Information: Triglycerides and parenteral nutrition

Triglycerides (TG) and parenteral nutrition: reduce dose of lipids if concentrations >25 mg/mL in infant or >40 mg/mL in older children
If hypertriglyceridaemia: increase lipids by 0.5 g/kg/day and monitor TGs
Note high risk for raised TGs: ELBW infants, sepsis and critical illness, higher lipid dose

Hypertriglyceridaemia

Acute rises in triglycerides increases left ventricular contractility and can induce acute pancreatitis
Risk for sepsis, diabetes and liver damage, and can be associated with hyperglycaemia, as excess carbohydrate can be converted to fatty acids
If acute and severe, insulin has been used to treat

Parenteral nutrition components

NB: see ESPGHAN guidelines for detailed overview of PN components and use, and cautions including manganese and aluminium toxicity.

PN consists of a complex mixture of macro- and micro-nutrients.
Most hospitalised children’s needs will be met by about 100–120% of resting energy expenditure, which may need to rise to 130–150% if malnourished (see ESPGHAN guidelines for PN)
Lipids are more calorie dense than glucose and allow smaller total volumes of fluid for the same total calorie intake, and a lower total osmotic load
Balancing lipid and carbohydrate helps prevent hepatic steatosis, as too high a glucose load results in lipogenesis and impaired protein metabolism, and high lipid dosing is associated with intestinal failure-associated liver disease (IFALD)
Amino acids are needed to maintain positive nitrogen balance

Protein (Table 45.1)

Provided as amino acid solution
Mixture of essential/non-essential/conditionally essential amino acids for protein synthesis
A minimum of 1–1.5 g/kg to prevent a negative nitrogen balance; max 4 g/kg/day in premature babies decreasing to about 2 g/kg/day in older children

Table 45.1 Amino acid preparations for parenteral nutrition

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