Reducing Hours Of Parenteral Nutrition Resulting In Hypoglycaemia In Infants With Intestinal Failure: A Case Report

Introduction: Most infants with intestinal failure (IF) and weighing less than 4 kilograms receive total parenteral nutrition (TPN) for 24 hours/day. When TPN has to be discontinued in these infants due to; blood transfusion, intravenous antibiotics, a central venous catheter (CVC) lock or in emergency as a result of a ruptured CVC, hypoglycaemia may occur. Hypoglycaemia is life-threatening and might be due to hyperinsulinemia caused by the continuous high glucose supply by PN. Therefore, it is necessary for each infant to be safety disconnected from PN for at least one hour, without developing hypoglycaemia. Especially in case of an emergency stop. Case report: We present the case of a premature born boy (gestational age 28 + 1 weeks) with intolerance to enteral nutrition due to short bowel syndrome following multiple resections and open abdomen treatment. Parents were trained to leave the hospital with total home PN. At time of prepared discharge, the infant was 23 weeks old (11 weeks corrected age) and weighed 3.36kg (-3SD weight-for-age corrected for prematurity) and was receiving 100% PN with minimal enteral feeding for 13 consecutive weeks. The PN glucose was administered in 24 hours/day and delivered 10.6mg/kg/min. At this stage, we tried to discontinue the PN for one hour, but blood glucose level dropped to 2.8mmol/L in the first 15 minutes after discontinuation of the PN. We decided to postpone discharge and repeat the same test a week later. It was impossible to reduce glucose intake considering insufficient growth and the restriction of limited fat intake because of liver function disorders. After this week, the infant was not able to keep a steady blood glucose level after discontinuation of PN either. One week later, we tested an emergency plan, consisting of the administration of glucose through a nasogastric feeding tube when the PN was discontinued. The blood glucose remained stable and the patient could then be discharged home safely. Conclusion: It is important to check blood glucose levels in infants receiving PN for 24 hours/day shortly after PN is discontinued, since hypoglycaemia may occur rapidly.