What is the role of parenteral nutrition in the treatment of necrotizing enterocolitis (NEC)?

Updated: Dec 27, 2017
  • Author: Shelley C Springer, JD, MD, MSc, MBA, FAAP; Chief Editor: Muhammad Aslam, MD  more...
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Answer

In patients with necrotizing enterocolitis (NEC), prolonged parenteral nutrition is essential to optimize the baby's nutrition while the GI tract is allowed enough time to recover and return to normal function. Central venous access is essential to facilitate parenteral delivery of adequate calories and nutrients to the recovering premature baby to minimize catabolism and promote growth.

Prolonged central venous access may be associated with an increased incidence of nosocomial infection, predominately with skin flora such as coagulase-negative Staphylococcus species, as well as methicillin-resistant S aureus (MRSA). A high degree of clinical suspicion must be maintained to detect the subtle signs of such infection as early as possible.

Parenteral administration of lipid formulations via central venous catheters is also associated with an increased incidence of catheter-related sepsis.

Lipids coat the catheter's interior, allowing ingress of skin flora through the catheter lumen. A high degree of clinical suspicion is required for early detection of such an infection.

If line infection is suspected, obtain a blood culture through the central line and from a peripheral vein or artery. Antibiotics effective against skin flora, such as vancomycin, should be administered (although prolonged broad-spectrum antibacterial therapy increases the premature infant's risk for fungal sepsis). Persistently positive cultures require removal of the central line. Remove the central line once sepsis and bacteremia are confirmed, because eradication is almost impossible when the central line is kept in place.

Prolonged parenteral nutrition may be associated with cholestasis and direct hyperbilirubinemia but may be less likely with use of a fish oil–based lipid formulation. [52] This condition resolves gradually following initiation of enteral feeds.


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