Micronutrient Monitoring and Management in Parenteral Nutrition-Dependent Premature Neonates: A Case Series

We present a prospective case series of 3 premature neonates with abnormal vitamin A, vitamin E, and selenium levels after being managed on prolonged parenteral nutrition (PN). All 3 patients experienced gastrointestinal complications including spontaneous intestinal perforation, necrotizing enterocolitis, and/or short bowel syndrome. Additionally, all 3 patients developed PN-associated liver disease, which required the use of a mixed lipid emulsion and a fish oil-based lipid emulsion for a short period of time. We evaluated the micronutrient levels of these patients after they had been receiving PN for 1 to 2 months. After the early identification of these abnormalities, we promptly attempted to correct the levels through supplementation and restriction, as appropriate. One barrier we experienced in the treatment of these patients was the conflicting guidance of daily micronutrient dosing in PN and when to evaluate levels in premature infants from the European and American pediatric nutrition organizations, the European Society for Paediatric Gastroenterology Hepatology and Nutrition and the American Society for Parenteral and Enteral Nutrition. Additionally, after we assessed micronutrient levels, we experienced a lack of guidance on how to adjust dosing and when to monitor subsequent levels.