S3-Guideline of the German Society for Nutritional Medicine (DGEM) in Cooperation with the GESKES, the AKE, the DGKJ and the GNPI: Parenterale Nutrition in Pediatrics

Implementing parenteral nutrition (PN) in paediatric patients poses special challenges, which arise from the wide range of patients' conditions, ranging from extremely premature infants up to teenagers weighing up to and over 100 kg, and their varying substrate requirements. In addition age and maturity-related changes of the metabolism and fluid and nutrient requirements must be taken into consideration, along with the clinical situation during which PN is applied. The indication, the procedure as well as the intake of fluid and substrates are very different to that known in PN practice in adult patients, e. g. the fluid, nutrient and energy intake of premature infants and newborns per kg body weight is higher than that of older paediatric and adult patients. All premature infants <35 weeks of pregnancy and most ill term infants require full or partial PN. In neonates the actual amount of PN administered must be calculated (not estimated). Enteral nutrition should be gradually introduced and should replace PN as quickly as possible in order to minimise any side-effects from exposure to PN. Inadequate substrate intake in early infancy can cause long-term detrimental effects in terms of metabolic programming of the risk of illness in later life. In school-aged children and adolescents who achieve an oral or enteral intake that however does not approach their energy and nutrient demands, partial or total PN should be considered no later than after 7 days, taking into account nutritional status and clinical conditions.