Complete Parenteral Nutrition Research Articles

Gayet-Wernicke’s encephalopathy complicating prolonged parenteral nutrition in patient treated for colonic cancer – a case report –

BackgroundGayet-Wernicke’s encephalopathy (GWE) is a neurological pathology caused by a Thiamine deficiency. While it is most often related to chronic alcoholism, GWE can occur in any situation that results in thiamine deficiency. It is a fairly common pathology that is frequently underdiagnosed and therefore under-treated, and is associated with a high mortality and morbidity rate. In the absence of pathognomonic signs, the diagnosis of GWE relies on a range of clinical, biological and radiological assessments. GWE is considered a medical emergency.We present a case of Gayet-Wernicke’s Encephalopathy resulting from complete parenteral nutrition in an undernourished North African male operated for a left colon tumor. Through this report, our aim was to put the light on this often underknown disease and to remind the interest of thinking about this pathology in patients at risk of undernourishment especially in oncology.Case presentationA 66-year-old North African male with no personal or family history was operated for a sigmoid colon tumor. He was put on exclusive parenteral nutrition on day thirteen post-operatively and presented with a GWE on day sixteen post-operatively. The patient was treated with intravenous vitamin B1 on day eighteen post-operatively and deceased on day twenty-four post-operatively.ConclusionsAlthough most often associated with chronic alcoholism, GWE occurs in any situation where there is an increased energy demand or decreased nutritional intake especially in oncology.GWE is common but under-diagnosed and remains lethal if not treated urgently, hence the importance of prophylactic treatment.

Complete parenteral nutrition: when, to whom and how much? (Review)

Complete parenteral nutrition: when, to whom and how much? (Review)

Effect of Early Enteral Nutrition of Three-Cavity Nasal Jejunal Tube Under Superparamagnetic Iron Oxide Nanoparticles (SPIONs) in Treatment of Severe Acute Pancreatitis

This study was to explore the curative effect of early enteral nutrition (EN) of three-cavity nasal jejunal tube (NJT) based on nano superparamagnetic iron oxide (SPIO) in treating severe acute pancreatitis (SAP). After the Fe3+ and Fe2+ were mixed, the ions were co-precipitated to generate Fe3O4 nanoparticles, which were used as seeds for the sodium citrate-auric acid reduction reaction to form the gold-coated SPIO nanoparticles. 90 patients with severe AP were selected and randomly rolled into blank group (group B), control group (group C), and experimental group (group E), with 30 cases in each group. The three groups of patients were treated with complete parenteral nutrition support, EN through three-cavity NJT, an EN through three-cavity NJT under the guidance of SPIO nanoparticles, respectively. The resulted showed that the Acute Physiology and Chronic Health Evaluation (APACHE II) score (11.6±1.62) of the group E was much lower in contrast to the group B (16.34±1.45) and the group C (15.8±1.33) (P < 0.05). The computed tomography severity index (CTSI) in group E (5.03±0.65) was greatly lower than that in the group B (6.01±0.39) and the group C (5.89±0.44) (P < 0.05). Compared to the group B (14.5±1.25), the time required for the blood amylase to return to normal in the group C and the group E (11.8±1.39, 7.3±1.4) was shorter visibly (P < 0.05). The Visual Analogue Scale (VAS) scores during and after the placement of NJT were the lowest (P < 0.05). In short, the nutritional support through three-cavity NJT for patients with SAP was safe and effective, and had a positive effect on preventing infection and improving body function; in addition, the application of SPIO nanoparticles could help relieve patients’ pain and reduce adverse events.

