Infants and Children Parenteral

S Collier and C Lo, Children's Hospital, Boston, Harvard Medical School, and Harvard School of Public Health, Boston, MA, USA

© 2005 Elsevier Ltd. All rights reserved.

Parenteral nutrition (PN) is a technique that allows provision of complete nutrient requirements intravenously, containing adequate amounts of energy, carbohydrate, protein, fat, minerals, and vitamins, while bypassing the gastrointestinal tract. It has allowed survival of many thousands of patients who cannot or will not eat or absorb enough to maintain their weight or nutritional balance because of disease or surgery. From its beginnings only approximately 30-40 years ago, it has expanded rapidly to become available for many patients, especially in the United States and then in Europe, but its expense and complications preclude wide availability in many countries. Before the availability of PN, as many as 30-50% of hospitalized patients had unrecognized malnutrition from chronic diseases and would remain for weeks without adequate nutrition to maintain weight or lean body mass, making them susceptible to infections and poor wound healing. Surprisingly, it has been difficult to demonstrate substantial reductions in morbidity or mortality with PN except in moderately or severely malnourished patients or those with long-term intestinal failure. It is difficult to estimate the exact impact, but a US registry, the Oley Foundation, enumerated 10 035 Medicare beneficiaries on home PN in 1992, giving a rough estimate of 40 000 patients on home PN in the United States. Approximately 15-20% of these patients were children.

One of the first attempts at PN was carried out by Sir Christopher Wren in 1656. He infused ale, opium, and beer intravenously into animals. Complete intravenous nutrition that we are most familiar with for patient support has been available for approximately 40 years. The research carried out by Dr. Stanley Dudrick and others allowed the support of the first pediatric patient on intravenous nutrition. The provision of intravenous nutrition was challenged by the development of several factors prior to its completed use in patient support, including catheter access, sterility of solutions, and the optimal form of each macro- and micronutrient.

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