PN in Infants And Children

Question 1

Indications for PN in paediatric patients

Answer 1

• major intestinal surgery
• post chemotherapy
• severe acute pancreatitis
• multi-organ failure in extensive trauma and burns
• prematurity
• auto-immune enteropathy, micro-villus atrophy, severe diarrhoea
• CIPO
• gastroschisis, volvulus, short bowel syndrome

Question 2

Route of administration for PN in infants

Answer 2

• peripheral access requires low osmolarity, low kcal density, high volume needed to reach requirements
• central venous access allows for high osmolarity and caloric density. Meaning can reach requirements with a restricted fluid intake

Question 3

Standard PN solutions (advantages and disadvantages)

Answer 3

• standard PN should be generally used over individualised PN solutions in majority of paediatric patients
• advantages: improves patient safety, optimise resource efficiency
• disadvantages: fitting the patient to the bag, removes the clinical judgement, limited choice of standard regimens

Question 4

Individualised PN (advantages and disadvantages)

Answer 4

• individually tailored PN can be used when nutritional needs cannot be met by standard PN alone
• advantages: tailored to specific patient, can change regimen on a daily basis
• disadvantages: tinkering unneccesary, can be harmful if prescribed by inexperienced practitioners, unstable formulation using mixed products, may have manufacturing issues

Question 5

Guidance on glucose, amino acids, lipids

Answer 5

• glucose: provides 60-75% of non-protein intake, start at 4-8 mg/kg/min. Introduce slowly to prevent glycosuria
• amino acids: need more BCAAs, lower glycine/methionine and phenylalanine, need more cysteine/taurine/tyrosine/histadine
• start on 1.5g/kg/day protein (minimum of 1g/kg/day) and on day 2 have 2.5g/kg/day, max of 3g/kg/day in term neonates, max of 3.5g/kg/day in preterm infants
• minimum of 65 kcal/kg/day
• lipids: high density energy source, avoids excessive glucose, promotes protein synthesis, provides essential fatty acids (LA, ALA). For preterm infants need 0.5g/kg/day intralipid 20% or 1.34g/kg/day SMOF