Congenital sodium diarrhea

Congenital sodium diarrhea (P78.3 according to ICD 10) is a rare autosomal recessive disease, clinically and genetically heterogeneous. The sodium absorption defect is caused by disruption of the intestinal sodium-proton pump in the non-syndromic form and in the epithelial sodium channels in the syndromic form. Mutations in 3 genes,SPINT2(localization19q13.2; OMIMcode 270420) syndromic form;GUCY2C(localization 12q12.3; OMIM code 601330) andSLC9A3(localization 5p15.33; OMIM code 616868) non-syndromic form, can cause congenital sodium diarrhea. The frequency of the disease is unknown, since it is rare, so far only 50 cases have been described. The classic non-syndromic form of congenital sodium diarrhea ismanifested by polyhydramnios, severe secretory diarrhea, severe metabolic acidosis, alkaline pH of feces 7.5 and hyponatremia. The syndrome of congenital sodium diarrhea is also manifested by choanal and/or anal atresia, hypertelorism and erosion of the cornea. Typical laboratory data include metabolic acidosis and alkaline pH of feces (fecal pH 7.5), low Na+concentrations. The concentration of Na+in the stool is increased. Prenatal ultrasound diagnosis allows you to identify gidroamnion and expansion of intestinal loops, starting from the third trimester of pregnancy. The diagnosis is confirmed by genetic studies. Treatment: complete parenteral nutrition with correction of water-salt metabolism. The forecast is unfavorable.

Vitamins and trace elements as essential components of parenteral nutrition

In certain clinical situations, the usual food intake is impossible, insufficient or contraindicated, which causes nutritional deficiency with a deficiency of all macro- and micronutrients, and worsens the prognosis and treatment results. In such cases, parenteral nutrition (PN) is used to compensate for the deficiency of nutrients. Complex parenteral nutrition, along with macronutrients (amino acid solutions, fat emulsions and carbohydrates), includes solutions of vitamins (multivitamins, MVC) and trace elements (trace elements complexes, TEC). The aim of this work was to review the results of studies over the past 30 years on the clinical use of MVC and TEC for injections within the framework of the international ASPEN and ESPEN recommendations for the prevention and treatment of a number of diseases and pathological conditions accompanied by vitamin and trace elements deficiency, including full or partial PN. In accordance with international recommendations based on the results of most randomized clinical trials, the use of MVC and TEC allows preventing and eliminating vitamin and trace elements deficiency during long-term complete and/or partial PN, accelerating the recovery process of patients in critical conditions, and reducing the time spent in the ICU and in the clinic as a whole, to reduce the number of complications and mortality.

New insight of parenteral nutrition in children – short review

Abstract Admission. Parenteral nutrition (parenteral) is the supply of all essential nutrients - proteins, carbohydrates, fats, electrolytes, vitamins, trace elements and water intravenously. Parenteral nutrition is a generally available method of nutritional treatment used when the supply of food through the gastrointestinal tract is impossible, insufficient or contraindicated. Complete parenteral nutrition should be replaced as soon as possible with feeding to the gastrointestinal tract. Chronic diseases in children are often complicated by serious nutritional deficiencies.

Stability of Insulin in Total Parenteral Nutrition Solutions

Elneopa NF No. 1 and No. 2 infusions are complete parenteral nutrition solutions packaged as four-chambered bags. They have been used for home parenteral nutrition, with insulin injected into the bags for patients whose blood glucose becomes elevated. In this study, the stability of insulin in No. 1 and No. 2 bags was investigated. The quantity of insulin in Elneopa NF No. 2 was significantly lower than that in Elneopa NF No. 1. When insulin was injected into the upper chamber of either product, decreases in insulin levels were not observed. In contrast, the levels of insulin injected into the lower chamber of both products significantly decreased, with a larger difference in Elneopa NF No. 2. As the amino acid content is different between No. 1 and No. 2, amino acids may be considered a potential cause for the degradation of insulin in the bags. In addition, decreases in insulin levels were observed as the solutions passed through infusion sets just after flushing began, with both Elneopa NF No. 1 and No. 2. In conclusion, the concentration of insulin injected into the Elneopa infusion bags decreases, especially in No. 2 bags, and insulin is absorbed by the infusion sets.

