Parenteral nutrition in premature infants

Optimizing postnatal nutritional supply is a major challenge in premature infants despite recent studies evaluating how to improve early nutritional support. Severe cumulative nutritional deficits may occur with adverse consequences on both short- and long-term outcomes. Complete enteral feeding is frequently delayed in premature infants and parenteral nutrition represents essential therapeutic option for these infants. Available recommendations suggest starting parenteral nutrition as soon as possible after birth and rapidly attaining adequate intakes with a well-balanced solution in order to promote anabolism, to improve clinical outcomes, and to avoid biological disorders. A minimum intake of 40-60 kcal/kg*d with 2-3 g/kg*d of amino acids, 1-2 g/kg*d of lipids and sufficient minerals is now recommended from the first hours of life in all premature infants. After immediate postnatal adaptation, intakes should rapidly increase during the first week of life, up to 90-120 kcal/kg*d with about 3-4 g/kg*d amino acids, 3-4 g/kg*d of lipids and adequate amounts of electrolytes, minerals, trace elements and vitamins. There is a wide range of variation in parenteral nutrition practices among the neonatal units. This chapter discusses the principal theoretical aspects of parenteral nutrition in premature infants, the recommendations and the opportunity to routinely optimize nutritional support, especially in very premature infants