Total Parenteral Nutrition (TPN) via Peripheral Veins in Neonatal Surgical Patients

ABSTRACT

Parenteral nutrition has been an essential part of postoperative care of neonates requiring major surgery soon after birth followed by prolonged period of no allowable enteral feeding. However, TPN via central venous catheters (central TPN), used in increasing trend, still presents significant morbidity. To find out whether TPN via peripheral veins (peripheral TPN) could be used as a viable alternative for postoperative parenteral nutrition in neonates, a clinical study was carried out by a retrospective analysis of 53 neonates subjected to peripheral TPN for more than 7 days after surgery for esophageal atresia with tracheoesophageal fistula, gastroschisis and omphalocele at the Division of Pediatric Surgery, Hanyang University Hospital, from 1983 to 1994. The mean total duration of TPN was 13.3 days (range 7-58 days), the average daily total fluid intake was 117.6 ml/kg during TPN and 158.6 ml/kg during subsequent oral feeding. The average daily total calorie intake was 57.7 kcal/kg during full strength TPN and 101.3 kcal/kg during oral feeding. The mean urine output was maintained at 3.5 ml/kg/hour during TPN and at 3.6 ml/kg/hour during oral feeding. The increment of body weight observed during TPN was 132gm in TEF, 53gm in gastroschisis and 3gm in omphalocele patients, while loss of body weight was not oberved in each group. The mortality rate was 5.7% (3/53), related to underlying congenital anomalies but not to TPN. The common complications were laboratory findings suggestive of liver dysfunction in 23 cases (43.4%) with no significant clinical symptom or signs in any case, transient pulmonary edema in one case, and generalized edema in one case. The result of the study suggests that peripheral TPN could be used for adequate postoperative nutritional support in neonates requiring about 2 to 3 weeks TPN.