From the Guidelines
Total parenteral nutrition (TPN) in pediatric surgery is indicated for patients with short bowel syndrome, prolonged ileus or bowel obstruction, severe inflammatory bowel disease, high-output enterocutaneous fistulas, and severe malabsorption syndromes, as well as those with critical illness and hypermetabolism, or malnourished children requiring preoperative nutritional optimization 1.
Indications for TPN
The primary indications for TPN in pediatric surgery include:
- Short bowel syndrome following extensive bowel resection
- Prolonged ileus or bowel obstruction
- Severe inflammatory bowel disease
- High-output enterocutaneous fistulas
- Severe malabsorption syndromes
- Critical illness with hypermetabolism, such as major burns or trauma, when enteral feeding is insufficient
- Preoperatively, for malnourished children requiring nutritional optimization before major surgery
Considerations for TPN
TPN should be considered when enteral feeding is impossible, inadequate, or unsafe for more than 5-7 days, or when a child has lost more than 10% of body weight 1. The decision to initiate TPN must balance the benefits of improved nutritional status against potential complications like catheter-related infections, metabolic disturbances, and liver dysfunction.
TPN Formulations
TPN formulations for children must be carefully calculated based on age, weight, and specific nutritional requirements, typically providing 80-120 kcal/kg/day with appropriate proportions of protein (2-3 g/kg/day), carbohydrates, lipids, vitamins, minerals, and trace elements 1.
Monitoring and Management
Regular monitoring of electrolytes, liver function, and nutritional parameters is essential to prevent and manage complications 1. Standard parenteral solutions should generally be used over individualized PN solutions in the majority of pediatric and newborn patients, including VLBW premature infants, unless the nutritional requirements cannot be met by the available range of standard PN formulations 1.
From the Research
Indications for TPN in Paediatric Surgery
The indications for Total Parenteral Nutrition (TPN) in paediatric surgery include:
- Intestinal fistulas, severe short bowel syndrome, unresolving pancreatitis, advanced inflammatory bowel disease, delayed postoperative gastrointestinal function, developmental anomalies of the intestinal tract, protracted diarrhea of infancy, and hypermetabolic states 2
- Conditions where a pediatric patient cannot eat or be tube-fed enterally after 3 days of recovery and support with fluids, such as gastroschisis, short-bowel syndrome, necrotizing enterocolitis, and Hirschsprung's disease 3
- Malnutrition, which can be identified through standard techniques of nutritional assessment, and where the gastrointestinal tract cannot be utilized 4
Specific Conditions
TPN may be indicated in specific conditions, including:
- Inflammatory bowel disease, where TPN can restore the patient's impaired nutritional status and allow bowel rest while supplying adequate calorific intake and essential nutrients 5
- Pediatric and adolescent patients undergoing continent urinary tract reconstruction, where malnutrition is common and TPN may be associated with worse surgical outcomes in patients with a bowel anastomosis 6
Contraindications
Contraindications to the use of TPN in pediatric patients include:
- Severe congenital (usually genetic) defects and terminal cancer, conditions in which life expectancy and quality of life are severely decreased 3