Parenteral nutrition in the neonatal intensive care unit

Neonatal parenteral nutrition (PN) is readily available in many hospitals and plays an essential role in the management of sick and growing preterm and term infants. PN can be used as the sole source of nutrition support for infants who cannot be fed or as an adjunct to enteral feeding. Preterm infants are a particularly vulnerable population because they are born at a time, if they had remained in utero, of rapid intrauterine brain and body growth. The impact of early malnutrition can have long-lasting negative effects on central nervous system development and growth. Despite this, PN is often provided to preterm infants based on local traditions rather than experimental evidence. The quality of PN and its early initiation are critical in providing the most adequate substrates for appropriate development. This article reviews the energy and fluid requirements of infants and presents by component (protein, carbohydrates, lipids, minerals such as calcium and phosphorus, trace elements, and multivitamins) the available literature on neonatal PN and its complications. In addition, suggested guidelines for PN administration for preterm and term neonates are presented.