Severe hypersensitivity reaction to total parenteral nutrition (TPN) in the infant is a rare condition with no cases described in the literature involving neonates. We report the case of a newborn who presented with symptoms of anaphylaxis while receiving TPN.

Term intrauterine growth restricted female baby with feeding intolerance was started on standard TPN on day 4 of life. After 1 hour of perfusion, she abruptly developed respiratory distress (dyspnea, wheezing and tachypnea), tachycardia, diaphoresis, generalized edema and urticaria. Her blood pressure remained within normal limits. She gradually improved with oxygen and cessation of TPN. A dose of antihistaminic was given and she fully recovered within 90 minutes. She has not since received TPN and she has not shown any reoccurrence of anaphylaxis symptoms.

CBC and differential were normal; RAST test to eggs, soya and latex were negative; prick tests for aminoacids, intralipid solution and multivitamins, done 2 days after the reaction and repeated at the age of 3 months, were also negative.

The case presented fits the clinical picture of an anaphylactoid reaction to TPN in a newborn. Given the very common practice of neonatal TPN use, we would like to alert clinicians to the possibility of severe acute reactions.