Risk of Parenteral Nutrition in Neonates—An Overview

Abstract

Healthcare-associated infections (HAI) in preterm infants are a challenge to the care of these fragile patients. HAI-incidence rates range from 6 to 27 infections per 1000 patient-days. Most nosocomial infections are bloodstream infections and of these, the majority is associated with the use of central venous catheters. Many studies identified parenteral nutrition as an independent risk factor for HAI, catheter-associated bloodstream infection, and clinical sepsis. This fact and various published outbreaks due to contaminated parenteral nutrition preparations highlight the importance of appropriate standards in the preparation and handling of intravenous solutions and parenteral nutrition. Ready-to-use parenteral nutrition formulations may provide additional safety in this context. However, there is concern that such formulations may result in overfeeding and necrotizing enterocolitis. Given the risk for catheter-associated infection, handling with parenteral nutrition should be minimized and the duration shortened. Further research is required about this topic.

Standardised Parenteral Nutrition

“…Various outbreaks of hospital-acquired infections have been reported through administration of contaminated PN because of lapses in sterility during compounding PN at hospital pharmacy [53]. SPN especially when commercially prepared may decrease chances of contamination of PN [54]. …”

Standardized Nutrition Protocol for Very Low‐Birth‐Weight Infants Resulted in Less Use of Parenteral Nutrition and Associated Complications, Better Growth, and Lower Rates of Necrotizing Enterocolitis

“…3,4 In an attempt to spare growth, premature infants must get their nutrition intravenously through parenteral nutrition (PN) until adequate EN is established. However, both slow advancement of feeds and weaning off PN can lead to adverse consequences, such as metabolic bone disease, [5][6][7] cholestasis, 8,9 central-line infections, 5 and poor growth. 5,10 As a result, many infants suffer from extrauterine growth restriction (EUGR), where infants' anthropometrics fall below the 10th percentile of the expected intrauterine growth for the postmenstrual age at the time of discharge.…”

“…However, both slow advancement of feeds and weaning off PN can lead to adverse consequences, such as metabolic bone disease, [5][6][7] cholestasis, 8,9 central-line infections, 5 and poor growth. 5,10 As a result, many infants suffer from extrauterine growth restriction (EUGR), where infants' anthropometrics fall below the 10th percentile of the expected intrauterine growth for the postmenstrual age at the time of discharge. 1,2 This could be related to difficulty in optimizing energy in PN due to glucose and lipid intolerance, poor caloric and protein delivery that occurs while feeds are being advanced and PN is weaned, as well as increased metabolic demands.…”

“…1,2 This could be related to difficulty in optimizing energy in PN due to glucose and lipid intolerance, poor caloric and protein delivery that occurs while feeds are being advanced and PN is weaned, as well as increased metabolic demands. 5,10,11 Infants with EUGR are at risk for poorer neurodevelopmental outcomes, worsened neonatal intensive care unit (NICU) outcomes, and adult-onset disease. [12][13][14][15][16] Studies have shown that the use of preterm feeding protocols in the NICU can improve feeding tolerance and decrease the risk for NEC.…”

Adequacy of Parenteral Nutrition in Preterm Infants According to Current Recommendations: A Study in A Spanish Hospital

“…Maintenance of trophism improves intestinal maturation and provides other benefits such as improving postnatal growth, cardiac and respiratory diseases and reducing the risk of infections [39]. It must be taken into account that a long duration of PN can lead to complications, mainly infections [40] or metabolic complications (hyperlipidaemias, hyperbilirubinaemia, cholestasis) [41]. Therefore, PN should be terminated when it is possible to orally administer a sufficient amount of enteral nutrition (EN) to satisfy the minimum nutritional requirements equivalent to those achieved during foetal development [42].…”