Pharmaceutical Services Division, Ministry of Health Malaysia
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Pharmacist's Handbook of Parenteral Nutrition: In Neonates and Paediatrics
Implementing parenteral nutrition (PN) in paediatric patient could be challenging due to the wide range of patients, ranging from extremely premature infants up to teenagers that could be weighing more than 100kg. Therefore, it is extremely important to take into account of patient’s age and maturity related changes of the metabolism, fluid and nutrient requirement along with clinical situation in which PN is applied.
Therefore, the substrate requirements of paediatric patient cannot be proportionally derived from adult requirement but are determined according to age-specific and physiological conditions.
In comparison to older paediatric patient or adults, term and preterm infants have different energy requirements due to an extremely low body storage of nutrients in many aspects. This include immature gastrointestinal system, high metabolic rates and the tendency to suffer from evaporative fluid losses, thus requiring a carefully monitored intake to suit their specific requirements.
The goals of Parenteral Nutrition (PN) in paediatric patients are to:
- Provide sufficient nutrients to prevent negative energy and nitrogen balance.
- Prevent essential fatty acid deficiency.
- Support normal rates of growth without increased significant morbidity.