Parenteral Nutrition

Since the gastrointestinal tract of the preterm infant is immature, substantive enteral nutrition is not possible in the first 2-3 weeks after birth, especially in those infants whose birth weights are less than 1500 g; therefore, the preterm infant is dependent on intravenous fluid for the bulk of fluid needs. Parenteral nutrition (PN) is basically the infusion of a nutrient solution into the circulation. Its development has allowed for the provision of nutrients during the time that enteral nutrition cannot meet nutrient needs. The use of PN has reduced the cata-bolism that occurs until full enteral nutrition can be achieved. PN should definitely be considered in infants whose birth weights are <1500 g and/or gestational age <30 weeks. It may also be needed for the infant whose birth weight is between 1500 and 2000 g and/or gestational age 30-32 weeks especially if the initiation or progression of enteral feeding is likely to be prolonged.

Historically, parenteral nutrition was delayed for several days after birth, probably due to metabolic instability of the infant and concern for tolerance of the components in the solution. More recently, the early use of PN has been recommended within 24 h after birth. This practice minimizes the interruption of nutrient delivery and the catabolism that occurs when only dextrose solutions are infused.

Parenteral nutrition can be administered by two different routes. There are both risks and benefits associated with each route. In the early days of parenteral nutrition it was always infused via an indwelling, surgically placed catheter into a central vein. Since some of the complications with this method were related to the catheter, the use of peripheral veins for infusion became popular and is still employed today. The dextrose concentration of peripheral PN is limited to ~10%; thus, the nutrient intake by this route is somewhat limited without excessive fluid intake. Peripheral parent-eral nutrition is usually recommended when its use will be of short duration. While peripheral lines are considered less risky complications can occur. If the intravenous line infiltrates some infants have experienced serious deep sloughing, sometimes requiring skin grafts. These lines require vigilance on the part of nursing to prevent infiltrates and some infants will have multiple intravenous attempts daily because the line needs to be replaced. The advent of the percutaneously inserted central catheter and its liberal use in the last few years has improved and stabilized the delivery of parenteral nutrition to the preterm infant. Central parenteral nutrition is recommended when it is anticipated that it will be used for >5-7 days, usually in infants weighing <1000-1250 g. If the infant tolerates glucose and clears lipids well it is possible to meet estimated nutrient needs using this route. Complications such as pneumothorax, pleural effusions, and increased risk of sepsis are associated with central lines (Table 2).

Getting Back Into Shape After The Pregnancy

Getting Back Into Shape After The Pregnancy

Once your pregnancy is over and done with, your baby is happily in your arms, and youre headed back home from the hospital, youll begin to realize that things have only just begun. Over the next few days, weeks, and months, youre going to increasingly notice that your entire life has changed in more ways than you could ever imagine.

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