Pediatrics in Review
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(Pediatrics in Review. 1980;2:99-106.)
© 1980 American Academy of Pediatrics
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Total Parenteral Nutrition in Pediatric Patients

Joseph S. Levy MD1
Robert W. Winters MD1
William C. Heird MD1
 1 Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York

Total parenteral nutrition (TPN), ie, provision of all nutrients solely by the parenteral route, has been a clinical reality for approximately a decade. This era began with the demonstration that animals could be maintained solely with parenteral nutrients for as long as one year. Subsequently, apparently normal growth and development of an infant with little remaining small intestine was demonstrated. 1 In pediatrics, TPN is used routinely in infants with intractable diarrhea as well as in patients with many surgically correctable lesions of the gastrointestinal tract. 2 The technique as initially described or with special modifications has also been used in older children and adolescents with inflammatory bowel disease as well as a number of other chronic diseases (eg, cystic fibrosis, renal failure, malignancies). In addition, some enthusiasm exists concerning the possibility of maintaining sick, prematurely born infants with or without overt gastrointestinal disease solely with parenteral nutrients.

As with any new clinical technique, enthusiasm for total parenteral nutrition has waned and waxed. Several modifications of the technique have been introduced—some beneficial, some not. A number of actual and potential problems of the technique have been identified. Methods for controlling some of these have been found but others persist. The purpose of this review is to summarize the current status of parenteral nutrition in pediatrics.




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