Duration Of Nutritional Support Research Articles

СОВРЕМЕННЫЕ ВОЗМОЖНОСТИ ЛЕЧЕБНОГО ПИТАНИЯ ПАЦИЕНТОВ С ДЕТСКИМ ЦЕРЕБРАЛЬНЫМ ПАРАЛИЧОМ ПРИ НАРУШЕНИЯХ НУТРИТИВНОГО СТАТУСА

With the purpose of successful rehabilitation, reduction of concomitant diseases, improvement of nutritional status and the quality of life of patients with cerebral palsy (CP) it is necessary to develop therapeutic nutrition technology, which would include methods for nutritional status assessment, choosing of enteral nutrition formulas, methods of their delivery and the duration of nutritional support. The purpose of this research was to substantiate the nutritional support for patients with CP. Materials and methods used: 98 children aged 2 to 16 years and 9 months old (Me 5.7 y/o) with a spastic form of CP that had been admitted for examination, treatment and rehabilitation at the National Medical Research Center for Children’s Health (Moscow, Russia) were examined. Depending on the level of motor activity calculated with GMFCS, the participants were divided into two groups: G1 of 51 (52%) with severe motor impairment (GMFCS IV to V) and G2 of 47 (48%) with mild and moderate motor impairment (GMFCS I to III). Clinical and anamnestic data, information about the severity and the course of the disease, concomitant pathology were analyzed as well as the anthropometric data (Z-scores: weight/age, height/age, BMI/age) using the WHO AnthroPlus application (2009 revision). EDACS survey had also been carried out. Results: Patients with severe motor impairments were significantly more likely to have problems associated with food intake, such as: prolonged feeding (over 30 minutes), predominance of semi-liquid and pureed food in the diet as well as frequent choking, vomiting, wheezing and coughing during the feeding process. All patients in this group needed external assistance in feeding. 75% had respiratory and 72% had gastrointestinal complications. Severe impairments (EDACS IV to V) characterized by significant restrictions on food safety were identified in 24 (23%) children, that met statistically significantly (p<0.001) more often in patients from G1 than from G2 (41% vs. 4%, respectively). Dietary analysis children with CP had showed that the quality and quantity of food consumed were monotonous and deficient. Consumption of pasta, cereals, and baking was 1.5 times higher than recommended whilst vegetables, fruits and healthy dairy products were reduced by 3 and 1.8 times, respectively, on the contrary. The WHO recommendations for children on the mandatory daily intake of 3 to 4 servings of various vegetables and fruits were not followed: in the majority (80%) of cases they’ve only had it once per day, and they even were completely absent in some cases. Nutritional assessment revealed that patients with severe movement disorders, regardless of the gender and nutritional status, had significant deficiencies in energy and protein intake. All studied anthropometric indicators in G1 patients were significantly (p<0.005) lower compared to G2 children. Prevalence of undernutrition was 72% and 32% (p<0.001), respectively. Individual nutritional program was developed for each and every studied patient with identified malnutrition and oropharyngeal dysphagia, followed by its clinical effectiveness assessment. Conclusion: enteral nutritional support with specialized formulas based on both whole and hydrolyzed proteins using the sipping/gastrostomy method, as well as with the use of a food and liquids thickeners, proved to be highly effective in the treatment and rehabilitation of CP children. Indicators characterizing food intake (time taken for feeding, frequency of choking records during meals, episodes of vomiting and regurgitation) have improved as well as the anthropometric indicators improved accordingly.

Creating the optimal preoperative nutritional status for neonates undergoing cardiac surgery by implementing a preoperative nutritional support plan.

