Balanced Intravenous Nutrition in Pediatric Surgery

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Abstract
Our present routine program for postoperative intravenous (i.v.) feeding of infants is successful in the sense that it sustains normal growth in the postoperative period. The high amount of fat in the program (Intralipid ‘Vitrum’) facilitates the use of infusions in peripheral veins for prolonged periods of time, since the osmolarity due to carbohydrates can be kept within reasonable limits. There is, however, room for both practical and nutritional improvements in our program: Laborious mixing of different components prior to infusions are necessary because the commercial amino acid-carbohydrate solutions do not contain these major constituents and the necessary electrolytes in the right proportions. We thus have to add carbohydrates, potassium, phosphate, calcium, and occasionally magnesium. The present communication describes an attempt to improve the program from the point of view of amino acid composition by the introduction of the amino acid solution Vamin ‘Vitrum’. This is very rich in essential amino acids, and does contain cysteine-cystine. In these respects it is very similar to the composition of mother’s milk protein. The metabolic performance of the i.v. program based on Vamin and Intralipid ‘Vitrum’ was analyzed by the method of multiple simultaneous balance studies. The metabolic results were good, but not better than those obtained with our routine program. Thus the percentage of the infused nitrogen which was incorporated in new tissue protein, did not increase beyond the usual range i.e. around 55%. It remains to be investigated whether an increase of the caloric supply beyond 100 kcal/24 h will augment the nitrogen retention.

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