Stability studies of parenteral nutrition with a high dose of vitamin C

Postoperative administration of parenteral nutrition has become routine management in patients with gastrointestinal cancer. Providing patient the complete parenteral nutrition containing not only the macronutrients and electrolytes but also adequate doses of vitamins is a significant issue of nutritional therapy. The aim of the study was to develop parenteral nutrition containing a high dose of vitamin C (500 mg) and evaluate their stability. Five compositions of parenteral nutrition were developed and stored for seven days in three different conditions. Physical stability studies including visual examination and determination of pH, size of lipid droplets (using dynamic laser scattering method), and zeta potential (using laser Doppler electrophoresis method) were performed for all studied parenteral nutrition with and without vitamin C immediately after preparation and after storage. The content of vitamin C was determined using high-performance liquid chromatography (HPLC) method. The addition of vitamin C to parenteral nutrition did not affect its physical stability. Degradation of vitamin C in parenteral nutrition occurred according to first-order kinetics reaction. The content of vitamin C remained above 90% of zero-time content within the first 24 h for each studied parenteral nutrition compositions stored at 4°C and 25°C with light protection. Vitamin C added to parenteral nutrition was unstable regardless of the storage conditions nor parenteral nutrition compositions. However, for the first 24 h, the content of vitamin C remained in the pharmacopoeial limit. Therefore, supplementation of parenteral nutrition admixtures with vitamin C in the dose of 500 mg is possible in the condition of administration to the patients within the first 24 h.

Photoprotection But Not N-acetylcysteine Improves Intestinal Blood Flow and Oxidation Status in Parenterally Fed Piglets.

The purpose of the present study was to determine if protecting parenteral nutrition solutions from ambient light and supplementing with N-acetylcysteine (NAC) improves mesenteric blood flow, gut morphology, and oxidative status of parenterally fed neonates. Neonatal Yucatan miniature piglets (n = 23, 7-11 days old) were surgically fitted with central venous catheters and an ultrasonic blood flow probe around the superior mesenteric artery. Piglets were fed continuously for 7 days either light-protected (LP) or light-exposed (LE) complete parenteral nutrition that was enriched with either NAC or alanine (ALA). There were no differences in body weight or overall gut morphology among groups after 7 days. Plasma concentrations of NAC were greater and total homocysteine lower in NAC- versus ALA-supplemented pigs on day 7 (N-acetylcysteine: 94 vs 7 μmol/L; P < 0.001; homocysteine: 14 versus 21 μmol/L; P < 0.005); plasma total glutathione was not affected. Hepatic lipid peroxidation was reduced by 25% in piglets that received LP parenteral nutrition (P < 0.05). The mesenteric artery blood flow decreased in all pigs between days 2 and 6 (P < 0.001) because of parenteral feeding. Photoprotection alone (LP-ALA) attenuated the decrease in mesenteric blood flow to 66% of baseline on day 6 compared with LE-ALA (37%; P < 0.05) and LP-NAC pigs (43%; P = 0.062); LE-NAC piglets had intermediate reductions in blood flow (55%). Photoprotection of parenteral nutrition solutions is a simple, effective method to attenuate decline in blood flow to the gut and hepatic lipid peroxidation, which are both commonly associated with parenteral feeding.

Determination of the diagnostic value of early symptoms in the prognosis of necrotizing enterocolitis in neonates of different gestational age

