Indications for PN

• Infants <1000g or <28 weeks should start PN as soon as possible after birth. An emergency bag should be considered to avoid any delays in starting nutrition.
• Infants <1250g on feeding regimen B or C should have PN ordered via pharmacy at the next available opportunity.
• PN is not routine for infants >1250g but can be started at consultant discretion.
• All infants who are unlikely to establish sufficient EN quickly e.g., babies with a congenital gut disorder or with critical illness such as sepsis (NICE 2020) at consultant discretion

Relative contraindications to PN

• Infants who are seriously ill, especially if acidotic or hypotensive, or have thrombocytopenia or coagulopathy
• Infants who are ill with septicaemia or NEC until they clinically improve and/or triglyceride levels are available

How to start:

• Prescribe SMOF lipid solution and the relevant aqueous PN solution equivalent to infant’s daily fluid requirement minus other essential fluid infusions.
• Both aqueous and lipid are included in prescribed fluid volume
• If starting PN in the first 4 days after birth, full requirements should be gradually increased e.g., over 4 days (NICE 2020)
• If starting PN more than 4 days after birth, there is no need to gradually increase over a few days (NICE 2020) and full requirements can be quickly met
• Additional fluid may be needed to meet desired overall fluid volume.

Table 1.0: Current Simpsons policy for overall fluid recommendations during the first few days after birth for reference:

If < 750g start with 100 mls/kg/day and review fluids after 4 hours (see below). May need to increase above 150 mls/kg/day if insensible losses are high

The following describes the key information required for each of the 3 aqueous bags used.  Examples of PN prescriptions using the volumes and nutritional content above can be seen in Appendix 4 and Appendix 5.