Administering Parenteral Nutrition in the Neonatal Intensive Care Unit Logistics, Existing Challenges, and a Few Conundrums

Opportunities for risk-reduction exist during neonatal PN administration. A common theme for many elements in PN utilization is that daily assessments of the risks and benefits of the PN-related intervention (eg, continuing CVC utilization, repeated blood testing in the context of past and anticipated results) can be expected to reduce risk. The highest yield of such assessments will stem from multidisciplinary input, including pharmacists and dieticians. Examples of research gaps include further delineation of ideal times for PN initiation in select neonatal populations, especially those born late preterm and full-term, cost-effective materials to achieve complete photoprotection, and mechanisms by which suboptimal energy and nutrient delivery may be mitigated during transitions from PN to FEN. Still, early initiation and transition to FEN for pa-tients without contraindications to enteral nutrition should remain a priority for neo-nates receiving PN.