Duration Of Total Parenteral Nutrition Research Articles

Cholestasis induced by total parenteral nutrition: effects of the addition of Taurine (Tauramin®) on hepatic function parameters; possible synergistic action of structured lipids (SMOFlipid®).

Assess the hepatoprotective effect of Taurine (Tau) in cases of hepatic cholestasis induced by Total Parenteral Nutrition (TPN). We describe a retrospective series of 54 patients who received TPN, in which cholestasis was detected at an (Intermediate) point that separates the duration of TPN into 2 Phases. From this moment -Phase 2- on, and according to clinical criteria, some patients (Group A, n = 27) received amino acids with Tau (22.41 ± 3.57 mg/kg/day)(Tauramin®), while the rest (Group B, n = 27) received the standard solution without Tau. The mean TPN durations were 39.2 ± 17.1 and 36.4 ± 18.1 days respectively, with the Intermediate points on days 19.56 ± 10.51 and 17.89 ± 11.14. They all received diets that were homogeneous in terms of kcal and macronutrients. In Phase 2, 21 patients from Group A received structured lipids (SMOFlipid®); while 20 from Group B received soy MCT/LCT [ Medium Chain Triglycerides/Long Chain Triglycerides ] (physical or structured mixture). In a retrospective study, differences could not be avoided. The analytical parameters from three periods (Initial, Intermediate, and Final) were obtained from Nutridata® and Servolab®. We compared interperiod values using the Wilcoxon test SPSS® (p < 0.05). After introducing Taurine AST, ALT, and GGT were significantly reduced; Bilirubin was also reduced, but not significantly. The values obtained for GGT in Group A were (Mean(σ)/median): Initial 48.6 (23.1)/46; Intermediate 473.7 (276.2)/438, and Final 328.9 (190.4)/305. We stress that the mean GGT value is reduced by 30.56% after adding Taurine, while in its absence all parameters are elevated, and mean GGT increases 45.36%. These results show Taurine's hepatoprotective effect and support its use in cases of TPN-induced cholestasis. We acknowledge the possibility that the differences between SMOF and the MCT/LCT mixtures also may have influenced the results in a combined effect with taurine.

610 Total Parenteral Nutrition as a Source of Oxidant Load Leading to Bronchopulmoanry Dyplasia

BackgroundImmaturity of antioxidant defense coupled with oxidant load is suspected to induce the development of bronchopulmonary dyplasia (BPD) in premature infants. Peroxide load from total parenteral nutrition (TPN) is associated...

1400 Body Fat in VLBW is Influenced by Duration of Total Parenteral Nutrition (TPN)

BackgroundAdequate postnatal nutrition and growth are essential for optimal neurodevelopment in VLBW infants. In an effort to optimize nutrition, early TPN implementation is recommended while enteral nutrition is achieved. However,...

Pretransplant Nutritional Habits and Clinical Outcome in Children Undergoing Hematopoietic Stem Cell Transplant

This study sought to investigate the effects of pretransplant nutrient content, nutritional status, and nutritional habits on the clinical outcome of children undergoing hematopoietic stem cell transplant. Forty-one children were enrolled in this study. Dietary assessment was based on a semiquantitative food frequency questionnaire, consisting of 47 food items (including all commonly used prebiotic and probiotic foods in the Turkish cuisine), for the last week before hematopoietic stem cell transplant and a 24-hour dietary recall on admission. Thirteen girls (31.7%) and 28 boys (68.3%) comprised the study group. Of the 41 children, 5 (12.2%) were classified as underweight; 12.2% at risk of being underweight; 53.6% healthy weight; 9.8% overweight; and 12.2% obese. Nutritional status of the children had no effect on the complication rate, duration of febrile neutropenia, and the day of neutrophil and platelet engraftment. Correlation analysis revealed that there was a negative correlation between the day of neutrophil engraftment and the amount of soluble fiber, iron, breast milk, bazlama (a traditional yeast bread), and bulgur consumption. A negative correlation was detected between the number of febrile neutropenia episodes and the amount of yogurt and onion intake. Increased intake of parsley and onion was associated with reduced duration of total parenteral nutrition. The amount of parsley consumption was found to be lower in patients who experienced transplant-related complications. The nutrient contents and nutritional habits of the patients may affect the course of transplant. It might be recommended that "let them eat yogurt, bazlama, bulgur, onion, and parsley."

