Published: 2020-05-22

Recommendation of an ideal mixed fluid preparation to be used as partial parenteral nutrition in surgical Neonatal Intensive Care Unit

Arindam Ghosh, Anirudhdha Basak, Dibyarup Datta Pramanik, Prafulla Kumar Mishra


Background: This study was conducted to assess the role of Partial Parenteral Nutrition (PPN) and a specially prepared “mixed fluid formula” used as PPN in sick surgical neonates.

Methods: This single institution based Randomised Control Trial was performed in Surgical NICU of a tertiary care Centre. Surgical neonates who required bowel rest for >3 days like Esophageal Atresia (22), Duodenal Atresia (38), Jejuno-Ileal Atresia (50), Necrotising Enterocolitis (29) and others (11), were chosen. As a CONTROL population half (75) neonates were allowed maintenance fluid only (Isolyte P) and rest (75) were given a combination of maintenance fluid (Isolyte P) and PPN (specially prepared mixed fluid). This mixed fluid each 100 ml was prepared with 65ml Isolyte P, 15 ml 25% Dextrose, 10 ml Normal Saline, 7 ml Astymin 3, 2 ml Multivitamin and 1 ml Injection KCl. Fluid was continued till enteral feeding was established.

Results: Neonates according to their body weight were divided in three groups <1 kg (50), 1-2.5 kg (71) and >2.5 kg (29) and their post-operative outcome was assessed as Clinical Positive/Negative and Laboratory Positive/Negative. Results were separately assessed in 3 body weight groups under “Control” and “Study” which showed both Clinical and Biochemical improvement in “Study group”.

Conclusions: The composition of mixed fluid, its nutritional value, calorie supplementation, compatible osmolarity for peripheral venous administration and most importantly its easy and cost-effective preparation were assessed thoroughly and we recommend this “mixed fluid” preparation as a very useful PPN for sick surgical neonates.


Calorie requirement, Osmolarity, Partial parenteral nutrition, Post-operative IV fluid, Surgical neonate

Full Text:



Allen LH, Howson CP. Description of Nutrition Algorithms of the Sick Child Initiative; National Academies Press (US), Washington (DC);1995;2.

WHO Library, Pocket book of Hospital Care for Children, WHO, 2nd Ed; 2013:299-305.

Loretto G, Kelly M, Austin KM. Care of Surgical Neonate: Pediatric Surgery Na T, Am Pediatr Surg Associ. 2018. Available at:

Pediatric General and Thoracic Surgery- Resident’s Manual Division of Pediatric Surgery; Children’s Hospital and Regional Medical Center; University of Washington, Seattle. John Waldhausen (MD), Fourth Edition. 2008:20,32-34.

Mohanharjai M, Fluid and Electrolyte concept in Newborns ; Medical J Armed Forces India, Elsevier. 2002;58(2):182-3.

Taylor and Walkar. Fluid and electrolyte management and nutritional support. In: Lister Llrving 1M. edt: Neonatal Surgery. 3rd Ed, Butterwonh & Co. Ltd, London; 1990;37-49.

Rowe MI. The newborn as surgical patient. In: O'Neill JA. Rowe Ml. Grosfeld JL. Fonkalsrud EW. and Corao AG. editors: Paediatric Surgery. Stlled, Mosby-Year Book, Inc. St Louis; 1998;43-70.

Lonnqvist PA, Fluid management in association with neonatal surgery: even tiny guys need their salt : Br J Anaesth. 2014;112(3):406-9.

Holliday MA, Seger WE. Reducing errors in fluid therapy management. Pediatrics. 2003;111:424-5.

Paut O, Lacroix F. Recent developments in the perioperative fluid management for the paediatric patient. Curr Opin Anaesthesiol. 2006;19:268-77.

Neonatal Parenteral Nutrition: Intensive Care Nursery House Staff Manual; UCSF Children’s Hospital; University of California; 2006:136-142 Available at:

Hussain Imam Hj, Muhammad Ismail, Ng Hoong Phak Terrence Thomas; Paediatric Protocols For Malaysian Hospitals: Kementerian Kesihatan Malaysia, 3rd Edition; 2012;71-75.

Ramachandra C, Pediatric Surgery Resident Handbook: Bangalore; 2015:18-36.

Kenney B, Arca MJ. Fluids, Electrolytes and Nutrition adapted from Handbook Of Pediatric Surgical Critical Care’; American Pediatric Surgical Association, Surgical Critical Care Task Force, First Edition; 2013;147-169.

Guidelines for the use of Parenteral and Enteral nutrition. JPEN 2002;26(1 suppl):15a-1385A

OHSU Guideline, Paediatric Total Parenteral Nutrition - Requirements; PICU Handbook, Oregon Health and Science University Pharmacy, Portland, Oregon; 2002:106-112.

Ekhard E Ziegler, Nutrient Requirements of premature Infant; University of Iowa, Iowa City, IA, USA. Nestle Nutr Workshop Ser Pediatr Program, 2007(59):161-76.

TPN Guidelines ; Memorial Solan- Kettering Cancer Center: 2008 (6):1-2 Available at:

Pankaj K. Mehta, Reena Mehta; Domiciliary Intravenous Fluid Therapy in Children: BHJ, Issue Special. 2000(11):4201.

Isolyte P in 5% Dextrose (Multi Electrolyte Injection) Description Available at:

Astymin 3 (Pure Crystalline Amino Acid IV Infusion) composition Available at:

M.V.I. Pediatric (multiple vitamins for injection) composition Available at:

Infant Dextrose -25% Dextrose Injection Description Available at:

Normal saline (0.9% Sodium Chloride Injection, USP) composition Available at:

Forms and strengths, route of administration of 10% Potassium Chloride injectable Available at:

Almuete VI. Ask the expert on Osmolarity for Peripheral Parenteral Nutrition Formulas- Medscape September; 2008:2005.

Cies JJ, Moore WS. Neonatal and pediatric peripheral parenteral nutrition: what is a safe osmolarity? Nutrition in Clinical Practice. 2014 Feb;29(1):118-24.