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After prolonged parenteral nutrition a 12 month old infant died with pulmonary hypertension and granulomatous pulmonary arteritis. A review of necropsy findings in 41 infants who had been fed parenterally showed that two of these also had pulmonary artery granulomata, while none of 32 control patients who died from sudden infant death syndrome had similar findings. Particulate contaminants have been implicated in the pathogenesis of such lesions and these were quantified in amino acid/dextrose solutions and fat emulsions using automated particle counting and optical microscope counting respectively. Parenteral feed infusions compounded for a 3000 g infant according to standard nutritional regimens were found to include approximately 37,000 particles between 2 and 100 microns in size in one day's feed, of which 80% were derived from the fat emulsion. In-line end filtration of intravenous infusions may reduce the risk of particle associated complications. A suitable particle filter is required for use with lipid. [ABSTRACT FROM AUTHOR]

A microcomputer program has been designed to provide comprehensive assistance to the clinician in prescribing parenteral nutrition in children of all ages. It is implemented on a fully portable, independent machine that can be taken to the bedside anywhere in the hospital. The user is guided through a standardised prescribing process based on a well tried protocol and taking into account the patient's age, clinical condition, concurrent parenteral infusions, laboratory findings, and enteral intake. A printout is produced for insertion into the patient's clinical record, giving all concerned in the care of the child a clear, legible record of when, how, and by whom the prescription was calculated. The user can review and amend the proposed prescription before printing, giving ultimate control to the prescriber, not the computer. The system saves time by performing accurately the necessary calculations, and provides financial savings by reducing wastage of parenteral nutrition during the re-introduction of enteral feeding.

A nitrogen source based on egg protein (Vamin 9 glucose) and an alternative with an amino acid profile more similar to breast milk (Vaminolact), were compared in 14 parenterally fed infants. Subjects were randomly allocated to receive one or other amino acid solution, but were otherwise given identical diets. At the start of the study the two groups did not differ significantly in postconceptual age, postnatal age, or weight. Over a six day study period on a stable intake of intravenous nutrients there was no significant difference in growth or nitrogen retention between the two groups. Plasma amino acid profiles in those receiving Vamin 9 glucose, however, were frequently abnormal. Notably, mean concentrations of potentially neurotoxic phenylalanine and tyrosine were significantly higher (140% and 420%, respectively) in patients fed Vamin 9 compared with those given Vaminolact. An amino acid solution based on the composition of breast milk protein therefore brings plasma amino acid profiles during parenteral nutrition closer to those found in breast fed infants, and reduces in particular, the risks of hyperphenylalaninaemia and hypertyrosinaemia.