Retinopathy of Prematurity in Infants Born before 25 Weeks Gestation in a Korean Single Neonatal Intensive Care Unit: Incidence, Natural History and Risk Factors

As younger preterm infants are able to survive, more extremely preterm infants are at risk of developing retinopathy of prematurity (ROP). To investigate the incidence, progression and risk factors of ROP in extremely preterm infants in Korea, the medical records of infants born before 25 weeks gestation were retrospectively reviewed. The criteria for laser treatment agreed with type 1 ROP as defined by the Early Treatment for Retinopathy of Prematurity study. Of the 121 infants included in the analysis, 119 (98.4%) infants developed any stage ROP, including 78 infants (64.5%) with type 1 ROP. The mean postmenstrual age (PMA) at the onset of any ROP and type 1 ROP were 33.5 and 36.1 weeks, respectively. All but one infant developed type 1 ROP after 31 weeks PMA. Univariate analysis showed that duration of total parenteral nutrition and onset of any ROP (PMA) were associated with the development of type 1 ROP. In conclusion, this study shows high incidence of ROP in extremely preterm infants and suggests that, although current screening protocols are feasible for most preterm infants born before 25 weeks gestation, earlier screening before 31 weeks PMA may be necessary in infants with an unstable clinical course.

Aggressive Total Parenteral Nutrition is Associated with an Increased Incidence of Nephrocalcinosis in Very Low Birth Weight Infants

Background and Aims:As aggressive total parenteral nutrition (TPN) is replaced as the standard protocol, the aim of our study was to determine the effect of aggressive TPN focusing on the immature kidney. We compared the incidence and natural course of nephrocalcinosis (NC) in premature infants from two different nutrition strategies.Methods: We studied all preterm neonates with a birth weight below 1500g who were born from Jan 2006 to Dec 2010 retropectively. Sequential abdominal ultrasonography was performed in all patients. The clinical parameters, maternal factors, respiratory support and duration of furosemide were analyzed. The change of nutrition strategy was also compared with the incidence of NC.Results: NC was detected in 35 of 101 VLBW infants (34.7%). Low birth weight was significantly associated with NC (P< 0.05). The duration of oxygen use, furosemide treatment and TPN were also strongly associated with NC. Concerning the change in our hospital's nutritional strategy since 2008, such as the increase of protein intake in the first week, the incidence of NC was significantly increased after 2008 (19.5% vs. 43.3%, p< 0.05). NC persisted in four infants (4/35, 11.4%) after 12 months follow-up period and one infant developed urolithiasis. Among these four infants, three infants received aggressive TPN.Conclusions: Though NC resolves spontaneously in most patients, persistent progressive renal injury can develop, especially after aggressive TPN. Therefore, early diagnostic evaluation is crucial and close follow up of NC in preterm neonates are needed.

The role of ultrasonography in determining central venous patency in patients undergoing bowel transplantation

Ultrasonography (US) is an attractive alternative for invasive studies to evaluate venous patency. However, little data exist concerning the usefulness of US in patients undergoing bowel transplantation. Twenty-five adult patients with bowel transplantation were retrospectively identified with both US and contrast venography (VG) performed preoperatively. The median age was 43 yr, and the median duration of total parenteral nutrition was 36 months. The vessels were evaluated as positive with ≥ 50% stenosis. Among the internal jugular veins and the subclavian veins examined with US (96% of the all sites) and with VG (69%), 66 venous sites were available for comparison. VG confirmed positive in 42% (28/66), while US found positive in 27% (18/66); US had three false positives and 13 false negatives, giving the sensitivity of 54% (95% confidence interval [CI], 34-72) and the specificity of 92% (CI, 77-98). The positive and the negative likelihood ratios weighted by prevalence (42%) were 5 (CI, 1.7-14.3) and 0.37 (CI, 0.23-0.60), respectively. In addition, VG confirmed stenosis in 32% of the right and 50% of the left brachiocephalic veins and 41% of the superior vena cava. US is not a reliable method for assessing the upper body venous system of patients undergoing bowel transplantation.

