Clinical Outcome as Assessed by Anthropometric Parameters, Albumin, and Cellular Immune Function in High-Risk Infants Receiving Parenteral Nutrition By Richard A. Helms, Jane L. Miller, Gilbert J. Burckart, and Robert G. Allen~" Memphis, Tennessee 9 Twelve infants with underlying gastrointestinal tract disorders receiving 16 courses of total paren- teral nutrition were retrospectively studied. Statifl- cation according to calorie intake provided the best means for discriminating among different outcomes. Infants receiving greater than 110 calories/kg/d experienced significantly greater increases in weight, mid-arm muscle circumference, and triceps and subscapular skinfold thicknesses than did infants receiving less than 110 calories/kg/d. Catch-up growth was only seen in infants with intakes of greater than 110 calories/kg/d. In nine of these 12 infants, in vitro cellular immune parameters were assayed. Infants in both the high- and low-calorie groups experienced similar increases in transforma- tional responses to pokeweed mitogen (PWM) and phytohemagglutinin (PHA} and in the percentage of peripheral blood T lymphocytes. No increase in serum albumin was seen regardless of calorie intake. INDEX WORDS: Anthropometric parameters; paren- teral nutrition. T HE ABILITY OF parenteral nutrition to sustain life over prolonged periods of time has been documented in infants with underlying disorders prohibiting enteral feeding. However, there are limited data on achievable growth rates in stressed infants during courses of total paren- teral nutrition (TPN). Several clinical studies have examined calorie intake relative to average daily weight gain in infants receiving TPN either through central or peripheral venous catheters. Filler and co-work- ers evaluated 14 infants with underlying gastro- intestinal tract (GIT) disorders. In these infants, provision of 122 calories/kg/d resulted in an ~Deceased. From The Departments of Pharmacy and Cardiovascular Surgery, LeBonheur Children's Medical Center and The Departments of Pharmacy Practice and Pediatric Surgery, University of Tennessee Center for the Health Sciences, Memphis, Tennessee. Address reprint requests to Richard A. Helms, Pharm D, Assistant Professor, Department of Pharmacy Practice, 3 North Dunlap, Memphis, TN 38163. 9 1983 Grune & Stratton, Inc. 0022/3468/83/1805-0008501.00/0 average daily weight gain of 10.1 g/kg/d.J Heird and associates demonstrated an average gain of 12.6 g/kg/d in 21 surgical infants receiving 110 to 120 calories/kg/d. 2 In a series of 25 infants with GIT disorders, Coran noted an average weight gain of 10.6 g/kg/d on infusion of 88 calories/kg/d. 3'4 Thirty-four surgical infants studied by Ikeda and Suita experienced average gains of 5.0 g/kg/d with infusions providing 67 to 124 calories/kg/d. 5 However, none of these studies assessed the degree of change in any anthropometric parameter other than weight. There have been many studies demonstrating impairment of host defense mechanisms, partic- ularly cell-mediated defense mechanisms, in malnourished children.6-j~ Most of these studies were performed in Third World countries where a number of factors may contribute to the malnourished state and influence immune response, lj'12 A few studies have been done in hospitalized adults confirming the association of malnutrition to alteration in immune function, but more significant was the reversal of immune deficits with intense nutritional support. 13-~6 Thus far, little has been done evaluating immune function in the hospitalized infant? TM and no study has been published that evaluates changes in immune function relative to daily calorie intake while on TPN. Therefore, the objective of this study was to determine how calorie intake affects clinical outcome as measured by change in anthropom- etric measurements, albumin, and immune func- tion parameters. MATERIALS AND METHODS Infants receiving central vein TPN during 1980 were studied retrospectively. Only patients weighing 5 kg or less on initiation of therapy were included in order to closely parallel previous clinical study populations. Excluded from analysis were TPN courses of less than seven days duration and courses for which an initial anthropometric assessment and at least one additional assessment (at 1 week and/or at discon- tinuation of TPN) were not available. The study population consisted of 12 infants receiving a total of 16 independent courses of TPN. Clinical characteris- tics, stratified according to calorie intake, are presented in 564 Journal of Pediatric Surgery, Vol. 18, No. 5 (October), 1983