The purpose of this study was to explore the effect of a preoperative nutritional support programme on improving preoperative nutritional status and promoting postoperative recovery in neonates undergoing cardiac surgery. The clinical data of neonates undergoing cardiac surgery who received preoperative nutritional support therapy in our hospital from March 2021 to December 2021 were collected, and the clinical data of neonates undergoing cardiac surgery who did not receive preoperative nutritional support therapy in our hospital from February 2020 to February 2021 were selected as the control. The nutritional status and postoperative recovery of the two groups were compared. A total of 30 neonates who received nutritional support before cardiac surgery were included in this study. A total of 28 neonates who did not receive nutritional support before cardiac surgery were included in the control group. There were no significant differences in general information or the nutritional status at birth between the two groups. The duration of nutritional support in the intervention group was 16.8 ± 7.1 days. Before the operation, the intervention group was significantly better than the control group in terms of body weight, albumin, prealbumin and haemoglobin, which indicated that the nutritional status of the intervention group was better than that of the control group. The intensive care time, ventilator time and hospital stay time in the intervention group were significantly lower than those in the control group. Nutritional support plans after birth for neonates with severe congenital heart disease can effectively improve the nutritional status of patients before surgery and accelerate the speed of postoperative recovery.

The Importance of the ileocecal valve and colon in achieving intestinal independence in infants with short bowel syndrome

PurposeInfants with short bowel syndrome (SBS) wean from parenteral nutrition (PN) support at variable rates. Small bowel length is a predictor, but the importance of the ileocecal valve (ICV) and colon are unclear. We aim to determine if the ICV and/or colon predict enteral autonomy. MethodsInfants from a single intestinal rehabilitation program were retrospectively reviewed. Etiology of SBS, intestinal anatomy, and duration of nutritional support were collected for three years. The primary outcome was time to full enteral nutrition. ANCOVA and Cox proportional hazards model were used, with p < 0.05 significant. Results55 infants with SBS were included. After accounting for the effect of small bowel, PN duration was shorter for infants with the ICV compared to those without (mean 218 vs. 538 days, p = 0.003), and had a more significant effect on infants with ≤50% of small bowel. Increased small bowel length was a positive predictor of weaning. Patients with ≤50% of colon spent less time on PN with the ICV, compared to without (mean 220 vs 715 days, p = 0.009). ConclusionsPreservation of the ICV was associated with shorter duration of PN support, while colon was not. Small bowel length is a positive predictor of enteral autonomy. Level of EvidenceLevel III retrospective comparative study Type of StudyRetrospective review

Nutrition Support After Cardiac Surgery: Lessons Learned From a Prospective Study

The importance of postoperative nutrition support (NS) has been poorly recognized in cardiac surgery. In this population, we aim to describe the delivery of NS, factors affecting calorie/protein delivery and NS-associated morbidity. From January 2015 to January 2017, we prospectively observed all cardiac surgery patients at a single institution who could not take nutrition orally, requiring postoperative NS, either enteral or parenteral, for the duration of NS up to 14 days. We compared outcomes to patients without NS and examined NS indications, factors affecting its delivery and its associated complications. Nine percent of patients (232/2603) required NS for a total of 1938 NS-days. The most common indication was mechanical ventilation. NS met 69% of daily caloric needs. On days when tube feeds (TFs) were held (mean of 13 hours), this decreased to 43%, compared to 96% when TFs were not held (P < 0.001). The most common reason for holding TFs was procedures. When TFs were supplemented with parenteral nutrition (TFs + PN), 86% of daily caloric needs were met. Even on days when TFs were held, this only dropped to 77% (TFs + PN), compared to 36% (TFs-only). By multivariable logistic regression, elemental and semielemental formulas, TF volume, and postpyloric feeds increased the risk of diarrhea, occurring in 28% of patients and 18% of TF-days. In cardiac surgery patients given postoperative NS, mortality and morbidity were an order of magnitude higher than those able to be fed orally. Enteral feeding delivered approximately two-thirds of needs, but PN supplementation dramatically improved this. Diarrhea was common, associated with the postpyloric route, increasing TF volume, and nonintact formula.