Impact of Increased Amino Acid Intake on Very Low Birth Weight Infants

Background . A consensus has not been reached on whether higher doses of parenteral amino acids improve growth in preterm infants without causing adverse side effects. The objective of this study was to evaluate the impact of a more rapid increase in amino acids dosing in very low birth weight (VLBW) infants during their first few days of life. Methods . The study design was a 1:1 ratio case matched retrospective analysis of data from two distinct periods when the hyperalimentation practice differed. During phase I, a five-day incremental dose of amino acids was utilized. In phase II, a two-step dose increase of amino acids was practiced. Duration of total parenteral nutrition (TPN), weight at 28 days, hepatic and renal function tests, and rates of complications were compared. This study was approved by two local IRBs. Results . The phase II protocol resulted in an increased dose of amino acid delivered by day 7 (16 g/k vs 12.8 g/k, p < 0.001). This increased dose of amino acids resulted in a shorter duration of TPN usage (16 days vs 18 days, p = 0.001). The increased dosage did not have a detrimental effect on hepatic or renal function. It also did not increase the incidence of feed intolerance or bowel perforation. However, an increase in amino acid dosing did not increase absolute weight gain (15 g/k/day vs 13 g/k/day, p = 0.282). Conclusions . No unfavorable outcomes were demonstrated with this increased amino acid regimen. VLBW infants may be able to tolerate even higher doses in the first month after birth. KJM 2011; 4(2):31-36.

Multidisciplinary nutritional support for autologous hematopoietic stem cell transplantation: A cost–benefit analysis

ObjectiveThe objective of the present study was to evaluate the economic and clinical efficacy of a multidisciplinary nutritional support team (NST) for autologous stem cell transplantation. MethodsWe performed a retrospective cost–benefit analysis of autologous stem cell transplantation (ASCT) in patients with and without NST intervention at a single institute. Patients (n = 120) had undergone 169 ASCTs, 67 before the commencement of NST intervention in September 2005 and 102 after September 2005. The conditioning regimens, prophylactic antibiotics, and supportive care were unchanged from 2001 through 2008. The duration of hospitalization, cost, and laboratory data were analyzed. ResultsWith NST intervention, the duration of total parenteral nutrition, absence of oral food intake, hospitalization, and therapeutic antibiotic usage were significantly shortened by 11.4, 9.7, 8.1, and 4.5 d, respectively. With NST intervention, the incidence of hepatic adverse events and hyperglycemia was low, and the total cost of hospitalization was significantly decreased by 403 600 yen (US $4484.40). Two cases of therapy-related death were recorded before September 2005. No therapy-related mortality was observed after commencement of NST intervention; however, the difference was not significant. ConclusionMultidisciplinary NST intervention has a positive effect on cost decrease, and it may decrease the incidence of adverse events associated with ASCT and total parenteral nutrition.

