The importance of different calorie sources in the intravenous nutrition of infants and children.

The intravenous infusion of amino acid and carbohydrate solutions is a well-established technique for nutritional support of the pediatric surgical patient. By using peripheral veins for total parenteral nutrition (TPN), weight gain can be achieved and the complications of central venous catheters avoided. Over a 2-year period, 45 patients from 1 day to 16 years of age received peripheral TPN in which fat provided a major portion of the daily calories. Treatment periods ranged from 5 to 74 days. Each patient received 125 cc/kg/day, with 30% of the calories derived from a fat emulsion and the remainder from a 12% glucose-2% amino acid solution. All 29 patients under 1 year of age gained weight, averaging 18 gm/day. These infants received an average of 98.8 calories/kg/day, with 31 calories provided by fat. In this group, the mean nonprotein calorie to nitrogen ratio (CNR) was 285 calories/gm, ranging from 239 to 343. Fat calorie and carbohydrate CNRs were determined and no correlation to weight gain could be found for either calorie source. The few complications related to this technique included three episodes of phlebitis, two small skin sloughs, two subcutaneous abscesses, and two episodes of jaundice. Normal weight gain can be achieved in infants after operation by employing peripherally infused, intravenous fat as a major calorie source. Furthermore, regardless of calorie source, a CNR of 285 calories/gm allows normal growth and weight gain in these critically ill neonates.