From TPN to breast feeding - Feeding the premature infant - 2000: Part I. Parenteral nutrition

Advancements in medical technology have allowed for the survival of smaller, more premature infants, during the past several years. Infants as immature as 23 weeks gestational age and as small as 500 g, or even less, are now common sights in Neonatal Intensive Care Units throughout the United States. These infants present a unique challenge to neonatologists and registered dietitians, who must provide them with the nutrients needed for normal growth and development. With mounting evidence of a direct link between early nutrition and later outcome, the need for a better understanding of fetal and neonatal nutrition is critical. From admission to discharge, most infants will transition from a dependence on parenteral feeding, to a dependence on tube feeding, and finally, the ability to orally feed. In the early days of postnatal life, decisions must be made about when to initiate TPN, what type of intravenous access will be required, and to what extent and at what rate parenteral nutrients should be advanced. Similar decisions are made about the introduction and advancement of enteral nutrition. The following is a review of the available literature on the parenteral feeding of premature infants, with an emphasis on how our practice in the year 2000 was evolved over time. A similar review of enteral feeding practices will be presented in a future installment.