Necrotizing enterocolitis in newborns - non-specific inflammation of the intestine, predominantly in preterm infants, which puts a child's life at risk when it progresses. Despite the large number of studies of foreign and domestic scientists in the study of etiology and pathogenesis, clinical, laboratory and instrumental diagnosis of NEC, this disease remains one of the leading causes of infant mortality in intensive care units. Clinical symptoms of NEC can be manifested from intolerance to nutrition and intestinal paresis to severe peritonitis and multiple organ failure, and most diagnostic methods have high specificity but insufficient sensitivity or vice versa. The detection of early symptoms and progression symptoms of the NEC allows you to choose the best treatment tactics and improve your results. Therefore, differential diagnosis on the basis of clinical, instrumental and laboratory studies plays an important role in the diagnosis and determination of the stages of the NEC. The success of NEC treatment depends not only on timely diagnosis and evidence of surgical treatment, but also on the depth and distribution of bowel damage. Currently, there are no reliable non-invasive methods for diagnosis of the spread and depth of damage to the intestinal wall under the NEC. The terms of pre-operative preparation, the scope and type of surgical treatment remain controversial.Objective. The purpose of the study is to determine the diagnostic value of early symptoms in the development and progression of necrotizing enterocolitis in newborns of different gestational age.Materials and Methods. The work is based on studying the results of treatment of 94 newborns with NECs who were on treatment in the department of intensive care and pathology of newborns "Dniepropetrovsk Specialized Clinical Medical Center of Mother and Child. prof. MFRudneva "DOR" in 2015-2018. The diagnosis was established on the basis of clinical, instrumental (ultrasound, doppler, x-ray), laboratory and bacteriological studies. Patients were divided in terms of treatment tactics into two groups: the first group consisted of patients with NEC who did not require surgical intervention (uncomplicated NEC) (n = 71), the second group included patients requiring surgery (complicated by the NEC) ( n = 23). Additionally, patients in both groups performed intra-abdominal pressure measurements.Measurement of abdominal circumference in all patients with NECs was performed at the navel level in at least three measurements taken at intervals of 4-6 hours.Initial treatment was the same for patients in both groups and included: decompression of the stomach, complete parenteral nutrition, antibiotic therapy.Results and discussion. Increased symptoms of inability to enter into the stomach (inferiority syndrome), congestive growth in the stomach, auscultation of peristaltic bowel sounds, bloating, pain and / or tightness of the stomach accompanied the deterioration of the general condition of patients and the development of complicated forms of NEC.The appearance of a venous figure on the anterior abdominal wall and its pronounced nature over time, hyperemia and edema of the anterior abdominal wall and external genital organs revealed the presence of intraperitoneal hypertension and intra-abdominal circulation disturbance as a result of reduced perfusion pressure and inflammatory changes in the peritoneum.The increase in the abdominal circumference in patients of the I group was not more than 5 mm in the previous measurement, with the progression of the HEC and the development of complicated forms of NEC, the increase in abdominal circumference was 7 mm larger than the previous results.The main diagnostic tool for detecting progression and complications of NEC was the performance of X-ray of the abdominal cavity. X-ray of the abdominal cavity was performed for all patients with a suspicion on a NEC in a straight projection in an upright position. The most common X-ray symptoms of complicated NECs were the discovery of pneumoperitoneum, free fluid in the abdominal cavity and non-peristaltic static bowel loop. Also, the data obtained indicate that patients with complicated forms of NEC disease are accompanied by a significant increase in intraabdominal pressure, mainly due to sequestration of fluid in the third space, increasing intestinal paresis and its edema. If you do not diagnose and not eliminate a significant increase in intra-abdominal pressure, this leads to a violation of capillary perfusion of the internal organs, which leads to further ischemia and the development of abdominal compartment - a syndrome.When diagnosing pneumoperitoneum, ascites on the background of NEC or with the advent of clinical symptomatology, the progression of HEC (to exclude a hidden perforation) under ultrasound control was performed for all patients under local anesthesia abdominocentesis. In the case of a positive result of abdominocentesis, drainage of the abdominal cavity was performedConclusions. Among the early clinical syndromes that characterize the progression of the NEC, it is necessary to pay attention to the growth of the syndrome of enteral insufficiency. An increase in the incidence of intra-abdominal hypertension is an early symptom of the progression of the NEC.

Essential Amino Acid Profile in Parenteral Nutrition Mixtures: Does It Meet Needs?

