Advances in parenteral nutrition.

Parenteral nutrition is an expensive therapy that is often necessary in certain situations, such as short-bowel syndrome. In many other conditions, its efficacy remains controversial. Providing optimal parenteral nutrition can be particularly challenging in premature infants while managing metabolic and catheter complications. Use of special nutrients, glutamine, and growth hormone may have benefits in the nutritional management of premature infants and trauma patients. Metabolic complications of parenteral nutrition such as cholestasis might be reduced by early enteral feedings, ursodeoxycholic acid, and cholecystokinin-octapeptide. Trace-element deficiencies may still occur, and thus patients must be monitored carefully. Methods that have been used to prevent or reduce catheter occlusion or infection include heparin, oral anticoagulants, antibiotics, and thrombolytic agents such as urokinase and tissue plasminogen activator.