Shafer Grant J, Abdenur Jose E, Dhar Vijay, Mikhael Michel
Division of Neonatology, Children's Hospital of Orange County, Orange, California.
Division of Neonatology, University of California, Irvine School of Medicine, Irvine, California.
AJP Rep. 2023 Mar 13;13(1):e11-e16. doi: 10.1055/a-2032-9737. eCollection 2023 Jan.
Total parental nutrition (TPN) is a critical component of neonatal intensive care. Supply shortages leading to deficiencies in TPN constituents can have devastating consequences for critically ill patients in the neonatal intensive care unit (NICU), who may be initially misdiagnosed as potential inborn errors of metabolism. Here, we present three cases of patients with prolonged TPN dependence due to intra-abdominal pathology who presented with signs and symptoms concerning for metabolic disorders and who were ultimately determined to be a result of vitamin deficiencies in the TPN after unnecessary testing and interventions had occurred. These diagnostic errors highlight the need for clinicians to maintain a high index of suspicion for nutritional deficiencies when treating patients in the NICU with potential metabolic disorders during times when TPN constituents are not available, as well as advocating to ensure that adequate supplies are maintained for this vulnerable population.
全胃肠外营养（TPN）是新生儿重症监护的关键组成部分。供应短缺导致TPN成分不足，可能对新生儿重症监护病房（NICU）的重症患者产生毁灭性后果，这些患者最初可能被误诊为潜在的先天性代谢缺陷。在此，我们报告三例因腹部病变而长期依赖TPN的患者，他们出现了与代谢紊乱相关的体征和症状，在进行了不必要的检查和干预后，最终确定是TPN中维生素缺乏所致。这些诊断错误凸显了临床医生在TPN成分无法获得时，治疗NICU中可能患有代谢紊乱的患者时，需要对营养缺乏保持高度怀疑，同时倡导确保为这一弱势群体维持充足的供应。
