Parenteral Nutrition for the High-Risk Neonate

A high proportion of very low birth weight (VLBW) infants exhibit poor growth during their stay in the neonatal intensive care unit. With delay in nutrient supplementation after birth, nutritional deficits rapidly accumulate in VLBWs and play a large factor in these growth outcomes. The goal of parenteral nutrition use in this population is to provide sufficient supplementation of nutrients to conserve neonatal body stores and accrete nutrients at a rate similar to that of the fetus. Early use of parenteral nutrition in VLBW infants has been shown to minimize nutrient store losses and improve growth outcomes. In VLBW infants, early parenteral nutrition should be started soon after birth with goals including a glucose infusion rate of 4 to 8 mg/kg/min, amino acids of 2 to 3 g/kg/day, and a lipid dose of 2 g/kg/day. The caloric needs of the preterm infant vary based on multiple factors, including chronological age, weight, calorie intake, and environment. Additional electrolyte, vitamin, and mineral supplementation of parenteral nutrition solutions are necessary. Recommended doses for each additional constituent exist, but the individual patient determines the ultimate needs of each. Complications of parenteral nutrition are possible, and clinicians should monitor for and treat these complications should they occur. While parenteral nutrition is a necessary treatment in VLBW and ill neonates, its use should be limited to as short a time as possible to avoid these complications. To achieve this goal, early enteral feeding should be considered when able in this population.