is total parenteral nutrition?
newborns can’t absorb sufficient nutrition through the stomach and intestine.
This area is known as the gastrointestinal (GI) tract. In this case, they need
to receive nutrients through a vein, or intravenously (IV).
some infants, the GI tract functions well enough to allow some regular
feedings, along with some IV feedings. This is called partial parenteral
nutrition (PPN). Other infants must receive all of their nutrition via IV. This
is called total parenteral nutrition (TPN).
allows fluids to enter the body and provide nutrients while bypassing the GI
tract. TPN delivers a combination of protein, carbohydrates, fats, vitamins,
and minerals to an infant’s body. It also delivers electrolytes that help regulate nutrient balance at the cellular level.
When is total parenteral nutrition necessary?
children, and newborns can all benefit from TPN in certain cases. Adult
patients and children may need TPN when they cannot get proper nutrition
through normal eating or via a tube passed into the stomach.
may be due to inflammatory bowel diseases like Crohn’s disease or ulcerative
colitis that cause severe diarrhea. It may also be due to short bowel syndrome
after a large part of the small intestine is removed through surgery, due to a
disease of the intestine.
is used when an infant is unable to receive food or liquids by mouth that will
be delivered directly to the stomach. Infants may require TPN if they are sick
or born prematurely.
Why do infants need total parenteral nutrition?
sick or premature infants can’t properly absorb nutrients by mouth for an
extended period it may be dangerous. The UCSF
Children’s Hospital recommends that while it is always preferable
for nutrition to be given via the GI tract, if this is not possible, then TPN
may be started.
or premature newborns often have an increased need for nutrients. This may be
due to factors such as:
- stunted kidney growth that prevents normal functioning
- inadequate time in the womb, which prevents the infant from
receiving their full supply of necessary nutrients for healthy growth and
to the American
Society for Parenteral and Enteral Nutrition (ASPEN), TPN can
help save the lives of underweight or sick infants who are unable to process
food taken by mouth or given by tube feedings to the GI tract. TPN offers a
more effective way for these babies to meet their nutritional needs than
through water-based IV feedings. This is because TPN provides more than just the
sugars and salts available from IVs.
study in the medical journal Mayo Clinic Proceedings found that
infants might benefit from TPN when oral feeding is impossible. These include
premature infants with certain medical conditions and other infants with
diarrhea and surgical problems. One review of 20 patients found that infants
received enough calories to regain weight and continue to grow.
in the medical journal Archives of
Disease in Childhood studied the effectiveness of TPN versus milk in
34 infants who had very low birth weights. Researchers found that the TPN group
had higher daily intakes of both protein and carbohydrates compared to the
group fed with milk.
study concluded that TPN, when properly managed, could be an effective
treatment for infants with very low birth weights. However, these studies were
done in the early years of TPN use. Further experience has shown that TPN has a
high risk of complications and is not routinely recommended for low birth
weight infants who can receive nutrition via the GI tract.
How is total parenteral nutrition given to an infant?
is given through a vein by placing an IV line into the baby’s hand, foot,
scalp, or navel. Fluids are delivered via a “peripheral” route. This means
nutrition is supplied through smaller veins that are less centrally located in
the baby’s body. This is generally the method for PPN, used for short-term
longer IV may be used when an infant needs to receive ongoing TPN feedings.
This is sometimes called a “central line.” A central
line can provide the
infant with a greater nutrient concentration through larger veins.
What are the risks of total parenteral nutrition to an infant?
TPN can be lifesaving for infants who are not able to receive nutrition
normally, it is not without risks. The Merck
that about 5 to 10 percent of patients of all ages have complications related
to central line IV access.
following health problems often develop in infants through the use of TPN or IV
lines for feeding:
- liver problems
- levels of fats, blood sugars, and electrolytes that are too high
or too low
- sepsis, a severe response to bacteria or other germs
Manual also notes
that chronic lung disease or high blood pressure may be a complication of fat
intake through TPN.
problems due to TPN can develop at any age. However, they are most common in
infants, particularly those who were born prematurely. This is because their
livers are not yet fully developed. Liver problems most often occur when TPN is
first started. Reducing the amount of protein in the IV mixture may help
providers caring for sick or premature infants closely monitor each infant’s
nutritional needs by taking blood and urine tests. The results of these tests alert
the medical team if the infant requires adjustments to the nutritional
components of TPN.
What is the outlook for people on TPN?
According to the Parenteral Nutrition Fact Sheet issued by ASPEN,
both children and adults can thrive using parenteral nutrition if no
complications arise. Although parenteral nutrition is usually halted once the
person is able to eat by mouth again, it can be continued for as long as