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Total parenteral nutrition increases the risk of acute cholecystitis [27] due to complete disuse of the gastrointestinal tract, which may result in bile stasis in the gallbladder. Other potential hepatobiliary dysfunctions include steatosis , [ 28 ] steatohepatitis , cholestasis , and cholelithiasis . [ 29 ]
In critically ill patients admitted to an intensive care unit, if phosphate drops to below 0.65 mmol/L (2.0 mg/dL) from a previously normal level within three days of starting enteral or parenteral nutrition, caloric intake should be reduced to 480 kcals per day for at least two days while electrolytes are replaced. [3]
Advancing enteral feed volumes at lower rates does not appear to reduce the risk of NEC or death in very preterm infants and seems to increase the risk of invasive infection. [30] Not beginning feeding an infant by mouth for more than 4 days does not appear to have protective benefits. [31]
Transient tachypnea of the newborn occurs in approximately 1 in 100 preterm infants and 3.6–5.7 per 1000 term infants. It is most common in infants born by caesarian section without a trial of labor after 35 weeks of gestation. Male infants and infants with an umbilical cord prolapse or perinatal asphyxia are at higher risk.
In newborn infants with less than 10% of expected intestinal length, 5 year survival is approximately 20%. [15] Some studies suggest that much of the mortality is due to a complication of the total parenteral nutrition (TPN), especially chronic liver disease . [ 16 ]
After many hours in the lab at the swing balances, measuring the precise amount of each chemical required, [3] he was able to keep beagles alive for months with TPN, by-passing their digestive systems. [7] After showing the feasibility in lab animals, in 1967 he applied the technique to sick infants and then adults.
The infants present in the first few days of life with watery diarrhoea. This leads rapidly to dehydration and electrolyte imbalance and metabolic decompensation. Enteral feeding with a protein hydrolysate or amino acid based formulas worsen the diarrhoea and the children rapidly fail to thrive and develop protein energy malnutrition.
Nutritional requirements, he maintained, could in theory be provided with total parenteral nutrition. "With TPN feeding all of the nutrients that a human being needs, from the time of infancy to the latter years, one can be maintained alive and well and growing without ever eating a morsel of food or drinking a drop of liquid." [5]