NUTRITIONAL SUPPORT IN HOSPITALIZED PATIENTS UNDERGOING ALLOGENIC HEMATOPOIETIC STEM CELL TRANSPLANTATION

Assessment of the need of parenteral nutrition (PN) for patients undergoing allogeneic Haematopoietic Stem Cell Transplantation (HSCT) and effectiveness of nutritional support. 41 consecutive patients (20 females, 21 males) undergoing allogenic HSCT at the Transplant Center of the AOU Federico II of Naples in the years 2014-2016. Anthropometric parameters, biochemical indices and artificial / parenteral nutrition requirements were evaluated at admission and discharge. Total or supportive PN due to several disease and therapy related complications was indicated for 68.3% of patients (89.3% galenic, 35.7% glutamine enriched, indication reported in table 1). Median duration of nutritional support was 13 days, median timing for start support was 8 days. 87.5% of patients in PN received a TBF conditioning scheme (thiotepa, busulfan, fludarabine), 57.1% immunosuppressive therapy with high-dose cyclophosphamide, 53.6% hematopoietic stem cells from a haploidentical donor (67.9% bone marrow source). Average length of hospitalization, biochemical nutritional and hematological indices and anthropometric parameters observed at discharge are shown in table 2. 42.2% of the patients had home artificial nutrition support (71.5% oral nutritional supplement, 28.5% PN). PN (personalized nutritional intervention) allows patients undergoing allogenic HSCT who have developed more severe complications to achieve a clinical-haematological recovery such as patients without or with minor complications.

Survey of nutritional practices in total gastrectomy and oesophagectomy procedures

Total gastrectomy and Ivor Lewis oesophagectomy procedures are the mainstay of upper gastrointestinal cancer management. Maintenance of adequate nutritional intake is essential for positive patient outcomes. Although numerous nutritional support options exist, clear evidence-based guidelines on the optimal means and duration of nutritional support are lacking. The aim of this study is to establish preliminary data on the current perioperative nutritional practices of upper gastrointestinal surgeons performing these procedures across Australia and New Zealand. It is hoped this will help provide the platform for future research towards establishing evidence-based guidelines in upper gastrointestinal surgery. A questionnaire exploring the nutritional practices and considerations of surgeons was developed and emailed to the members of the Australia & New Zealand Gastric & Oesophageal Surgery Association. A total of 27.4% of Australia & New Zealand Gastric & Oesophageal Surgery Association members completed the questionnaire. Surgeons reported inserting a jejunostomy feeding tube intraoperatively in Ivor Lewis oesophagectomy procedures 80-100% of the time, compared to only 20-39% of the time in total gastrectomy procedures. For both procedures, surgeons often refer their patients to a dietitian preoperatively, and always postoperatively. Preoperative immune-enhancing nutrition is rarely administered. Patient age and BMI are deemed to be of low importance when determining the means of nutritional support. This study has demonstrated the current nutritional practices employed in Australia and New Zealand for patients undergoing major upper gastrointestinal surgery. Questions remain regarding the noted differences between procedures as well as the optimal means and duration of perioperative nutritional support.

Arbre décisionnel du soin nutritionnel

Undernutrition is a frequent complication of acute and chronic diseases, and is correlated with disease prognosis and patients’ quality of life. Undernutrition has a major impact on health care costs. Screening of undernutrition and nutritional care are recommended in current clinical practice and the identification of undernutrition-related costs is of prime importance. The management of nutritional care depends on nutritional risk and status, protein and energy needs, and spontaneous oral intake. The goal of nutritional care is to avoid the onset of malnutrition in patients at risk, and in undernourished patients to prevent its worsening and to correct it. Three different levels of nutritional intervention do exist: dietary counseling and oral nutritional supplements, enteral nutrition, and in case of enteral nutrition's contra-indications, intolerance or insufficiency, total or supplemental parenteral nutrition. The choice of feeding routes depends mainly on the expected duration of nutrition support. In every case, nutritional strategy should be regularly re-evaluated and adapted according to nutritional efficacy and disease evolution.

Nutrition Support for Head and Neck Squamous Cell Carcinoma Patients Treated with Chemoradiotherapy: How Often and How Long?

