Total parenteral nutrition (TPN) is a method of feeding that bypasses the gastrointestinal tract. Fluids are given into a vein to provide most of the necessary nutrients the body needs. The method is used when a person cannot or should not receive feedings or fluids by mouth.
Sick or premature newborns may be given TPN before starting other feedings or when they cannot absorb nutrients through the gastrointestinal tract for a long time. TPN delivers a mixture of fluid, electrolytes, calories, amino acids, vitamins, minerals, and often fats into an infant's vein. TPN can be lifesaving for very small or very sick babies. It can provide a better level of nutrition than regular intravenous (IV) feedings, which provide only sugars and salts.
The infants requirements for nutrition must be closely monitored. Blood and urine tests help can alert the health care team if any adjustments are needed.
HOW IS TPN GIVEN?
An IV line is often placed into a vein in the hand, foot, or scalp of the baby. The belly button also has a large vein (umbilical vein) that may be used. Sometimes a longer IV, called a central line or peripherally-inserted central catheter (PICC) line, is used to provide long-term IV feedings. This type of IV can deliver a higher concentration of nutrients to larger veins located centrally in a baby’s body.
WHAT ARE THE RISKS?
While TPN is a major benefit for babies who cannot otherwise feed, such feedings can result in blood sugars, fats, or electrolytes that are too low or too high.
Problems can develop due to use of the TPN or IV lines. The line may become dislodged or clots may form. A serious infection called sepsis is a possible complication of a central line IV. Infants who receive TPN will be closely monitored by the health care team, since complications can be serious and are not unusual.
Prolonged use of TPN may lead to liver problems.
American Society for Parenteral and Enteral Nutrition - Professional Association. Guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients. JPEN J Parenter Enteral Nutr. Jan-Feb 2002;26(1 Suppl): 1SA-6SA.
American Society for Parenteral and Enteral Nutrition - Professional Association. Normal requirements - pediatrics. JPEN J Parenter Enteral Nutr. Jan-Feb 2002;26(1 Suppl):25SA-32SA.
Parenteral nutrition. In: Pediatric Nutrition Handbook. 6th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2009; chap 22.
Kimberly G Lee, MD, MSc, IBCLC, Associate Professor of Pediatrics, Division of Neonatology, Medical University of South Carolina, Charleston, SC. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.