Total Parenteral Nutrition Date Revised: August 2013 Neonatology Clinical Guidelines

Parenteral Nutrition (TPN) is intravenous nutrition that is administered to assist in meeting the infant’s nutritional requirements for growth and development when enteral feeding is withheld or delayed INDICATIONS FOR TPN- Prematurity <32 weeks gestation and/or <1500g.- Infants <35 weeks who are unlikely to achieve full enteral feeds by day 5.- Necrotising enterocolitis (NEC).- Surgically correctable gastrointestinal tract anomalies (exomphalus, gastroschisis, tracheooesophageal fistula etc.).- Prolonged NBM due to other surgery e.g CDH- Short bowel syndrome. ADMINISTRATION TPN can be administered through peripheral or central lines. Concentrations of>12.5 % glucose must be given via a central vein catheter. Rates of infusion do not normally exceed 140 mL/kg/d. If a prolonged period of TPN is anticipated a percutaneous central venous catheter can be placed. The position of the tip of the catheter needs to be in a large vessel preferably the superior or inferior vena cava outside the heart with position confirmed by x-ray prior to use (see protocol for central line insertion. A strict sterile aseptic technique in preparation and administration of the TPN is essential. PROVISION OF TPN In the absence of exogenous protein, a preterm infant will catabolise 1g/kg/day of their own body protein to meet their metabolic needs. Therefore the prompt introduction of glucose and amino-acids via TPN achieves an early positive nitrogen balance for the infant