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Neonatal & Pediatric TPN

Instructor: Justine Fritzel

Justine has been a Registered Nurse for 10 years and has a Bachelor's of Science in Nursing degree.

There are times when a patient is unable to eat or tolerate nutrition through the gastrointestinal tract for various reasons. In these times, TPN is needed to meet nutritional requirements. In this lesson, we will learn about neonatal and pediatric TPN use.

What is Parenteral Nutrition?

Sherry is the mother of a 6-month-old baby girl. Over the last week, her baby had been sick and she wasn't eating and when she did, she would throw up. Sherry takes the very ill baby to the hospital and she was admitted to the pediatric unit. The nurses start a couple IV lines and have different fluids going through those. Sherry is quite distraught and is demanding that they feed her baby so she doesn't starve.

Total parenteral nutrition (TPN) is a solution of essential nutrients to provide nutrition to a patient. Parenteral refers to administering a solution through the veins. In contrast, enteral refers to nutrition being taken in through the stomach and gastrointestinal (GI) tract. The nurses comfort Sherry and educate her on the fact that one of the IVs has TPN running through it to provide her baby with some nutrition since she has been too ill to eat.

TPN is a solution that includes several essential ingredients. It consists of proteins in a solution of amino acids. It has carbohydrates and glucose which provide an energy source. It also provide fat in the form of fatty acids that are a very concentrated energy source as well. In addition to these ingredients, it provides electrolytes, minerals, trace elements and vitamins. There is also heparin in the mixture to help keep the IV line patent. Amazing how a solution can include so many nutritional substances!

When is Parenteral Nutrition Indicated for Neonatal and Pediatric Patients?

Neonatal patients, newborn babies, may have needs for TPN. Premature newborns that have a low birth weight will likely need to use TPN. These tiny babies have medical concerns that may include immature lungs, low body temperature, infections, or low blood pressure. They are sick little babies that will likely not tolerate enteral feedings. Research shows that inadequate nutrition in the first two weeks of life for these babies can result in growth failure that is difficult to correct and may result in permanent detrimental effects.

So we know these premature babies need nutrition but research also shows that starting enteral feedings too early can cause complications such as feeding intolerances or an infection of the intestine called necrotizing enterocolitis.

Starting parenteral nutrition promptly for these premature babies can minimize weight loss, increase growth, and improve their neurological development. Overall the use of TPN reduces the risk of mortality of these little babies.

TPN can also be used to provide nutrition in other situations for neonatal and pediatric patients. This is an option if the child has a congenital anomaly that makes them unable to take food through their stomach and GI tract. Other GI issues such as inflammatory bowel disease, necrotizing enterocolitis, and short bowel syndrome are situations in which TPN would be used.

If a baby or child is ill in the ICU they may be in a hypercatabolic state meaning they have increased metabolic breakdown that can result in weight loss and muscle wasting. These children would benefit from TPN use. Lastly, any healthy or ill baby or child that is not able to eat for an extended amount of time would be a candidate for TPN.

Risks and Possible Complications

There are risks associated with the use of TPN. The fact that it has to be administered through an IV causes the increased risk of infection. The TPN solution consists of many elements and therefore risks include abnormal levels in the body such as acidosis, increased ammonia, increased or decreased blood sugars, and increased lipids. Other risks include affecting the lungs, kidneys, or liver.

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