Background and Aims: The study compares the essential amino acid (EAA) composition of different parenteral nutrition (PN) mixtures with whey protein EAA profile and the theoretical daily EAA requirements (set by WHO/FAO/UNU or IAAO method). According to the individual EAA profile, the potential effect of several PN mixtures was evaluated on the skeletal muscle mass (SMM) of patients on home PN. Methods: Eight AA solutions and fifteen complete PN mixtures were considered. Twenty-nine clinically stable patients with short bowel syndrome on home total PN were retrospectively evaluated. SMM was estimated by bioelectrical impedance analysis. Results: The prescribed doses of EAA that showed a significant increase in home PN patients muscle mass were considerably greater than the theoretical ones, showing an EAA profile similar to whey protein. At the daily dose of 1 g of total AA s/kg body weight (BW), the considered PN mixtures mostly failed to improve SMM. Only prescribed doses which included more than 0.25 g/kg BW of total BCAA with at least 0.10 g/kg BW leucine, 0.08 g/kg BW isoleucine, and 0.06 g/kg BW methionine showed a significant increase in SMM. Conclusions: The theoretical daily requirement for each EAA was met by all considered PN solutions when the prescribed daily dose of total AAs was set at 1 g/kg BW. Nevertheless, our data suggest that only an increase in total BCAA, also richer in single AA leucine, isoleucine, and methionine, is associated with the maintenance and/or increase of SMM. According to these preliminary observations, we support the prescription of an EAA composition of PN mixtures close to that of whey protein for the preservation of SMM in patients on long-term total PN.

Long-term Impact of added Glutathione into Parenteral Nutrition Administered During the First week of life on Redox Potential and Energy Metabolism Enzymes in Guinea pig liver

Introduction Peroxides are generated in parenteral nutrition (PN). Infusion of PN or H2O2 in the first week of life of animals alters later in life their hepatic energy metabolism. Glutathione addition in PN prevented pulmonary oxidative stress induced by PN in newborn guinea pigs (GP). Hypothesis: Addition of glutathione into PN prevents the long-term impact of PN on activities of key enzymes of energy metabolism (glucokinase (GK), phosphofructokinase (PFK) and acetyl-CoA carboxylase (ACC)). Methods 4 groups (N=48) of 3-day old GP were used. Control: no manipulation, fed ad libitum all time; PN: animals nourished exclusively with a complete PN via a catheter; PN+ 6 or 12 µM GSSG; GSSG was used as pro-GSH. After 4 days, hepatic redox potential was measured in half of GP. The other half started oral diet. At 16 weeks of age, liver was collected for determination of GSH, GSSG and redox potential (capillary electrophoresis, Nernst’s equation), activities (U: nmol/min/mg prot) of PFK, GK (calorimetric method), and ACC (method with radioactive tracer). Data (mean±sem) were analyzed by ANOVA, p Results Immediately after treatments, there was no difference between groups for redox potential (mV) (-231±1). Four months later, redox potential, GSH and GSSG (nmol/mg prot) were lower in PN groups independently of GSSG addition, relatively to control (respectively, PN groups: -235±1, 69±2, 0.8±0.1 vs. Control: -229±2, 81±5, 1.8±0.3). ACC activity was higher in PN group (4.5±0.3 U) and greater in NP+GSSG groups (5.7±0.3 U) relatively to control (3.2±0.2 U). GK and PFK activities did not differ. Conclusion PN early in life induces later in liver reduction of redox potential and higher activity of a key enzyme of lipogenesis (ACC). In contrast to beneficial effect previously observed in lungs, addition of GSSG into PN did not prevent the long-term effects of PN on the liver.

Favourable Outcome in Two Pregnancies in a Patient with 3-Hydroxy-3-Methylglutaryl-CoA Lyase Deficiency.

In patients with 3-hydroxy-3-methylglutaryl(HMG)-CoA lyase deficiency (OMIM 246450), five pregnancies have been described worldwide, which were either terminated or resulted in severe metabolic sequelae during pregnancy or delivery. Here, we report on a patient with HMG-CoA lyase deficiency, who underwent two uncomplicated pregnancies. The 19-year-old patient was admitted because of recurrent vomiting and nausea. Diagnostics revealed pregnancy at week 8 of gestation. Metabolic analyses revealed normal lactate and blood glucose levels and normal acid-base status. Urine organic acid analysis showed an elevated excretion of 3-CH3-glutaric acid, 2,3-CH3-glutaconic acid, and 3-CH3-3-OH-glutaric acid. Oral treatment with carnitine and glucose wes administered intravenously during the period of nausea and vomiting. After clinical recovery, a diet with 0.89g/kg of protein/d and 38 kcal/kg body weight/d was given. Meals were taken every 3h. Additionally, 70g of starch was given at midnight to maintain normoglycemia at night time. Peripartum, a complete parenteral nutrition, was delivered through a central venous catheter. The patient delivered a healthy male infant by Caesarean section at week 38 of gestation (Apgar 9/10/10) and remained metabolically stable throughout the peripartum period. Postpartum nutrition was gradually changed from parenteral to oral diet. Two years later, the patient became pregnant again and presented with hyperemesis gravidarum. With metabolic monitoring and treatment as before no decompensation occurred. At week 38 of gestation, she delivered a healthy female infant by elective Caesarian section (Apgar 9/10/10). This case report describes the metabolic and obstetric management of two pregnancies in a patient with HMG-CoA lyase deficiency with favorable outcome without metabolic complications.

