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  • Print publication year: 2006
  • Online publication date: December 2009

39 - Nutrition in the neonatal surgical patient

    • By Agostino Pierro, Department of Paediatric Surgery, The Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust, University College London, London, UK, Simon Eaton, Department of Paediatric Surgery, The Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust, University College London, London, UK
  • Patti J. Thureen, University of Colorado at Denver and Health Sciences Center
  • Edited by William W. Hay, University of Colorado at Denver and Health Sciences Center
  • Publisher: Cambridge University Press
  • DOI: https://doi.org/10.1017/CBO9780511544712.040
  • pp 569-585

Summary

Introduction

The newborn infant is in a “critical epoch” of development not only for the organism as a whole but also for the individual organs and most significantly for the brain. Adequate nutrition in the neonatal period is necessary to avoid the adverse effects of malnutrition on morbidity and mortality and to minimise the future menace of stunted mental and physical development.

The survival rate of newborn infants affected by isolated congenital gastrointestinal abnormalities has improved considerably over the past 20 years and is now in excess of 90% in most pediatric surgical centers. The introduction of parenteral nutrition and advancement in nutritional management are certainly among the main factors responsible for this improvement.

Historical background

Parenteral nutrition stepped forward from numerous historical anecdotes in the 1930s with the first successful infusion of protein hydrolysates in humans, followed by the first report of successful total parenteral nutrition in an infant in 1944, and given a huge boost by the first placement of a catheter in the superior vena cava to deliver nutrients for prolonged periods. Using this system, Dudrick and Wilmore showed that adequate growth and development could be achieved in beagle puppies and in a surgical infant. Following these initial reports Filler and co-authors reported the first series of surgical neonates with gastrointestinal abnormalities treated with long-term total parenteral nutrition.

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