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We explore the history of parenteral nutrition (PN), a life-saving intervention in intestinal failure (IF) for over 50 years. Publications were identified by an index search of relevant terms, and selected to represent the whole period, illustrating key issues in the evolution of this aspect of nutritional support.
At the beginning
Scientific interest in PN was triggered by Harvey’s description of the circulation in 1628; clinical application waited three centuries until development of protein hydrolysates. In 1949, a Medical Research Council investigation of digested casein (‘casydrol’) containing both amino acids and polypeptides was published.1 Subjects (n=61) included infants with pyloric stenosis, paralytic ileus and severe gastroenteritis. Conclusions were that casydrol could be administered safely and might help maintain nutritional status. However, protein hydrolysates were associated with adverse reactions, little used in children and eventually superseded by amino acid solutions.
PN for children
Nineteen years later, successful long-term PN in neonatal short bowel syndrome was reported from America. An overview by Harries in 19712 provided a guide to use in infants and assisted the rapid spread of practical knowledge. The main indication was when enteral nutrition could not be maintained, posing a serious risk to health or life (figure 1). Although permeated with anxiety about potential complications, much in the Harries article remains familiar. A limited range of amino acid solutions and a variety of non-nitrogen energy sources including fructose, ethanol and sorbitol were referenced. Attractions of fructose (or sorbitol, which is metabolised to fructose) as a carbohydrate source included more rapid tissue uptake and less dependency on insulin. However, …
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Contributors The topic and content was discussed by both authors. The initial first draft was written by myself (RP) and then amended by JWP. The final draft was reviewed and agreed on by both authors.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.