仔犬における脂肪乳剤を含んだ完全経静脈栄養の実験的研究 : 第 2 部各臓器の病理学的並びに生化学的検討

仔犬における脂肪乳剤を含んだ完全経静脈栄養の実験的研究 : 第 2 部各臓器の病理学的並びに生化学的検討

Amino acid composition of standard and personalized complete parenteral nutrition mixtures

Amino acid composition of standard and personalized complete parenteral nutrition mixtures

Total nutrient admixtures (3-in-1): pros vs cons for adults.

Total nutrient admixture (TNA) is a complete parenteral nutrition (PN) formulation composed of all macronutrients, including dextrose, amino acids, and intravenous fat emulsions (IVFE), in one bag. The TNA may be safely administered to the patient, with all components aseptically compounded and minimal administration manipulation required, lending itself to decreases in risks of catheter contamination and patient infections. The TNA is compatible and stable at recommended concentrations, and since the IVFE is in the TNA, it is infused at slower rates, allowing for better fat clearance. The TNA offers convenience of administration and a potential cost savings to the healthcare institution both directly and indirectly. Unfortunately, the TNA is not without concerns. At low macronutrient concentrations (lower than recommended), the formulation is compromised. Greater divalent and monovalent cation amounts and increased concentrations of phosphate and calcium may destabilize the TNA or result in precipitation, respectively. With the addition of IVFE in the TNA, catheter occlusion is greater and larger pore size filters are necessary, resulting in less microbial elimination. Determining if the implementation of the TNA is appropriate for an institution requires a recognition of the advantages and disadvantages of the TNA as well as an understanding of the institution's patient population and their nutrition requirements.

Laparoscopic Surgery in Transplanted Patients: A Series of Case Report and Literature Review.

Following the enthusiastic effort by many experts around the world in Minimal Invasive Surgery (MIS) in the past several decades, we already have a big consensuses on the feasibility and advantages of this technique in nearly all the major open surgery. However there is still very few reports of application of MIS in the transplanted patients. Because, we all are still concerning about the similar superiority of MIS in such patients with complex abdominal organ transplantation like liver, kidney, pancreas and small bowel. Here we would to share with our limited experience on the laparoscopic intervention in acute abdomen as well as major abdominal surgery including malignancy. We reported 6 cases who underwent laparoscopic surgery for presumed acute appendicitis in a 52y/o male 8 months after deceased donor liver transplant (DDLT) and in a 50y/o patient 16 months after deceased donor kidney transplant (DDKT). Acute appendicitis in both patients were highly suspected preoperatively in computed tomography and early exploration with laparoscopic technique prompted early diagnosis, treatment and excellent surgical outcomes.A case of small right colon cancer not detected in preoperative computed tomography progressed quickly within one month after transplant had been managed with pure laparoscopic right hemi-colectomy and radical lymph node dissection. The specimen showed good surgical margin with enough lymph node numbers dissected. The fourth patient sustained chylous ascites 6 moths after LDLT and laparoscopy is very important for diagnosis, evaluation of peritoneal cavity, and placement of drain to release symptoms. He was also successfully managed by complete parenteral nutrition, octreotide, and low fat diet with medium chained triglyceride. We also like to expressed a case of morbid obesity (male, 41y/o) with BMI of 41 kg/m2 received laparoscopic sleeve gastrectomy three years after DDKT with good postoperative weight loss and resolution of diabetes, hypertension, high lipid level and renal dysfunction. The recent patient with incisional hernia of subcostal wound about one and half years after DDLT received laparoscopic hernia repair with dual mesh. All the patients had been operated without any significant difference from those with non-transplant patients and recovered uneventfully with all the benefits of MIS.

