ABSTRACT
The principles and practice of nutritional support in newborn and pediatric patients have made tremendous strides since the introduction of techniques and formulas for total parenteral nutrition (TPN) by S. Dudrick in the mid-1960s. The introduction of TPN, combined with advances in technology allowing highly specialized care in neonatal and pediatric intensive care units, has markedly improved survival in this special patient population. As an example, neonatal malrotation of the intestinal tract with midgut volvulus carries with it an anticipated mortality of approximately 2.9%. From 1937 to 1952 the reported mortality was 23%, with a subsequent decrease to 4% from 1952 to 1977. The trend toward improved mortality continued to 2.9% from 1977 to 1987. These changes are directly attributable to the ability to provide long-term parenteral nutritional support and the ability/technology for intensive care support (1). The philosophical trends toward early postoperative nutritional support and recognition of the benefits of enteral feeds (vs. parenteral) have been realized and eagerly employed by those intimately involved in providing nutritional support for newborns and children. In most hospitals, nutritional support of the very young patient population is usually undertaken by a few specialized individuals such as neonatologists and pediatric gastroenterologists. The principles of support are precisely those seen in older patient populations, and the practical aspects of nutrient delivery are relatively straightforward. Development of the initial nutritional support plan involves (1) projecting age-specific energy requirements, (2) determining protein needs based on the patient's age and specific disease process, and (3) establishing a safe and effective method of administering the nutrients (2).