Background. Oral intake of many patients with locally advanced head and neck cancer (LAHNC) decrease during chemoradiotherapy (CRT). Although prophylactic percutaneous endoscopic gastrostomy (PEG) is recommended, not a few patients complete CRT without using PEG tube. Patients and Methods. The subjects were patients with LAHNC who received CRT. We retrospectively investigated the incidence and duration of nutritional support during and after CRT, and predicting factors of nutritional support. For patients who required nutritional support, we also checked the day of initiation and the duration of nutritional support. Results. Of 53 patients, 29 patients (55%) required nutritional support during and/or after CRT. While no clear relation between requirement of nutritional support and variables including age, T stage, N stage, clinical stage and chemotherapy regimen, there could be some relationships between tumor primary sites and the requirement and duration of nutritional support. 17 (77%) of 22 patients with oropharynx cancer(OP) required nutritional support and prolonged for 4.4 months, and 11 (46%) of 24 patients with hypopharynx cancer(HP) required nutritional support and prolonged for 21.9 months. Conclusion. Nutritional support is indicated many HNC patients treated with CRT and primary sites may have some relation to its indication and duration.

Management of acute intestinal failure

Intestinal failure (IF) occurs when intestinal absorptive function is inadequate to maintain hydration and nutrition without enteral or parenteral supplements. It has been classified into three types depending on duration of nutrition support and reversibility. Type 1 IF is commonly seen in the peri-operative period as ileus and usually spontaneously resolves within 14 d. Type 2 IF is uncommon and is often associated with an intra-abdominal catastrophe, intestinal resection, sepsis, metabolic disturbances and undernutrition. Type 3 IF is a chronic condition in a metabolically stable patient, which usually requires long-term parenteral nutrition. This paper focuses on Types 1 and 2 IF (or acute IF) that are usually found in surgical wards. The objectives of this paper are to review the incidence, aetiology, prevention, management principles and outcome of acute IF. The paper discusses the resources necessary to manage acute IF, the indications for inter-hospital transfer and the practicalities of how to transfer and receive a patient with acute IF.

Thromboembolism in Infants and Children With Gastrointestinal Failure Receiving Long‐Term Parenteral Nutrition

Thromboembolism is an established complication of long-term parenteral nutrition (PN) administration which requires central venous lines in the pediatric population. Predisposing factors that increase the risk of thrombosis, as well as prophylaxis and treatment guidelines in this specific population, are not clearly defined. We performed a computerized search of PubMed, OVID databases, and pertinent articles from reference lists of related review papers. This review summarizes currently available data on the rates of thromboembolism in the pediatric population receiving long-term PN and concludes that control of factors such as location of catheter, duration of nutrition support, and prophylaxis with heparin or anticoagulants may reduce the rates of thrombosis in this patient population, although most data on the matter are inconclusive.

L‐Alanin‐l‐glutamine supplementation improves the outcome after colorectal surgery for cancer

To investigate the effect of l-alanine-l-glutamine (Gln) on postoperative complication rate and duration of hospitalization in patients operated for colorectal cancer. A total of 109 patients operated with the diagnosis of colorectal cancer and given enteral nutrition between January 2001 and January 2005 were prospectively analysed. The patients were randomized and analysed in two groups; Gln group (n = 57): patients were given parenteral Gln (1 g/kg/day, Dipeptiven, Fresenuis Kabi, Germany) together with enteral nutrition (Ensure; Abbott, Zwolle, The Netherlands) and the control group (n = 52) only received enteral nutrition (Ensure; Abbott), which was a standard isonitrogenous and isocaloric formula. The supplemental enteral nutrition was provided for at least 5 days pre- and postoperatively according to the nutritional status of the patients. Age, gender, subjective global assessment (SGA), body mass index (BMI), serum albumin, protein, associated disorders, localization of pathology, techniques of anastomosis, postoperative complications and length of hospital stay were analysed for each patient. The duration of nutritional support in the Gln group was 6 +/- 2 and 5 +/- 1 days pre- and postoperatively; while it was 7 +/- 1 and 6 +/- 1 days for the control group, and there were no significant difference among the groups (P > 0.05). Age, gender, SGA, BMI, levels of serum albumin and protein, localization of pathology and techniques of anastomosis were also similar (P > 0.05). Wound infection (P = 0.038), intraabdominal abcess formation (P = 0.044) and wound dehiscence (P = 0.044) were significantly higher in the control group than in the Gln group. There was no significant difference in terms of anastomotic leakage and other complications between both groups (P > 0.05). Hospital stay was significantly shorter in the Gln group (P < 0.001). Supplementation of parenteral Gln decreased the postoperative complications and hospital stay and in the patients undergoing the colorectal surgery for cancer.

