TOTAL PARENTERAL NUTRITION IN INFANTS WITH CATASTROPHIC GASTROINTESTINAL ANOMALIES

Intensive nutritional support is essential for survival and surgical rehabilitation of newborn infants with gastrointestinal anomalies. Oral feedings can usually be established after correction of a single congenital defect. At times, a feeding tube or gastrostomy may be required to provide nutrients to poor risk infants. However, all too often, enteral feeding is impossible and parenteral support inadequate, so that babies with multiple or complex lesions of the gastrointestinal tract die from the complications of starvation. The laboratory demonstration that normal growth and development can be achieved by supplying basic nutrients exclusively by the intravenous route1 prompted use of the technic in surgical patients. More than 200 adults with chronic complicated gastrointestinal disease have been supported exclusively by the intravenous route with 2400-5000 calories per day for 10 to 200 days. Weight gain was observed in all patients associated with wound healing, fistula closure, positive nitrogen balance, and increased strength and activity.2. Preliminary data on the first infant to be nourished by this intravenous feeding technic demonstrated normal growth, development, and metabolism despite near total absence of the small bowel and gastrointestinal dysfunction.3 This is the first group of infants in whom total parenteral nutrition was used in conjunction with surgical treatment of catastrophic gastrointestinal anomalies. © 1969.