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


  • Arindam Ghosh Department of Pediatrics, Surgery, N R S Medical College and Hospital, Kolkata, West Bengal, India
  • Anirudhdha Basak Department of Pediatrics, Surgery, N R S Medical College and Hospital, Kolkata, West Bengal, India
  • Dibyarup Datta Pramanik Department of Pediatrics, Surgery, N R S Medical College and Hospital, Kolkata, West Bengal, India
  • Prafulla Kumar Mishra Department of Pediatrics, Surgery, N R S Medical College and Hospital, Kolkata, West Bengal, India



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


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.


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.






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