Nutrición enteral domiciliaria en España. Resultados del registro de la Sociedad Española de Gastroenterología, Hepatología y Nutrición Pediátrica del año 2003

The number of children receiving prolonged home enteral nutrition (HEN) is increasing. However, precise information on the incidence and prevalence of HEN in Spain is lacking. Consequently, the Spanish Society of Pediatric Gastroenterology, Hepatology and Nutrition created a patients' register (NEPAD). The aim of the present study was to analyze the results of the first year of the NEPAD register (2003). The NEPAD is an on-line register that gathers information on the indications for HEN, route of access, type of diet and duration of nutritional support. Quantitative data are expressed as mean and standard deviation, and qualitative data as percentages. In 2003, 124 children from 6 hospitals were registered. The mean age at the beginning of HEN was 3.6 years. The underlying disease was gastrointestinal in 20%, neurological or mental retardation in 20%, cystic fibrosis in 14.5%, tumor in 11%, innate error of metabolism in 10%, congenital cardiac disease in 6%, severe primary malnutrition in 6%, and other causes in 13%. A nasogastric tube was used as the first route of access in 56%, and gastrostomy was used in 42%. Sixty percent of the children received continuous nocturnal enteral nutrition and 90% used an infusion pump. The type of feeding consisted of blenderized natural food in 14%, polymeric pediatric formula in 50%, and infant formulae in 18%. On December 31st, 84 children continued to receive enteral nutrition (68%). Despite the efforts made to maintain the on-line national register, it has been underused in its first year of existence (2003). Patients with gastrointestinal or neurological diseases constitute the main group of patients in the register. There is a slight preference for the use of nasogastric tube over gastrostomy.

SYSTEMATIC APPRAISAL OF NUTRITIONAL SUPPORT IN PATIENTS UNDERGOING PANCREATICODUODENECTOMY

Introduction: Pancreaticoduodenectomy (PD) represents a distinct surgical procedure in terms of resumption of post-operative feeding: the retention of the stomach or part of the stomach combined with loss of the intestinal pacemaker cells of Cahal is known to result in alteration of gastrointestinal motility. The aim of the present study is to undertake systematic, structured appraisal of the available literature in order to identify whether consistent themes emerge and thus aid the generation of evidence-based guidelines for post-operative nutrition in patients undergoing PD. Methods: Searches of the MEDLINE and EMBASE databases for the period January 1994 to November 2004 yielded 4 studies providing discretely analyzable data on outcome in 571 patients undergoing PD. Data were retrieved on: pre-operative weight loss, biochemical parameters type and duration of nutritional support and clinical outcome. Results: The optimal route of delivery of enteral nutrition(EN) is unestablished. NJ feeding tubes may avoid the risks of surgical jejunostomy but can dislodge and can be a source of post-operative discomfort. % loss of pre-illness body weight was similar in all studies. TPN was associated with a greater risk of post-operative morbidity in all trials in which it was used. EN is associated with a lower incidence of infective complications but there was no additional benefit from I-EN. There is evidence for prolonged requirement for NG intubation in patients receiving post-operative jejunal feeding as compared to controls not receiving EN (15.1 vs 3.4 days; P < 0.01). Cyclical nutrition with periods of fasting was associated with a lower incidence of post-operative gastric stasis. Conclusions: Clear themes to emerge are that pre-operative weight loss is widespread, post-operative EN (either via NJ or jejunostomy) is the preferred route and that there is no conclusive evidence in favour of I-EN. These results can be synthesised to produce contemporary evidence-based guidelines for nutritional support in patients undergoing PD.

