Prescription of Paediatric Industrial Triple-Chamber Parenteral Nutrition Bags: When, Why, How?

Parenteral nutrition (PN) is indicated in case of intestinal failure, as oral or enteral nutrition cannot fulfil nutritional requirements. Children specific nutritional needs differ from adults' and also vary with age. Some non-essential amino-acids are essential in the youngest, and the required quantities of each nutrient, even reported to patient's weight, depend on age. Consequently, paediatric designed PN solutions are needed to meet children's requirements. Individualized compounded PN requires expert prescribers and its production must meet high standards of good compounding practices. By contrast, industrial 3-chamber PN offer a continuously available, safe and easy-to-use choice that meets the nutritional requirements of a wide range of patients, as long as their requirement aren't too different from age-standards. An industrially prepared, heat-sterilized, standardized 3-chamber PN bag range (Numeta((R)), Baxter), specifically designed for paediatrics, is now available in Europe. It encompasses two formulations designed according to ESPGHAN/ASPEN PN guidelines and is adapted to children from 0 to 18 years of age. Numeta((R)) range offers relative flexibility in its use (possible nutrient additions, optional lipid infusion when accurate). Micronutrients have to be added as 3-chamber PN never provide vitamins nor trace elements for stability reasons. Age-related nutritional recommendations from scientific societies guide the initiation of PN which will then be adapted according to both its efficacy and tolerance. This paper focuses further on the advantages and prescription practical aspects of ready to use PN solutions.