Parenteral nutrition in neonates — viva

Stem

The examiner hands you the prescription chart for a 780 g infant born at 26 weeks, now two hours old, with a umbilical venous catheter in place. The team asks you to start parenteral nutrition. [3]

Examiner: What is your opening approach to prescribing PN for this infant? [3]

Strong answer: I would frame PN as a bridge, not a destination, and begin early aggressive nutrition to prevent the catabolic crisis of extreme prematurity. Within the first hours of life I would start amino acids at 1.5 to 2 g/kg/day, a glucose infusion rate of 4 to 6 mg/kg/min, and lipid at 1 to 2 g/kg/day, then advance to the ESPGHAN targets over the first days. I would secure central access, protect the line with a dedicated lumen and a no-break policy, and set up the daily monitoring of glucose, weight, electrolytes, triglycerides and liver function. [4] [3]