Nutrición basada en la evidencia en la pancreatitis aguda y la enfermedad hepática crónica estable

Acute pancreatitis is a disease that, by definition, generates an increase in metabolism. This metabolic reaction, together with the anorexia produced by the disease, clearly increases morbidity and mortality secondary to malnutrition. Malnutrition affects almost 70% of patients with cirrhosis, with a consequent increase in complications. The present review aims to evaluate the utility of the use of total parenteral nutrition (TPN) and/or enteral nutrition (EN) in patients with acute pancreatitis and in those with stable chronic liver disease. In patients with acute pancreatitis, the administration of enteral nutrition seems to confer advantages over parenteral nutrition in clinical variables (infections, surgical interventions, and mean length of hospital stay) (A-B); nevertheless, further studies stratifying patients according to the severity of pancreatitis and probably its etiology should be designed. Glutamine supplementation can be effective in reducing length of hospital stay and duration of nutritional support (B). In patients with stable chronic liver disease, there are no studies that demonstrate the superiority of EN over PN, or vice versa, in relevant clinical variables (mortality, length of hospital stay, etc.). There is only one study that has demonstrated that EN is superior to oral intake in reducing mortality (B). Improved study designs and the need to perform studies according to the type and severity of liver disease should be a research priority.

1400 Nutritional support in head and neck cancer patients

Nutritional support is an important consideration in the overall management of the head and neck cancer patient. Anti tumour therapies impair nutritional intake: extensive surgical resection can interfere with mastication and deglutition; radiotherapy may limit oral intake by reactive changes. This study is a review of the nutritional management provided for all patients undergoing enteral feeding via nasogastric (NG) and gastrostomy (PEG) routes concurrent to radiotherapy treatment at the Clatterbridge Centre for Oncology July 1993–present. Mean nutritional requirements, method of delivery, type and composition of enteral feed, duration of nutritional support, percentage weight changes and alterations in body mass index (BMI) for each method of enteral feeding will be analysed and the outcome of each feeding method determined. Preliminary results indicate the feeding methods to be equally effective at maintaining body weight (NG = −10.8% to +20.1%, PEG = −9% to +19%) and BMI (NG = −2.3% to +3, PEG = 2.4 to +4). There are marked differences in the method of delivery of the feed between the two groups; NG feeding is predominantly administered continuously [n = 42 (85.7%)]. Whereas PEG feeding is delivered via bolus [n = 11 (39.3%)] and continuous methods [n = 10 (35.7%)]. PEG feeding via bolus method allows an increase in the quality of life for the patient by allowing normal feeding patterns and increased mobility. The placement of a PEG in preference to an NG tube is considered to be more discreet and cosmetically pleasing for the patient.

1399 Role of total parenteral nutrition in the provision of nutritional support in cancer patients

Total parenteral nutrition (TPN) is a method of providing nutritional support to an individual whose gastrointestinal tract is either inaccessible or not functioning. This study will be a review of the nutritional support provided parenterally to cancer patients at the Clatterbridge Centre for Oncology July 1993–July 1995. The diagnosis, reasons for implementation, method of delivery, duration of nutritional support, percentage weight changes, alteration in body mass index (BMI) and outcome measures will be analysed. Preliminary results indicate 86% (n=12) had head and neck cancer. TPN was implemented in 64% (n=9) of cases due to the difficulty of passing a nasogastric (NG) tube, 14% (n=2) refused an NG tube, 7% (n=1) had bowel obstruction and the remaining 14% (n=2) were referred to the centre with TPN in situ. Feeding via this method was usually short, mean period of 9 days (range 3–29 days) and predominantly via the peripheral route [72% (n=10)] rather than via a central line [28% (n=4)]. Body weight was maintained successfully (range −1.7% to +4.5%). Enteral feeding was resumed in 64% of patients on cessation of TPN. 36% (n=5) were transferred back to the referring hospital on TPN, 7% (n=1) were discharged home with TPN in situ. Body weight can be maintained successfully using TPN. It is predominantly used as an interim feeding method whilst the gastrointestinal tract is inaccessible. The peripheral route is implemented in preference to a central line due to fewer associated complications.

