Examples of risk-benefit ‘tradeoffs’ associated with parenteral nutrition composition
| Component or issue | Example of risks and benefits |
|---|---|
| Minerals | Contamination (eg, aluminium) and solubility issues (eg, calcium and phosphate) limit mineral supply, and also affect tonicity |
| Amino acids | Inadequate supply of essential or semiessential amino acids may prevent optimal tissue growth, but high peak levels may cause neuronal damage |
| Lipids | Lipids provide higher caloric intakes than could be provided by carbohydrates alone, but raised circulating triglyceride and lipid levels may increase later metabolic and cardiovascular risk |
| Carbohydrate | Hyperglycaemia is common, but decreasing dextrose intake limits energy intake, and insulin therapy is associated with risks and may not promote anabolism |
| Osmolality | Hyperosmolar solutions require central venous catheters (CVC) but these increase the risk of sepsis. Peripheral administration avoids the risks of CVCs, but increases the risks of skin damage, pain and scarring |
| Monitoring frequency | Regular electrolyte and glucose measurement enables fine tuning of intakes, but may be associated with pain/discomfort, anaemia, and skin infections |
| Standardised bags | Cost savings and safety are improved by use of standard bags, but these limit the ability to tailor to individual infant needs, especially when fluid volumes are limited |