Three‐in‐One Parenteral Nutrition in Neonates and Pediatric Patients

Abstract

Parenteral nutrition (PN) is a life-sustaining therapy designed to deliver essential nutrients to patients unable to meet nutrition needs via the enteral route. PN may be delivered via a 2-in-1 system (one solution containing amino acids, dextrose, electrolytes, vitamins, minerals, and fluids and one solution containing intravenous fat emulsions [IVFEs]) or via a 3-in-1 system (all nutrients mixed in one container). Although the use of 3-in-1 PN solutions is not necessarily therapeutically advantageous, certain benefits may exist such as the potential to reduce the risk of contamination due to decreased manipulations; ease of administration, particularly in the home care setting; possible cost savings; and reduced IVFE wastage. However, the incorporation of IVFE in 3-in-1 solutions also presents unique risks for the neonatal and pediatric population such as decreased stability, increased lipid globule size, decreased sterility and the potential for increased microbial growth/infectious complications, the need to use a larger filter size, precipitation and compatibility risks, and an increased chance of catheter occlusion. This review outlines the unique issues and challenges to be considered when formulating neonatal and pediatric 3-in-1 PN admixtures. While 3-in-1 PN solutions may be advantageous for certain pediatric populations, specifically those dependent on home PN, the risks do not outweigh the benefits in neonatal patients, and use should be avoided in this population.

Current Knowledge of Necrotizing Enterocolitis in Preterm Infants and the Impact of Different Types of Enteral Nutrition Products

“…PN is initiated slowly, individually prescribed to ensure tolerance and safety, and advanced to meet the infant's nutritional and fluid needs. There are several risks associated with PN, such as line infections, liver damage, or gut atrophy (48,49). A clinician's aim is to wean PN and start enteral feeds as soon as possible while maintaining adequate energy and protein intake to promote appropriate growth velocity.…”

Preparación de las nutriciones parenterales pediátricas

“…-Pueden llevar heparina. En Estados Unidos y Canadá existe muy poca experiencia en el uso de NP ternarias y, por ello, encontramos muchos autores de estos países cautelosos sobre este tema (2). Sin embargo, en Europa, y especialmente en España, existe una amplia experiencia, de más de 20 años, en la utilización de estas emulsiones.…”

Nutrición intrahospitalaria del prematuro. Recomendaciones de la Rama de Neonatología de la Sociedad Chilena de Pediatría

“…Su uso solo se realiza por 24 h, y podría limitar el aporte de calcio y fós-foro. Un reciente estudio multicéntrico sobre fotooxidación muestra menor riesgo de DBP o muerte con el uso de esta mezcla, lo que requiere nuevos estudios prospectivos 13,14 .…”