Prevalence of liver complications in children receiving long-term parenteral nutrition

The hepatic prognosis of long-term home total parenteral nutrition (TPN)-dependent children is poorly documented. The objective was to study outcome data in home TPN-dependent children and to describe precisely their liver biopsies in the attempt to analyze risk factors for biochemical and histological hepatic abnormalities. Medical records of 42 children receiving home TPN for more than 2 years between January 1998 and December 2007 in a single approved home total parenteral center were reviewed. Hepatic biochemical abnormalities were analyzed. Hepatic biopsies were classified by two independent pathologists. Duration of TPN was 7.9±0.8 years (mean±s.e.m.), with an average age at onset of 1.5±0.5 years. A total of 24 patients (57%) developed biochemical liver abnormalities in an average of 2.9±0.4 years after starting TPN. Risk factors for biochemical abnormalities were younger age at TPN commencement, longer duration of TPN, higher rate of catheter-related infections and higher volume and energy content of TPN. Liver biopsies were carried out in 43% of patients (mean age 3.2±0.9 years). Almost all patients had fibrosis (94%). Risk factors were dependent on each histological abnormality: fibrosis was significantly associated with a shorter length of bowel and a longer duration of TPN; cholestasis correlated with a lower percentage of total parenteral energy intake due to lipids; and steatosis had no risk factor identified. Our study reports a high rate of histological liver abnormalities and analyzes risk factors in children who underwent very long-term home TPN.

Caphosol Mouth Rinse Diminishes Oral Mucositis In Allo-HSCT Recipients.

AbstractAbstract 3498 Introduction:Oral mucositis is a complication of conditioning treatment that produces pain and morbidity in allogeneic hematopoietic stem cell transplant (allo-HSCT) recipients. The rationale of this study was to evaluate the efficacy of a calcium phosphate mouth rinse (Caphosol) vs standard regimen in 40 adult patients undergoing allo-HSCT. Patients and Methods:40 patients treated with allo-HSCT (31 from unrelated donors, 9 from siblings) performed in Hematology and BMT center in Katowice in 2009 were randomized and stratified by the conditioning regimen (busulfan-, treosulfan- or TBI- based), type of transplant (unrelated or related) and age into two equal groups. Treatment group received Caphosol washes 4 times daily from first day of conditioning until reaching ANC 0.2 G/l. Control group received standard topical mouth care with salvia, antibacterial and antifungal solutions. During the trial patients subjectively assessed level of pain in mouth and in pharynx using 0–10 scale and swallowing problems using 0–5 scale. Mucositis was judged by experienced physician. Nonparametric Mann-Whitney U-tests were used for statistical analysis. Results:Average oral toxicity in WHO scale in Caphosol vs control group was 0.9 vs 1.8 (p=0.02), duration of mucositis was 3.2 vs 7.1 days (p=0.02). Total parenteral nutrition (TPN) due to mucosits was required in Caphosol vs control group in 0 vs 6 pts, average duration of TPN was 0 vs 1.9 days (p=0.009). Analgetics were required, respectively, in 3 vs 9 pts and analgesy lasted for 1.1 vs 3.4 days (p=0.047). Average subjective peak pain in mouth was 0.85 vs 1.75 (p=0.005) and in pharynx 1.95 vs 2.2 (NS) in Caphosol vs control group, average pain intensity was lower in Caphosol group throughout the whole period of mucositis. Intensity of swallowing problems tended to be lower in Caphosol group (NS). Acute GVHD was observed in 7 vs 9 pts in Caphosol vs control group and its average degree was 0.5 vs 0.9 (NS). Conclusions:Caphosol mouth rinse in the allo-HSCT recipients is associated with decrease of oral toxicity, lower peak pain due to mucositis and its shorter duration. In consequence, comfort of life is improved and the incidence of acute GVHD is reduced, as well as the requirement of TPN and analgetics. [Display omitted] Disclosures:No relevant conflicts of interest to declare.

PP-167. Total parenteral nutrition associated complications in NICU patients

Three groups of preterm infants (birth weight ≤1500 g) who received less than half of the total daily fluid intake and parenteral nutrition for more than two weeks were randomized to either erythromycin (12.5 mg/kg every 6 h) or placebo solution or ursodeoxycholic acid (5 mg/kg every 6 h) treatment. Liver function abnormality was considered as the primary outcome measure. Secondary outcomes were full enteral feeding, number of episodes of gastric residuals, duration of total parenteral nutrition and days of hospitalisation.

