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

Next steps

As a next step to the parenteral nutrition position paper, a German-speaking roundtable will be hosted to develop a practical handbook for healthcare professionals based on the position paper. The aim will be to improve the situation of parenteral nutrition in hospitals who take care of preterm and ill babies on a national level.  

There will be regular updates of this page, so come back later to find out the newest developments in this topic.

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

Interview with Professor Nadja Haiden

Professor Nadja Haiden

Professor Nadja Haiden, MD. MSc. is head of the Neonatal Nutrition Research Team of the Medical University of Vienna, Austria.  

In this interview she explains:

  • The process of parenteral feeding
  • Its benefits and possible challanges
  • How to include parents in the feeding process

 Read full interview

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

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.