Conditions requiring bowel rest and nutritional restitution–eg, nonspecific colitides and associated growth retardation, enterocutaneous fistulas and pancreatitis TPN is used for children with diaphragmatic hernia, malrotation, esophageal atresia, tracheoesophageal fistula, gastroschisis, volvulus, meconium ileus and omphalocele; severely malnourished See
. Cf
.
Complications of TPN
Hepatic dysfunction Cholestasis, cholelithiasis, hepatic dysfunction, jaundice, hepatomegaly, micronodular cirrhosis, lipofuscinosis and steatosis–most common in premature infants
Related to indwelling IV line Misplacement of line, infections, eg Candida spp, aspergillosis
Metabolic defects Hyperglycemia–osmotic diuresis, hyperosmolarity, post-infusion hypoglycemia, hyperosmolar coma, ketoacidosis and other metabolic derangements, excess or deficiency of electrolytes, including Na+, K+, Cl–, eg hyperchloremic acidosis and mineral imbalances, affecting Mg2+, PO4, and Ca2+ with hypercalcemia and accompanying pancreatitis, hypercalciuria and metabolic bone disease
Nutritional imbalances Generalized ↓ in essential fatty acids, trace minerals–copper, chromium, molybdenum, tin, zinc, and vitamins and ↑ TGs, cholesterol
.