Indications for Parenteral Nutrition

The often repeated adage continues to be true, ''If the gut works, use it.'' However, there are many circumstances in which PN is necessary and life sustaining. The indications for use have not changed dramatically throughout the years since the development of PN. Congenital malformation of the intestine, specifically small bowel atresia, was the diagnosis the first time PN was used in the infant and young child. Congenital malformations of the gastrointestinal tract continue to be one of the leading reasons for its use. Other indications include severe malabsorption, intestinal dysmotility, other congenital defects, and patients with hematology-oncology diseases (Table 1).

Table 1 Conditions commonly requiring parenteral nutrition

Condition

Examples/comments

Surgical gastrointestinal disorders

Gastroschisis, omphalocele, tracheoesophageal fistula, intestinal atresias, meconium ileus, peritonitis, malrotation and volvulus, diaphragmatic hernia, prolonged postoperative ileus, Hirschsprung's disease, intestinal dysmotility

Short bowel syndrome Prematurity

Congential heart disease Pancreatitis

Gastrointestinal fistulas Bone marrow transplantation Acute intestinal disease

Hypermetabolic states Chronic idiopathic intestinal pseudo-obstruction

Antibiotic colitis, necrotizing enterocolitis, inflammatory bowel disease, chronic or secretory diarrhea Burns, multiple trauma

Adapted from Hendricks KM, Duggan C, and Walker WA (eds.) (2000) Manual of Pediatric Nutrition, 3rdedn., London: BC Decker.

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