Position paper “Addressing the nutritional emergency of preterm birth – Optimal practice in neonatal parenteral nutrition”

Neonatal parenteral nutrition

Adequate nutritional intakes – especially during the first 1000 days of life – are essential for promoting growth and health, including long-term metabolic, cognitive and neurodevelopmental outcomes.

For babies born preterm who take some time to establish enteral intakes, parenteral nutrition provides the only alternative method that allows meeting nutrient requirements. Parenteral nutrition is also needed in babies with illnesses affecting the digestive tract (e.g. congenital or acquired gut disorder like necrotising enterocolitis (NEC)). Parenteral nutrition is a feeding method that bypasses the digestive tract by delivering nutrients directly to the bloodstream. This is a bit similar to the feeding of unborn through the umbilical cord. Although not the ideal source of nutrition for babies and including associated risks, parenteral nutrition is vital especially for very preterm and critically ill babies and allows for adequate growth and development.

More information on the administration and composition of parenteral nutrition as well as on associated benefits and risks can be found here and in our factsheet.

Roundtable and position paper

Several experts from various countries came together for the international EFCNI roundtable on parenteral nutrition in Munich on the 4th of July 2018. During this roundtable, the content of the position paper “Addressing the nutritional emergency of preterm birth – Optimal practice in neonatal parenteral nutrition” was developed highlighting the importance of parenteral nutrition as a life-saving treatment for very preterm and ill babies. Based on this fruitful discussion and constructive exchange of views and ideas, the position paper was developed by EFCNI together with the expert panel during the last months and is launched in Maastricht during the jENS congress this year! The position paper is intended to serve as a supplement to, and a driving force for the development and implementation of guidelines on a national level based on the newly revised European ESPGHAN/ESPEN/ESPR/CSPEN guidelines (see also our social media series below). It primarily targets policy makers and hospital administrators but can also be used as a tool by parent representatives and healthcare professionals to convince decision-making bodies to support delivery of appropriate, high-quality parenteral nutrition.

Download position paper

Members of the expert project for the topic neonatal parenteral nutrition (in alphabetic order)

Professor Virgilio Carnielli, Professor Magnus Domellöf, Katarina Eglin, Professor Nicholas Embleton, Harald Erdmann, Professor Christoph Fusch, Professor Nadja Haiden, Professor Egbert Herting, Dr Martina Kohl, Professor Berthold Koletzko, Professor Alexandre Lapillonne, Dr Helen Mactier, Dr Sissel Moltu, Livia Nagy-Bonnard, Dr Mattias Paulsson, Dr Miguel Sáenz de Pipaón, Professor Manuel Sánchez Luna, Stephen Tomlin, Professor Hans van Goudoever

+++ 17 September 2020 – WORLD PATIENT SAFETY DAY +++

Parenteral nutrition is life-saving in preterm babies. It supports adequate growth and has the potential to improve long-term brain outcomes. However, parenteral nutrition is not a “natural” way of feeding but a demanding procedure that requires guidelines for safe delivery. Within the topic of patient safety, we dedicate a month-long awareness campaign to the highly vulnerable patient group of preterm and sick babies that require parenteral nutrition.
On the occasion of World Patient Safety Day,  on 17 September, we kicked off our awareness activities to promote the need for standardisation of parenteral nutrition and the development and implementation of national guidelines so all babies who need it benefit from this procedure. All features of the campaign can be looked up in detail in the position paper. Material for social media can be downloaded from this page. Please feel free to post and share them on your own social media accounts

Get started and join our selfie-flashmob

  • click on the graphic and print flashmob sign
  • take a selfie of you holding that sign
  • upload and share the photo on your Facebook/Instagram account
  • write a short caption

Please use the hashtags #ParenteralNutrition #WorldPatientSafetyDay2020 and tag @efcni.


Interview with Professor Nicholas Embleton

Professor Nicholas Embleton

Professor Nicholas Embleton is Consultant Neonatal Paediatrician at the Newcastle-upon-Tyne hospital and a member of the expert panel for the topic of neonatal parenteral nutrition.

In our interview he explains:

  • Reporting practices in Quality Improvement (QI) and Risk Management (RM)
  • The Briefing in a minute (BIM) as a method of QI and RM
  • The importance of a blame-free culture

Read full interview

Safe neonatal parenteral nutrition: Download our social media graphics

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Neonatal parenteral nutrition requires good infrastructure and a well-coordinated routine of care procedures within the multi-professional team.
See how many steps are involved in administering parenteral nutrition in daily practice in our video (link opens on Facebook).

Music: SoundCloud „Snowfall“ by Scott Buckley

Click below for an overview of our launch activities in 2019:

Launch activities 2019

Factsheet "Parenteral nutrition": All you need to know about parenteral nutrition (PN) at a glance

For a quick overview and insights on parenteral nutrition, download our factsheet! Here you can learn e.g. which group of children require parenteral nutrition, how it is administered, how parenteral nutrition is composed and which benefits and risks may come with parenteral feeding. The factsheet is available in English and German.

Go to download section

ESPGHAN Guidelines Series


Common Call to Action

Parenteral nutrition is a life-saving feeding method in infants who cannot be fed enterally. Parenteral nutrition does however carry certain risks, especially if it is not performed according to evidenced-based guidelines.

The panel therefore calls on all stakeholders involved in parenteral nutrition to:

  • Implement the Guidelines on Paediatric Parenteral Nutrition of the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN), the European Society for Clinical Nutrition and Metabolism (ESPEN), the European Society of Paediatric Research (ESPR), and the Chinese Society of Parenteral and Enteral Nutrition (CSPEN) into daily practice by translating them to national and hospital level guidelines
  • Develop and implement a warning system for the early detection of errors and adaptation of processes
  • Develop and implement an evidence-based computerised order entry system according to current guidelines with appropriate interfaces with the compounding units in hospitals adapted to the special needs of neonatal parenteral nutrition
  • Increase research into optimal formulations and the long-term outcomes of infants treated with parenteral nutrition
  • Develop and implement a benchmarking system to measure and compare the use of parenteral nutrition
  • Implement antenatal preparatory conversations with mothers at high risk of having a preterm birth and include information about parenteral nutrition as well as counselling on breast milk expression in these conversations
  • Provide accurate and reliable information to parents and families on parenteral nutrition

Find our campaign materials for download:

We warmly thank the following healthcare societies and organisations for supporting the position paper on parenteral nutrition (in alphabetical order):

We warmly thank the following parent organisations for supporting the position paper on parenteral nutrition (in alphabetical order):

The roundtable and the position paper are kindly supported by an educational grant by Baxter.