title: History of parenteral nutrition in pediatrics with emphasis on amino acids.
abstract: Central venous total parenteral nutrition (TPN) has proved to be a valuable and often life-saving measure in selected newborn infants with surgically repairable, major anomalies of the gastrointestinal tract and infants with chronic intractable diarrhea. However, in infants of low--and especially very low--birth weight, the TPN regimen that was so successful in older infants was frequently associated with severe risks of hyperglycemia. An alternative approach that has proved to be the most satisfactory relies on the fact that the energy expenditure of a premature infant, nursing in a thermally neutral environment, rarely exceeds 50 kcal/kg, a level that can be safely and effectively maintained. With respect to the development of parenteral amino acid solutions, three generations of such mixtures can now be identified. The first of these was represented by the protein hydrolysates. With the advent of technology for the production of pure L-amino acids, a second generation of crystalline mixtures was developed. Evaluation of these revealed that extrapolation from data on oral nutrition was often unsatisfactory for the adequate formulation of such mixtures. The direct study of the parenterally nourished patient led to the third generation of special purpose amino acid solutions such as those targeted for patients with renal failure, liver failure, or trauma or for the promotion of anabolism. It seems likely that development of other solutions will follow the trend of relying on accurate definition of a given metabolic disorder and the perfection of a specific solution to correct it.
mesh_terms: D000596:Amino Acids / Q000008:administration & dosage* / Q000097:blood; D003968:Diarrhea, Infantile / Q000628:therapy; D049673:History, 20th Century; D006801:Humans; D007223:Infant; D007228:Infant Nutrition Disorders / Q000628:therapy; D007231:Infant, Newborn; D007234:Infant, Premature; D007422:Intestines / Q000002:abnormalities; D009584:Nitrogen / Q000378:metabolism; D010288:Parenteral Nutrition / Q000266:history*; D010289:Parenteral Nutrition, Total / Q000266:history* / Q000379:methods; D010372:Pediatrics / Q000266:history*; D011492:Protein Hydrolysates / Q000627:therapeutic use; D012996:Solutions
chemical_list: D000596:Amino Acids; D011492:Protein Hydrolysates; D012996:Solutions; D009584:Nitrogen