Background: Parenteral nutrition (PN) is a life‑saving intervention for neonates who are unable to meet their nutritional requirements through enteral feeding. Despite its essential role, PN is frequently associated with metabolic, electrolyte, and hepatobiliary complications. Objective: To evaluate the frequency and pattern of metabolic, electrolyte, and hepatobiliary complications associated with PN administration in neonates. Methods: A prospective case-series study was conducted in two tertiary neonatal intensive care units (NICUs) in Baghdad, Iraq. Term and preterm neonates who received PN for at least five days were included. PN‑related metabolic, electrolyte, hepatobiliary, and hematological complications were recorded and analyzed. Results: Of the 94 neonates included in the primary outcome. The incidence of hypoglycemia is 35.1%, and hyperglycemia is 31.9%. Cholestasis 11.7%, hypokalemia 20.2%, hyponatremia 18%, hypocalcemia 27.6%, and thrombocytopenia 28.7%. The mean ± standard deviation of gestational age was 32.1±3.8 weeks; for postnatal age at the start of PN, it was 9.72±17.4 days; for the duration of TPN exposure, it was 12.65±9.27 days; and for the weight of the patients at the start and end of TPN, it was 1.7±0.70 and 1.84±0.74 kg, respectively. Conclusions: PN‑related metabolic, electrolyte, and hepatobiliary complications are common in neonates. Close monitoring and individualized PN management are essential to improve neonatal outcomes.
