Providing the Best Parenteral Nutrition before and after Surgery for NEC: Macro and Micronutrients Intakes

Abstract

Necrotizing enterocolitis (NEC) is the main gastrointestinal emergency of preterm infants for whom bowel rest and parenteral nutrition (PN) is essential. Despite the improvements in neonatal care, the incidence of NEC remains high (11% in preterm newborns with a birth weight <1500 g) and up to 20–50% of cases still require surgery. In this narrative review, we report how to optimize PN in severe NEC requiring surgery. PN should begin as soon as possible in the acute phase: Close fluid monitoring is advocated to maintain volemia, however fluid overload and electrolytes abnormalities should be prevented. Macronutrients intake (protein, glucose, and lipids) should be adequately guaranteed and is essential in each phase of the disease. Composite lipid emulsion should be the first choice to reduce the risk of parenteral nutrition associated liver disease (PNALD). Vitamin and trace elements deficiency or overload are frequent in long-term PN, therefore careful monitoring should be planned starting from the recovery phase to adjust their parenteral intake. Neonatologists must be aware of the role of nutrition especially in patients requiring long-term PN to sustain growth, limiting possible adverse effects and long-term deficiencies.

Analysis of Postoperative Outcomes and Extrauterine Growth Retardation in Preterm Infants with Necrotizing Enterocolitis: A Retrospective Study

“…The current recommendation for PN caloric requirements in the early postoperative period in Chinese infants after NEC enterostomy is 45 to 55 kcal/kg/d, while some foreign studies suggest that energy requirements in the postoperative recovery phase should be increased to 90 to 120 kcal/kg/d, but these studies are mostly from critically ill neonates and not specific to the particular population after NEC surgery. 10,27 In this study, the duration of postoperative PN was longer in the EUGR group, but there was no significant difference in the initiation time of enteral nutrition (EN) between the two groups. The duration of PN after NEC surgery correlates with the resection of intestinal tube and ileocecal flap, while the initiation time of refeeding depends on the length of the remaining intestinal tube and the clinical condition of patients.…”

“…14,21,22 Patients undergoing NEC surgery are at high risk of imbalanced and deficient nutrition due to limited nutrient absorption caused by intestinal failure or short bowel syndrome, and the need for higher energy intake to repair tissues after recovery from surgery. 5,10 Previous studies showed that EUGR in preterm infants has significant effects on growth and development, especially neurological development, and can lead to impaired neurological development. 6,21,23 Longterm follow-up results suggested that patients who survive NEC surgery have a poor neurological prognosis and might develop severe neurological developmental disorders, which are critical to the survival quality.…”