HPE HPE 85 – Spring 2017 - Page 41

Practical therapeutics Issue 85 | Spring 2017 Neonatal parenteral nutrition The use of new lipid sources and early parenteral in the post-natal period may have an impact on long-term growth and health of neonates and premature infants Venetia Simchowitz (née Horn) MRPharmS IPres MFRPSII PG Dip MSc Senior Specialist Pharmacist – Clinical Nutrition & NICU Great Ormond St Hospital for Children NHS Foundation Trust, London, UK Nutrition is one of the key factors for normal cell growth and development. For infants, and during early childhood, the therapeutic goal is to ensure that nutritional intake is sufficient to provide nutrients for maintenance of body tissues and balanced somatic growth. Malnutrition, particularly in the last trimester of pregnancy a nd first two years of life, will lead to stunting of growth and may be associated with neurodevelopmental outcomes such as intellectual impairment. For the premature infant, there are limited body stores, immature body functions (gastrointestinal, renal, and metabolic), rapid tissue differentiation and organ development and therefore an increased nutrient requirement per kilogram body weight. The neonatal brain is sensitive to periods of malnutrition and metabolic insult during this period of rapid growth. Energy and protein requirements need to be met to address ‘catch up’ growth, which is beneficial for neurodevelopment, but the consequences of nutritional programming or the ‘early origins of adult disease’ also need to be considered. existing problems (necrotising enterocolitis, patent ductus arteriosus) will require nutritional support in the form of PN while enteral feeds are graded up or while recovering from gastrointestinal surgery. PN in a small infant who cannot tolerate feeds may be a matter of urgency due to the limited energy reserves. A preterm infant of 1kg, who has perhaps no more than 10g of storage fat, might survive for only four days if starved. 1 Parenteral nutrition Parenteral nutrition (PN) should be initiated when normal metabolic and nutritional needs are not met by enteral feeding in patients with adequate intestinal function. Premature infants by nature of their prematurity and co- Fluid requirements The requirement for fluid to body weight is much greater in very small children. Infants have a much larger body surface area relative to weight than older patients and lose more fluid through evaporation and dissipate much more heat per kilogram than their older counterparts, which accounts for the increased requirements. Fluid balance and hydration status can be monitored by regularly weighing the patient. Energy requirements Nutritional requirements differ according to age and are affected by the underlying disease and current nutritional status of the child. Energy requirements may be increased when the body is under catabolic stress, fever or sepsis or if there is failure to thrive. Suboptimal nutrition may be due to fluid restriction, lack of central access, and a build up of nutrition over several days. But in the critically ill child in the acute phase of illness, basal energy requirements will only need to met. 1 Catch-up growth may be achieved hospitalpharmacyeurope.com 39