Chez quels patients a-t-on démontré l'efficacité de la nutrition artificielle préopératoire ?

Today a consensus on the value of peroperative nutritional support is not existing, despite a recognized correlation between the stage of denutrition and the postoperative mortality and morbidity rates. This review of 11 prospective randomized studies, comparing undernourished patients with a major malignant or non-malignant surgical illness, according to the use or not of preoperative nutritional support, showed a wide discrepancy between the techniques of denutrition assessment, the underlying surgical disease, the tumor extension, the extend of surgery, the level and duration of nutritional support between the studies. However, among them, those without major bias show that a preoperative nutritional support of at least seven days, decreases significantly the rate of postoperative complications, especially the infection, in the most undernourished patients.

Chez quels patients a-t-on démontré l'efficacité de la nutrition artificielle préopératoire ?

Today a consensus on the value of peroperative nutritional support is not existing, despite a recognized correlation between the stage of denutrition and the postoperative mortality and morbidity rates. This review of 11 prospective randomized studies, comparing undernourished patients with a major malignant or nonmalignant surgical illness, according to the use or not of preoperative nutritional support, showed a wide discrepancy between the techniques of denutrition assessment, the underlying surgical disease, the tumor extension, the extend of surgery, the level and duration of nutritional support between the studies. However, among them, those without major bias show that a preoperative nutritional support of at least seven days, decreases significantly the rate of postoperative complications, especially the infection, in the most undernourished patients.

Hyperlipemia in 9 miniature horses and miniature donkeys.

The medical records from 9 consecutive miniature horses (n = 5) and miniature donkeys (n = 4) with hyperlipemia (serum triglyceride concentration > 500 mg/dL) were reviewed. In all cases, hyperlipemia was a secondary complication of a primary systemic disease including septicemia, colitis, parasitism, esophageal obstruction, gastric impaction and rupture, fecalith, and pituitary adenoma. Therapy consisted of specific treatment for the primary disease, supportive care, and nutritional support. The mean time for resolution of hyperlipemia in cases requiring nutritional support (n = 6) was 7 days, and the duration of nutritional support in surviving patients was 11.7 days. Seven of 9 patients survived. The primary disease resulted in death in 2 patients. Enteral feeding with commercially prepared low residue diets and treatment of the primary disease was successful in reversing hyperlipemia in 5 of 6 surviving patients that required nutritional support. Parenteral administration of a glucose-based (non-lipid) solution was successful in resolving hyperlipemia in 1 patient.

Total parenteral nutrition needs in different types of short bowel syndrome.

Thirty-nine patients with short bowel syndrome after extensive small bowel resection, with or without associated partial or total colectomy, received continuous total parenteral nutrition followed by discontinuous parenteral nutrition. Home parenteral nutrition was introduced in 16 of these patients; in eight it was permanent. The assessment of nutritional status included body weight; standard urinary and blood studies; albumin, prealbumin, and transferrin serum levels; and both urinary and fecal nitrogen. A statistically significant correlation (P less than 0.001) was observed between the length of the remaining small bowel and the necessary duration of nutritional support. Multivariate analysis allowed us to classify patients into three groups as a function of remaining gut length and the duration of required nutritional support. This study should help to define the best nutritional support protocol for patients with various short bowel syndromes in order to ensure the best possible intestinal adaptation and to improve their quality of life.