Intravenous Lipid Emulsions in the NICU.

The clinical goals of intravenous lipid emulsions (ILEs) have changed since their initial development. In the past, 100% soybean oil was used to provide energy and prevent an essential fatty acid deficiency. Now, different oil sources are used with the goal of improving nutritional status and preventing common neonatal comorbidities. We now have a better understanding of specific ILE constituents, namely, fatty acids, vitamin E, and phytosterols, and how these components contribute to complications such as intestinal failure-associated liver disease. This review addresses the development and composition of different ILEs and summarizes how individual ILE ingredients affect infant metabolism and health.

The Development of Total Parenteral Nutrition.

The first patient to receive complete nourishment of a patient by intravenous infusion independent of the alimentary tract was an infant girl born with near-total small bowel atresia. Total parenteral nutrition, the intravenous infusion of nutrients, has been attempted since Harvey's description of the circulatory system in the early 17th century. The modern era of parenteral nutrition began in the early 20th century, when infusions of glucose, plasma, and emulsified fat into humans proved feasible. Robert Elman, working in the 1930s and 1940s, demonstrated that carefully prepared protein hydrolysates could be safely infused intravenously and incorporated by the body. Stanley Dudrick and Douglas Wilmore, surgeon researchers at the University of Pennsylvania, worked through the many details of preparation, administration, and clinical monitoring in beagle puppies before testing them on adult patients malnourished from a variety of surgical complications and gastrointestinal conditions. They applied their techniques and formulations on a newborn wasting away from congenital absence of the small bowel, the baby growing and developing for several months while being nourished completely by total parenteral nutrition. Their techniques, inspired by patients with progressive malnutrition from devastating intestinal conditions and malformations, form the basis of the practice of intravenous nutrition practiced today.

Jonathan Roads Symposium Papers. History of parenteral nutrition.

A survey is given of the development of parenteral nutrition with the beginning of William Harvey's fantastic discovery of the circulation to today's discussion of what is an optimal regime of parenteral nutrition. The important and different steps of development during the 17th and 19th centuries are discussed. The modern steps during the last century leading to the concept we have today of parenteral nutrition is mentioned, with reference to all pioneers all over the world. Glucose, protein hydrolysates and crystalline amino acids, development of safe fat emulsions, and the current concepts of parenteral nutrition and future considerations are discussed.

Parenteral nutrition.

Parenteral nutrition therapy was born 35 to 40 years ago when the first steps were taken to perform a protein nutrition by the intravenous supply of amino acids in man. Since that time, many efforts have been made to supply adequate amounts of energy intravenously. These efforts have resulted in the two available systems for parenteral nutrition: the lipid-carbohydrate system and the glucose system. The lipid-carbohydrate system, which corresponds to the nutrient content of normal food, may be given either in a peripheral vein or through a central vein catheter. The glucose system is administered through a central venous catheter. Many problems concerning the parenteral nutrition need to be solved and further elucidated. However, our present knowledge and technique in this field are far advanced over earlier methods. Now all patients who cannot take food in adequate amounts orally or enterally may be kept in good nutritional status by parenteral nutrition. In this way it is possible to prevent starvation and its complications in these patients.