| Abstract: |
Parenteral vitamins are usually applied as a mixture of different vitamins. Vitamins pose particular pharmacological problems, when given intravenously, since some may adhere to the tubing and/or be degraded by light. Also stability in regard to admixture and ‘‘ingredients’’ may have an effect. Therefore the actual amount of vitamins delivered to the patient may be much lower than the intended dose, particularly in the case of retinol (vitamin A) and in premature infants who receive solutions with slow infusion rates. The optimal parenteral vitamin requirements for children and neonates have never been determined. While there are several parenteral vitamin preparations for adults and older children, there are just a few multivitamin preparations available for preterm infants and neonates. The available products for infants contain the same relative amount of lipid soluble vitamins despite different pharmacological properties in different preparations (combined water and fat soluble vitamin solution versus only fat soluble vitamin preparation). Adult formulations containing propylene glycol and the polysorbate additives are not recommended for use in infants because of concerns on potential toxicity. There is little data on vitamin needs of children with acute and chronic diseases whose requirements might differ. Vitamin concentrations in the effluents of the application sets are the result of a complex interaction of several factors, including flow rates, tubing materials and sizes, intensity of light exposition, environmental humidity and temperature as well as the relative content of each vitamin. Little new data has been published in this area during the last 20 years. Therefore, this chapter cannot provide a fully evidence based recommendation but tries to provide a reasonable framework for the pediatrician who prescribes parenteral vitamins and to point out particular areas of problems. All studies determining vitamin levels during intravenous supply have been undertaken with commercially available mixtures, either given in the glucose–amino acid solution or in the lipid emulsion. Therefore, current recommendations are based on the composition of specific products. Given the lack of adequate evidence, it is recommended to maintain, for the time being, parenteral vitamin dosages that have been previously recommended ((1–3) (LOE 4)) and have been used without apparent harmful effects in clinical practice for a number of years, with the exception of thiamine where needs may be higher than previously assumed. (GOR D) |
