JPEN J Parenter Enteral Nutr 1993 Jul-Aug;17(4 Suppl):33SA-38SA [46 references] RELEASE DATE:
1993 Jul-Aug (reaffirmed 1999)
MAJOR RECOMMENDATIONS:
Grade of evidence (A-C) definitions are listed at the end of the Major Recommendations field.
Practice Guidelines for low-birth-weight (LBW) infants:
Parenteral nutrition is indicated for selected LBW infants during the first few days after birth before enteral nutrition is initiated, and as a supplement while enteral nutrition is being advanced. (A)
Parenteral nutrition
can be initiated 1 or 2 days after birth. Protein, fat, and dextrose content of the formula are generally increased over several days. (B)
Parenteral nutrition can be maintained by the peripheral route during the first few
weeks after birth before a central catheter is considered. Maintenance of peripheral access often dictates the timing of central intravenous line placement. (C)
Enteral nutrition support is graded increments should be provided
as medically indicated. Breastfeeding, when possible, or expressed human milk feedings should be encouraged. Parenteral nutrition should not replace enteral nutrition unless the latter has failed or is precluded by medical indications.
(B)
Intravenous lipid emulsions are indicated for the prevention of essential fatty acid deficiency, for maintenance of substrate for central nervous system growth, and as an additional isotonic nonprotein calorie source.
(A)
Protein, electrolyte, mineral, vitamin, and trace element status should be appropriately monitored, and when possible nutritional interventions modified accordingly. (C)
Specific considerations: Necrotizing Enterocolitis in LBW Infants:
Cautious introduction of enteral nutrition should be considered for LBW infants. (B)
Parenteral nutrition should be provided when enteral nutrition is discontinued because of suspected or proven necrotizing enterocolitis.
(A)
The parenteral amino acid concentration should be increased by 10% to 30% for proven cases of necrotizing enterocolitis. (C)
Protein and mineral status should be monitored frequently to assess additional needs
during the parenteral nutrition interval. (C)
Enteral nutrition should be reintroduced gradually only when the necrotizing enterocolitis has resolved, as evidenced by heme test-negative stool. (C)
Specific considerations: Bronchopulmonary Dysplasia in LBW Infants:
Enteral nutrition support should be provided if possible to LBW infants with bronchopulmonary dysplasia. (C)
Parenteral nutrition should be administered to bronchopulmonary dysplasia patients when satisfactory enteral
support cannot be provided. (C)
When parenteral nutrition is used exclusively or as a supplement to enteral support cannot be provided. (C)
Calcium, phosphorus, and magnesium requirements may be increased with the use
of high-ceiling diuretic therapy. (B)
Definitions:
There is good research-based evidence to support the recommendation.
There is fair research-based evidence to support the recommendation.
The recommendation is based on expert opinion and panel consensus.
CLINICAL ALGORITHM(S):
None provided
DEVELOPER(S):
American Society for Parenteral and Enteral Nutrition (ASPEN) - Professional Association
COMMITTEE:
Parenteral and Enteral Nutrition Technical Advisory Group
GROUP COMPOSITION:
The Technical Advisory Group members represent expertise in internal medicine and surgery, clinical care and research in nutrition, adult and pediatric medicine, and the four health professions (medicine,
nursing, pharmacy, and dietetics) represented in the Society.
Members of the Parenteral Nutrition Group:
John M. Daily, MD (chairman); Stacey Bell, MS, RD, CNSD; Gordon Klein, MD; Linda S. Knox, MS, RN, CNSN; Edward W. Lipkin, MD, PhD; Robert Rapp, PharmD.
Members of the Enteral Nutrition Group:
Steven B. Heymsfield, MD (chairman); Jacqueline Barber Pihlstrom, PharmD; Michele Gottschlich, PhD, RD, CNSD; Genie Moore, PhD, RD, RN, CNSN; Genie Moore, PhD, RD, RN, CNSN; Jennifer Nelson, MS, RD, CNSD; J. Nevin Isenberg, MD; Vivien Morris, MS, RD; Karyl Rickard, PhD, RD; Christine Tinstman, RN; Sally Weisdorf, MD; Harland S. Winter, MD.
ENDORSER(S):
Not stated
GUIDELINE STATUS:
This is the current release of the guideline.
According to the guideline developer, this guideline has
been reviewed within the last five years and is still considered to be current.
An update is in progress at this time; the revised guidelines are expected to be released in 2001.
GUIDELINE AVAILABILITY:
Electronic copies: Not available at this time.
Print copies: Available from the American Society for Parenteral and Enteral Nutrition (ASPEN), 8630 Fenton St, Suite 412, Silver Spring, MD
20910-3805; (800) 741-8972. For details, please see the
