Lesson 5: Preterm Infant Nutritional Management in Low-resource Settings
5.4 Parenteral feeding of preterm infants in a resource-constrained setting
Administration of parenteral nutrition may not be possible in resource-limited settings. Its availability may be limited by cost or the level of expertise of health care providers. When parenteral nutrition is available, it is usually reserved for infants who are showing signs of feeding intolerance, NEC or bowel obstruction. If the parenteral nutrition strategy outlined in Lesson 3 of this unit cannot be followed, an alternative strategy is the intravenous administration of a commercially-formulated glucose-electrolyte solution or a glucose solution to which sodium, potassium, calcium and phosphate have been added. Enteral feeds are started and advanced as soon as possible (Murguia-Peniche & Kirsten 2014).
If parenteral nutrition is available, the umbilical vein may be used for up to 7 days. Thereafter a central line is preferable. These lines must be used exclusively for PN. Extreme caution must be taken to keep any intravenous access sterile. Tubing must be changed daily and the hub of the administration catheter must be protected from microbial contamination. This can be achieved through the use of a special connector or by wrapping the hub in betadine-soaked gauze and enclosing the entire connection in a waterproof dressing which is also changed daily. Although administration of PN through a peripheral venous line is possible, any extravasation of fluid can lead to tissue necrosis and there is a risk of thrombophlebitis (Murguia-Peniche & Kirsten 2014).
An infant receiving PN requires monitoring of electrolytes twice a week and liver function tests as well as a complete blood count once a week (Murguia-Peniche & Kirsten 2014).