Neonatal PN

Question 1

Why do we give neonatal PN?

Answer 1

• improved nutrition is linked to better survival and neurodevelopmental outcomes
• the brain triples in size between 27-40 weeks gestation (and grows by 50% between 35-40 weeks)

Question 2

Who do we give neonatal PN to?

Answer 2

• NICE indicates that it is for babies <31 weeks gestation, or preterm babies >31 weeks gestation not making significant progress with EN by 72 hours of age
• OR any baby >30 weeks gestation not expected to achieve full enteral nutrition due to a congenital abnormality or critical illness

Question 3

When do we give neonatal PN?

Answer 3

• NICE states within 8 hours of birth, but in practice may be more like within 4 hours of birth

Question 4

What do we give in neonatal PN?

Answer 4

• standardised PN to meet requirements: correct ratio of CHO to lipid, correct ratio of non-nitrogen energy to nitrogen energy, ratio of phosphates to amino acids
• need at least 1.5 g/kg/day amino acids for a positive N balance
• standard bags should be used UNLESS there is a complex disorder associated with fluid and electrolyte imbalances or renal failure then an individualised bag should be used
• need to give 40-60 kcal/kg/day from birth and gradually increase to 75-120 kcal/kg/day (start with this if baby more than 4 days old)

Question 5

Which way do we give neonatal PN?

Answer 5

• peripheral may be used as a short term alternative to avoid delays with starting PN
• although central is the ideal best practice as it has a longer lifespan and lower risk of thrombophlebitis

Question 6

PN monitoring

Answer 6

• weight, length and head circumference
• fluid balance, urine output
• blood glucose
• blood electrolyte levels
• LFTs, ALT, bilirubin
• triglycerides, trace elements, vitamins
• infection or coagulation defects