Total parenteral nutrition in surgical infants.

Introduction The newborn infant is in a 'critical epoch' of development. Nutritional deprivation may adversely affect not only the infant as a whole but also individual organs, notably the brain, leading to stunted physical and intellectual development [l]. In the surgical infant malnutrition is associated with increased morbidity and mortality; therefore, it is important that nutritional integrity is maintained regardless of the severity of the illness or organ failure. Surgical infants are likely to be deprived of enteral nutrition for some period during their treatment. The nutritional management of these vulnerable patients has improved over the past 20 years following the introduction of parenteral nutrition (PN). Our group has recently investigated several problems related to metabolism and nutrition of surgical infants. The energy requirements and substrate utilization of surgical newborn infants receiving PN has been studied using the combined techniques of indirect calorimetry and stable isotope tracer techniques. The aim of this article is to review briefly our recent contribution in the field of nutrition and metabolism of surgical newborn infants receiving PN. The article will discuss: (i) the partition of energy metabolism and the energy requirement; (ii) the major pathways of metabolic utilization of intravenous protein, carbohydrate and fat.