Pre-term neonate with intestinal failure, feeding issues.

A male neonate was delivered at 26 weeks gestational age by emergent cesarean section due to severe preeclampsia. Birth weight was 520 g, which was below the third percentile, indicating signifi cant growth restriction. The immediate postnatal course included endotracheal intubation, administration of surfactant, and placement of umbilical catheters. Nutritional support started shortly after birth with a pre-prepared solution containing dextrose and amino acids. During the fi rst weeks, parenteral nutrition (PN) provided the main source of calories and was delivered through a central venous catheter. In addition to the carbohydrate and protein infusions, intravenous fat was started soon after birth. The lipid was soybean oil-based, with a high ratio of omega-6:omega-3 fatty acids. Protein was advanced to a dose of 3.5 g/kg per day, carbohydrate to a glucose infusion rate of 12 mg/kg per minute and lipid dose to 3 g/kg per day. Micronutrient administration included electrolytes and minerals as well as a multivitamin, all included in the parenteral solution. Minimal enteral nutrition was initiated on the second day of life with maternal breast milk, but was held due to the patient’s development of signifi cant hypotension. By day of life 6, the hypotension resolved and feedings were restarted. After a few days of minimal enteral nutrition, feedings were advanced daily by 20 mL/kg per day. These were initially well tolerated as evidenced by minimal gastric residuals, passing of stool and a normal abdominal exam. On day of life 17, bilious emesis occurred and feedings were stopped. Serial plain fi lms of the abdomen showed a gasless abdomen but no evidence of pneumoperitoneum. Gastric decompression was started, blood cultures were obtained and antibiotics were administered. Within 48 hours, the abdomen became increasingly tense and distended with fl ank erythema. 1. Highlight the role and complications of parenteral nutrition in the nutritional support of premature neonates.