What is Neonatal Parenteral Nutrition?

Neonatal parenteral nutrition supplies needed fluids and nutrients for babies who are unable to eat or maintain adequate nutrition in other ways. Partial parenteral nutrition (PPN) supplements oral intake, and total parenteral nutrition (TPN) provides all of a baby's daily nutritional needs. Neonatal parenteral nutrition feeds a newborn baby intravenously, through an intravenous (IV) line that supplies nutrition directly through the bloodstream instead of through the baby's gastrointestinal tract.

The total parenteral nutrition solution includes water, amino acids, energy, fatty acids, and minerals and vitamins. The nutrition solution is modified based on the baby's lab results, hypermetabolism, or diagnosed disorder. The solution is infused intravenously and continuously for several hours each day.

Neonatal parenteral nutrition is often prescribed in a neonatal intensive care unit, but it can also be used at home or in another medical facility environment. The solutions used for parenteral nutrition are concentrated, so the treatment usually requires a central venous catheter. When a baby’s gastrointestinal (GI) tract is immature, intravenous feeding may be necessary to maintain neonatal health. Parenteral nutrition is not generally recommended for babies — or even adults — with an intact and functioning GI tract. Medical complications are more likely with intravenous nutrition, but it's often the only feasible option for babies with conditions that require complete bowel rest.

Though neonatal parenteral nutrition provides the nutrition a baby needs to grow and thrive, complications are a risk. The IV line increases the possibility of infection; babies treated with partial or total parenteral nutrition are carefully monitored and often treated with antibiotics if infection is detected or even suspected. Premature babies are sometimes at risk of hyperglycemia, an elevated blood sugar level, or they may experience increased levels of triglycerides if their liver functions are not optimal. Prolonged treatment with total parenteral nutrition also risks cholestasis, which affects the flow of bile from the baby's liver. Untreated, cholestasis can lead to jaundice.

Partial parenteral nutrition is sometimes used to supplement normal feeding for a baby with health problems. Small enteral feedings may be used in conjunction with parenteral nutrition treatment to stimulate metabolic function in the baby's system. The combination of treatments is carefully prescribed, monitored, and adjusted depending on the baby's progress.

Babies born prematurely are more likely than full-term babies to require neonatal parenteral nutrition, because the GI tract of a premature baby is immature. The GI tract is fully formed at the 20th week of pregnancy, but it's not yet fully functional. The normal intestinal contractions, known as peristalsis, that move food through the digestive system are not functional until about the 29th week, and enzymes necessary for milk digestion often aren't adequately produced by a premature baby. The physical coordination a baby needs for sucking and swallowing usually do not develop until the 34th week of pregnancy.

Other situations or medical conditions may indicate the need for neonatal parenteral nutrition. A baby breathing with the help of a ventilator, for example, cannot be breast-fed or bottle-fed. A baby with ulcerative colitis, Crohn's disease, or an obstructed bowel may require parenteral nutrition to rest the bowels and let the digestive system heal. Some GI disorders in babies, such as prolonged diarrhea or certain anomalies in the gastrointestinal tract, may also require the use of parenteral nutrition.