Clinical review of total parenteral nutrition use among pediatric: Critics and outcomes

Abstract

The introduction of total parenteral nutrition (TPN) as an alternative nutrition provided a life saving solution to children with chronic bowel obstructions, fistulas, loss of mucosal body surfaces, short bowel syndrome, and other clinical problems that precluded enteral diet by mouth or tube feeding for long periods of time. Intravenous administration of TPN became an essential fluid to meet nutritional needs and to avoid progressive starvation-induced malnutrition, which changed the outcome of patients from dying. As a result, the prognosis for patients with SBS has changed dramatically and the management with the expected survival for infants with congenital gastrointestinal anomalies and gut failure has improved significantly. However, its use has been shown to associate with an increased incidence of infection. Routine laboratory monitoring may include serum electrolytes, glucose, blood urea nitrogen (BUN), creatinine, calcium, phosphorus, magnesium, albumin, pre-albumin, complete blood count with differential, and iron indices as well as assessment of acid-base status. Routine monitoring of laboratory values is not indicated for medically stable pediatric patients receiving EN at advised levels and achieving adequate growth. There are 2 fatty acids in humans that must be supplied via the diet primarily from plants. They are linoleic and α-linolenic acid and are known as essential fatty acids (EFAs). Patients receiving EN and PN must be adequately supplemented with both EFAs because their oral intake may be minimal. If inadequate amounts are provided, an essential fatty acid deficiency (EFAD) may eventually occur.