Neonatal exposure to phthalate and alternative plasticizers via parenteral nutrition


If food needs are expected to be short term, peripheral parenteral nutrition (PPN) can be given for several days. Because this type of diet is fat-based and completely carbohydrate-free, it provides only a fraction of the nutrients a patient needs on a given day and should only be used as a temporary solution. A major advantage of this type of feeding is that it can be administered via an intravenous (IV) line. Peripheral parenteral nutrition can be continuous, day and night, or cyclical (administered over several hours per day). A patient cannot receive her PPN at home. If patients cannot tolerate enteral nutrition for more than a few days, total parenteral nutrition (TPN) can provide the full range of nutrients they need. Although TPN provides complete nutritional support, it contains large amounts of carbohydrates that can damage small blood vessels. It should be administered through a line placed intravenously. These leads include peripherally inserted central catheter leads (PICCs), which are typically inserted into the arm. a temporary centerline inserted into the neck or chest; or a long-term tunneled catheter or implanted port inserted into the chest. Like PPN, TPN can be administered continuously or cyclically. The advantage of TPN is that patients can continue to receive it at home. However, there is a risk of serious infection associated with the central line. Parenteral nutrition can cause serious complications. Bloodstream infections from feeding lines can be serious, requiring interruption of feeding, antibiotics, and line replacement. Parenteral nutrition can cause mild to severe liver damage, including liver failure, in some patients. Parenteral nutrition is broken down into basic elements such as electrolytes and amino acids, and these elements cannot be adjusted from hour to hour and are constantly supplied over a given 24-hour period. On the other hand, food taken in from the intestine is used by the body as needed. It may take several days to tailor parenteral nutrition to the patient's specific needs. Needs can change from day to day, and serious electrolyte imbalances can develop. Patients should have frequent blood tests to ensure their diet is safe. In hospitals, the TPN must be specially prepared each day. Once the right prescription is reached, the patient can go home and weekly adjustments can be made if needed. Peripheral parenteral nutrition (PPN) is often considered the stepchild of parenteral nutrition (PN), which is infused via a central venous catheter. Anecdotal reports suggest that interest in PPN is growing in the United States and that improvement in catheter design and injection techniques in Europe offer even greater potential to reduce complications such as injection phlebitis. increase. Like PN, PPN contains glucose, amino acids, electrolytes, vitamins, and minerals delivered through a central venous catheter, but in smaller amounts. One of the recognized advantages of PPN is the relative ease with which peripheral access can be established. This can prevent delays in establishing nutritional support. PPNs are intended for short-term use or replenishment. Bridge to intensive IV fluids or enteral nutrition, most often to maintain previously well-nourished non-hyper metabolic patients, or until more adequate nutrition is provided used as In some cases, improper use can lead to infusion phlebitis or poor nutrient absorption. Conflicting recommendations from different organizations further complicate and confuse prescribing physicians.