Parenteral Nutrition with Oliclinomel N8-800 in Patients with Hypercatabolism during Extended Abdominal Surgery

Objective: to determine the efficiency of postoperative 3-in-1 parenteral nutrition with Oliclinomel N8-800 in correcting protein-energy malnutrition in patients undergoing extended surgical interventions into the abdominal organs. Subjects and methods. Forty-one patients with gastric and pancreatic neoplasms treated in the intensive care unit, N. N. Burdenko Main Military Clinical Hospital, in January to October 2013 were examined. All the patients were males. The mean age was 63.5±11.87 years. The study design: a prospective controlled randomized trial. Group 1 (a comparison group) entered 21 patients. Conventional parenteral nutrition regimens with Oliclinomel N7-1000E 2000 ml were used on postoperative day 2. The intestine was lavaged with a glucose-electrolyte solution within the first postoperative hours. The glucose-electrolyte solution and standard enteral formula were intraintestinally administered as the absorptive and digestive functions of the small bowel recovered. On postoperative days 7 and 8, the parenteral nutrition was stopped and completely switched to enteral feeding. The dissimilarity of Group 2 (a study group) (n=20) was that it received parenteral nutrition with Oliclinomel N8-800 2000 ml. Results. Complete parenteral nutrition, then mixed parenteral-enteral nutrition stabilized protein metabolic parameters in the patients of both groups in a unilateral fashion, but more promptly in Group 2 than in Group 1. The nutritional support program in Group 2 caused significantly less reduction in the body' cellular weight than in Group 2 in the first and entire period of the follow-up, which appears to be related to the administration of large amounts of nitrogen. Conclusion. The results suggest that the use of Oliclinomel N8-800 for parenteral nutrition adequately corrects postaggressive nitrogen deficiency, promotes the normalization of protein and carbohydrate metabolism and a positive nitrogen balance and the resolution of hypermetabolism/hypercatabolism after extended abdominal surgery.

Treatment status of parenteral nutrition-associated cholestasis in preterm infants

Parenteral nutrition (PN) is one of the important measures to cure premature babies and critically ill infants. In recent years, with the improvement of rescue techniques in the perinatal period, a growing number of preterm infants alive, very low birth weight and low birth weight infants gradually become an important part of the neonatal disease. The gastrointestinal development of these premature babies are not mature or combined with other diseases, in a long period of time after birth need partial or complete PN support. Due to the use of PN, provides the children with survival and greatly reduce the case fatality rate, but the cause of parenteral nutrition associated cholestasis would become one of the main complications of premature infants, seriously affect the patient′s quality of life. In this paper, the treatment of premature parenteral nutrition associated cholestasis status is summarized. Key words: Parenteral nutrition; Cholestasis; Treatment; Premature infant

The use of central venous lines in the treatment of chronically ill children.

Treatment of chronic diseases in children is aspecial medical problem. Maintaining constant access to the central vascular system is necessary for long-term hemato-oncological and nephrological therapies as well as parenteral nutrition. Providing such access enables chemotherapic treatment, complete parenteral nutrition, long-term antibiotic therapy, hemodialysis, treatment of intensive care unit patients, monitoring blood pressure in the pulmonary artery and stimulation of heart rate in emergency situations as well as treatment of patients suffering from complications, especially when chances of access into peripheral veins are exhausted. Continuous access to the central vascular system is desirable in the treatment of chronically ill children. Insertion of acentral venous catheter line eliminates the unnecessary pain and stress to achild patient accompanying injection into peripheral vessels. In order to gain long-term and secure access to the central venous system, respecting the guidelines of the Center for Disease Control and Prevention contained in the updated 'Guidelines for the Prevention of Intravascular Catheter-Related Infections' is necessary.