Infants total parenteral nutrition

To define the incidence of fractures and rickets that we were encountering in infants who required prolonged parenteral feeding, we reviewed the roentgenograms of a series of preterm infants who developed necrotizing enterocolitis and who required at least four weeks of total parenteral nutritional support (4). These data are recorded in Table I. 

Equally, demonstrating that a compound has a physiological function as a coenzyme or hormone does not classify that compound as a vitamin. It is necessary to demonstrate that endogenous synthesis of the compound is inadequate to meet physiological requirements in the absence of a dietary source of the compound. Table 1.3 lists compounds that have clearly defined functions, but are not considered vitamins because they are not dietary essentials endogenous synthesis normally meets requirements. However, there is some evidence that premature infants and patients maintained on long-term total parenteral nutrition may be unable to meet their requirements for carnitine (Section 14.1.2), choline (Section 14.2.2), and taurine (Section 14.5.3) unless they are provided in the diet, and these are sometimes regarded as... 

In addition to the established vitamins, a number of organic compounds have clear metabolic functions they can be synthesized in the body, but it is possible that under some circumstances (as in premature infants and patients maintained on long-term total parenteral nutrition) endogenous synthesis may not be adequate to meet requirements. These compounds include biopterin (Section 10.4), carnitine (Section 14.1), choline (Section 14.2), creatine (Section 14.3), inositol (Section 14.4), molybdopterin (Section 10.5), taurine (Section 14.5), and ubiquinone (Section 14.6). 

Persons at risk for EFA deficiency tend to be the same as those at risk for vitamin E deficiency. Some signs are shared by both defidencies. Premature infants may be at risk for EFA deficiency because of their low stores of lipids and their rapid growth, especially when they are fed diets that do not contain EFAs. For example, fats have been omitted from diets used to feed preterm infants (to avoid a variety of complications). EFA deficiency may develop later in life with fat malabsorption syndromes, EFA deficiency has presented in adults fed by total parenteral nutrition for longer periods, where EFAs had not been included in the liquid diet. 

Kaneko K, Shimizu T, Nagaoka R, Fujiwara S, Igarashi J, Ohtomo Y, Yamashiro Y. Megaloblastic anemia in an infant receiving total parenteral nutrition. Pediatr Int 2002 44(l) 101-2. 

Chou YH, Yau KI, Hsu HC, Chang MH. Total parenteral nutrition-associated cholestasis in infants clinical and liver histologic studies. Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi 1993 34(4) 264-71. 

Greene HL, Hambidge KM, Schanler R, Tsang RC. Guidelines for the use of vitamins, trace elements, calcium, magnesium, and phosphorus in infants and children receiving total parenteral nutrition report of the Subcommittee on Pediatric Parenteral Nutrient Requirements from the Committee on Clinical Practice Issues of the American Society for Chnical Nutrition. Am J Clin Nutr 1988 48 1324-42. 

Also at risk are those with chronic renal disease infants receiving formula (particularly total parenteral nutrition solutions containing considerable Al which comes from Ca and phosphate sources) and those who consume pharmaceuticals, such as antacids containing Al (Syracuse 1999). 

Noeose N and Aeai K (1987) Analysis of manganese deficiency in an infant receiving long-term total parenteral nutrition (TPN) (in Japanese). Jpn J Parent Ent Nutr 9 978-981. 

In the only study that has investigated total parenteral nutrition in infants, intakes of 150ml/kg/day, with no enteral component, suppfied a mean iodide intake of... 

MCFA are fatty acids with 6-12 carbon atoms and are often used for production of SL. As mentioned earlier, MCFA are highly susceptible to 3-oxidation (31). These fatty acids are not stored in the adipose tissues and are often used in the diet of patients with maldigestion and malabsorption (32). They have also been employed in total parenteral nutrition and formulas for preterm infants. In addition, calorie-reduced SL containing MCFA have recently been developed and represent exciting new application areas (33). 

Bresson JL, et al. Energy substrate utihzation in infants receiving total parenteral nutrition with different glucose to fat ratios. Pediatr Res. 1989 25(6) 645-8. 

Copper deficiency + + + + Unlikely in the absence of low birth weight, total parenteral nutrition, low-copper diet or in a term infant in the first 6 months of life... 

This review will focus first on the effect of providing total parenteral nutrition (TPN) on the outcome of various nutrient-depleting diseases in infants, then on a discussion of the need for, and metabolism of, new essential nutrients which are recommended for inclusion in TPN regiments biotin, carnitine, zinc, copper, iron, and others. 

Total Parenteral Nutrition in the Newborn Table III. Diagnosis of Infants Receiving TPN in the Neonatal Intensive Care Unit at the Hospital for Sick Children (Toronto) During 6 Mo of 1982 ... 

Filler, R. M., and Coran, A. G., 1976, Total parenteral nutrition in infants and children Central and peripheral approaches, Surg. Clin. N. Amer. 56 395. 

Gunn, T., Reaman, G., and Outerbride, E. W., 1978, Peripheral total parenteral nutrition for premature infants with respiratory distress syndrome A controlled study, J. Pediatr. 92 608. 

Penn, D., Schmidt-Sommerfeld, E., and Wolf, M., 1980, Carnitine deficiency in premature infants receiving total parenteral nutrition. Early Hum. Rev. 4 23. 

Seashore, J. H., and Seashore, M. R., 1976, Protein requirements of infants receiving total parenteral nutrition, J. Pediatr, Surg. 11 645. 

Karpel and Peden (1972) have also reported an infant who developed symptomatic copper deficiency despite seven blood transfusions and four plasma transfusions. After 236 days of total parenteral nutrition the serum copper was 9 pg/lOO ml. Following 2.5 mg of oral copper per day there was prompt improvement but complete recovery required approximately 3 weeks. 

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