Abstract
Necrotizing enterocolitis (NEC) is the main gastrointestinal emergency of preterm infants for whom bowel rest and parenteral nutrition (PN) is essential. Despite the improvements in neonatal care, the incidence of NEC remains high (11% in preterm newborns with a birth weight <1500 g) and up to 20–50% of cases still require surgery. In this narrative review, we report how to optimize PN in severe NEC requiring surgery. PN should begin as soon as possible in the acute phase: close fluid monitoring is advocated to maintain volemia, however fluid overload and electrolytes abnormalities should be prevented. Macronutrients intake (protein, glucose, and lipids) should be adequately guaranteed and is essential in each phase of the disease. Composite lipid emulsion should be the first choice to reduce the risk of parenteral nutrition associated liver disease (PNALD). Vitamin and trace elements deficiency or overload are frequent in long-term PN, therefore careful monitoring should be planned starting from the recovery phase to adjust their parenteral intake. Neonatologists must be aware of the role of nutrition especially in patients requiring long-term PN to sustain growth, limiting possible adverse effects and long-term deficiencies.
Highlights
Necrotizing enterocolitis (NEC) is the main gastrointestinal emergency in newborn infants, especially in preterms [1]
NEC incidence varies between centers [2,3], it is still 11–22% in very low birth weight infants (VLBWI) or extremely low birth weight infants (ELBWI), respectively [4,5], and has a significant mortality and morbidity (23.5% of NEC stage ≥II Bell and 50% of cases, respectively) [6]
BeIfnortehiSsunragrerraytive review, we report the main evidence of the best parenteral nutrition strateIngyptahtaietnctlsinwiciitahnsNsEhCoudldiafgonllooswis,toPNproavlliodwe sthfeoropbtoimwaell irnetsatkaess oafnneuatrrliyenmtse,alismurietintog pthreevpeonstsidbilseeaadseveprrsoegerfefsescitosna,nadnadt itthceosnasmisetstiomf eglluoncogs-ete,rammdineoficaiceindcsi,elsi.pids, electrolytes, water, vitamins, and trace elements administered intravenously
Summary
Necrotizing enterocolitis (NEC) is the main gastrointestinal emergency in newborn infants, especially in preterms [1]. Up to 40–50% of patients refractory to medical management (progressive clinical deterioration, multi organ failure) and all patients with perforated NEC require surgery [7] These patients need extended periods of parenteral nutrition (PN) and are at high risk of nutrient imbalances and deficiencies (Figure 1), intestinal failure (IF), and consequent failure to thrive [6]. Nutrition does not satisfy total nutrients’ requirement and especially if extensive bowel resection causes IF [11] In this narrative review, we report the main evidence of the best parenteral nutrition strategy that clinicians should follow to provide the optimal intakes of nutrients, lim2itoifn1g7 the possible adverse effects and at the same time long-term deficiencies.
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