Parenteral nutrition for preterm infants: benefits and risks in 2025
Nicholas D. Embleton, Chris H.P. van den Akker, Mark J. Johnson
Abstract
Parenteral nutrition (PN) has been a key component of neonatal care for preterm infants since the 1980's and provides macronutrients for growth, along with electrolytes, minerals, vitamins and trace elements.In this article we consider common issues with routine provision to very preterm infants including estimation of nutrient requirements, optimal starting doses of PN, rates of increase and maximum intakes.We consider monitoring strategies and outline common complications which may be serious and fatal.Finally, we consider risk-benefit ratios in different populations of preterm infants, and outline some of the major uncertainties in current practice. Practice points Parenteral nutrition (PN) can be started on admission to the Neonatal Intensive Care Unit (NICU) for most very preterm infants. Starting doses of 1-2 g/kg/day of amino acids and 1-2 g/kg/day of intravenous lipid are usually well tolerated. PN improves growth and lean mass accretion whilst enteral feeds are being established. Enteral nutrition is always preferable to PN when milk feeding is safe and well tolerated. PN requires biochemical monitoring and robust clinical governance to reduce risks, some of which can be serious or fatal.Research agenda Optimal PN macronutrient intakes for very preterm infants PN needs during critical illness Long term cognitive and metabolic outcomes of differing PN regimes Cognitive impact of newer multicomponent intravenous lipids