Parenteral nutrition in neonatology and pediatrics: physicochemical stability, risks and precautions. Narrative review

Abstract

Parenteral nutrition is a high-risk therapy due to some of its components and the exceptional inclusion of drugs. It can contain more than 50 nutrients, with different characteristics of osmolarity, ionic charge, and pH, which can affect its physicochemical stability. In addition, environmental conditions such as light, temperature, and oxygen must be considered. Their prescription and administration represent a challenge for the healthcare team, especially in the pediatric and neonatal setting, due to factors such as the state of metabolic immaturity and greater susceptibility to oxidative damage. This group also requires smaller volumes with higher concentrations of nutrients, which complicates its preparation and risks of incompatibility/interactions. The objective of this article is to review current concepts of parenteral nutrition according to the criteria of the Scale for the Assessment of Narrative Review Articles (SANRA), to make recommendations on physicochemical stability according to clinical relevance. It describes how environmental conditions and inputs can affect the stability of the mixture and provides recommendations and values to reduce the risks of instability, including amino acids, lipids, cations, anions, and different calcium and phosphate salts. Given the variability in the reproduction of the same mixture due to clinical conditions and inputs, this subject constitutes an open area for research due to the methodological diversity used in the reports. Finally, the recommendations from the pediatric/neonatal sphere are the strictest in the literature, so they are valid for adults.