Consultation with the Specialist
The Role of Peripheral Venous Nutrition During Childhood
Alan M. Lake MD1
1 Associate Professor of Pediatrics, Johns Hopkins University, Baltimore, MD.
Case History
A previously healthy 2-year-old presents to the local emergency room having an acute abdomen, anemia, and peritonitis. At laparotomy, a perforation of the proximal ileum with a Meckel diverticulum is discovered. Following a limited resection and reanastomosis, the child will remain NPO for at least 1 week, longer if septic complications ensue. Intravenous nutrition, therefore, will be required for at least 1 week, and you are asked to advise how this best can be accomplished.
Discussion
Over the past several decades, major advances in nutritional therapy have presented the pediatrician with a number of responses to a child's nutritional needs. This spectrum ranges from ad lib oral intake when enteric function and access are intact to total venous nutrition when enteric function is lost. A child's position on this spectrum, of course, is never fixed over time, thus mandating regular reassessment and adjustment of nutritional therapy. As enteric function declines, appetite is reduced and oral supplements are initiated. When enteric function reaches the point that not even tube feedings can meet the child's need, intravenous nutrition is initiated.
It is amazing to realize that total peripheral venous nutrition was first described nearly 50 years ago when Helfrick and Abelson reported in 1944 the successful "intravenous delivery of a complete diet to a child."
