Of TPN:

TPN provides a number of advantages that include:

• It provides essential nutritional compounds that regulate hydration, bone strength, and high energy in babies [4].

• Preemies tend to have more energy and healing power. The energy provided by TPN is crucial for healthy growth and development [5].

• TPN is also used to treat adults with various conditions, such as poor digestion, low food intake, and poor absorption.

• The best fact about TPN is that the parents can administer TPN to their baby at home. 

 

Complications Associated With TPN:

TPN has more benefits than its complications, but it can cause many health risks too. The following complications include:

1. Glucose Complications: They include either hypoglycemia or hyperglycemia. Hypoglycemia, short-term and prolonged, can be treated by resuming or reversing the dextrose solution concentration in TPN.

2. Hepatic Complications: When TPN is started in babies, levels of alkaline phosphatase and bilirubin can increase, causing the liver to function improperly.

3. Bone Demineralization:  If infants receive total parenteral nutrition for over three months, bone density decreases, resulting in bone demineralization [6].

 

 

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References: 

1. Maudar KK. Total parenteral nutrition. Medical Journal Armed Forces India. 1995 Apr 1;51(2):122-6. https://doi.org/10.1016/S0377-1237(17)30942-5

2. Uauy R, Castillo C. Lipid requirements of infants: implications for nutrient composition of fortified complementary foods. The Journal of nutrition. 2003 Sep 1;133(9):2962S-72S. https://doi.org/10.1093/jn/133.9.2962S

3. WU G, BAZER FW, CUDD TA, MEININGER CJ, SPENCER TE. Recent Advances in Nutritional Sciences Arginine Nutrition and. Am Soc Nutr Sci. 2004;(13):2626–30. 

4. Embleton ND, Morgan C, King C. Balancing the risks and benefits of parenteral nutrition for preterm infants: can we define the optimal composition?. Archives of Disease in Childhood-Fetal and Neonatal Edition. 2015 Jan 1;100(1):F72-5. http://dx.doi.org/10.1136/archdischild-2013-304061

5. Trindade CE. Minerals in the nutrition of extremely low birth weight infants. Jornal de pediatria. 2005 Mar;81(1):S43-51.  https://doi.org/10.1590/S0021-75572005000200006 

6. Huston RK, Baxter LM, Larrabee PB. Neonatal parenteral nutrition hypersensitivity: a case report implicating bisulfite sensitivity in a newborn infant. Journal of Parenteral and Enteral Nutrition. 2009 Nov;33(6):691-3.  https://doi.org/10.1177/0148607109347643

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