PP-166. Is clarithromycin treatment effective in facilitating enteral feeding in VLBW infants?

Three groups of preterm infants (birth weight ≤1500 g) who received less than half of the total daily fluid intake and parenteral nutrition for more than two weeks were randomized to either erythromycin (12.5 mg/kg every 6 h) or placebo solution or ursodeoxycholic acid (5 mg/kg every 6 h) treatment. Liver function abnormality was considered as the primary outcome measure. Secondary outcomes were full enteral feeding, number of episodes of gastric residuals, duration of total parenteral nutrition and days of hospitalisation.

The Impact of Environmental and Genetic Factors on Neonatal Late-Onset Sepsis

To assess the genetic contribution to late-onset sepsis in twins in the newborn intensive care unit. A retrospective cohort analysis of twins born from 1994 to 2009 was performed on data collected from the newborn intensive care units at Yale University and the University of Connecticut. Sepsis concordance rates were compared between monozygotic and dizygotic twins. Mixed-effects logistic regression analysis was performed to determine the impact of selected nongenetic factors on late-onset sepsis. The influence of additive genetic and common and residual environmental effects were analyzed and quantified. One hundred seventy monozygotic and 665 dizygotic twin pairs were analyzed, and sepsis identified in 8.9%. Mean gestational age and birth weight of the cohort was 31.1 weeks and 1637 grams, respectively. Mixed-effects logistic regression determined birth weight (regression coefficient, -0.001; 95% CI, -0.003 to 0.000; P = .028), respiratory distress syndrome (regression coefficient, 1.769; 95% CI, 0.943 to 2.596; P < .001), and duration of total parenteral nutrition (regression coefficient, 0.041; 95% CI, 0.017 to 0.064; P < .001) as significant nongenetic factors. Further analysis determined 49.0% (P = .002) of the variance in liability to late-onset sepsis was due to genetic factors alone, and 51.0% (P = .001) the result of residual environmental factors. Our data support significant genetic susceptibility to late-onset sepsis in the newborn intensive care unit population.

Risk factors for late onset gram-negative infections: a case–control study

ObjectivesTo determine the incidence, mortality and risk factors for neonatal late onset gram-negative sepsis and meningitis (LOGNS).DesignRetrospective case–control study.SettingTertiary neonatal unit in London.PatientsConsecutive inborn infants with late onset (>48 h...

Impact of massage therapy on motor outcomes in very low‐birthweight infants: Randomized controlled pilot study

The purpose of the present study was to determine the effects of massage therapy on motor development, weight gain, and hospital discharge in preterm very low-birthweight (VLBW) newborns. Twenty-four preterm VLBW newborns (<34 weeks and <1500 g) were enrolled in this randomized controlled pilot study. The intervention group (n = 12) received massage therapy starting at 34 weeks post-conceptional age (15 min daily, 5 days/week for 4 weeks). The infants in the sham treatment group (n = 12) received similar duration of light still touch. Test of Infant Motor Performance (TIMP) score gain, weight gain, and post-conceptional age at discharge were compared between the two groups after intervention using Mann-Whitney U-test. No significant between-group difference in TIMP score gain and weight gain was identified when all subjects were analyzed. In subgroup analysis, among those with below-average pre-treatment TIMP score (<35), the intervention group (n = 6) achieved significantly higher TIMP score gain (P = 0.043) and earlier hospital discharge (P = 0.045) than the sham treatment group (n = 5). These same infants, however, also had significantly shorter duration of total parenteral nutrition than their counterparts in the sham treatment group (P = 0.044). Massage therapy might be a viable intervention to promote motor outcomes in a subgroup of VLBW newborns with poor motor performance. A larger randomized controlled trial is required to further explore the effects of massage therapy in this high-risk group.

The Experience of Operative Management in Jejunoileal Atresia

Purpose: Intestinal atresia is a common cause of neonatal intestinal obstruction. Recently, the survival rate has been increasing from development of prenatal diagnosis, total parenteral nutrition (TPN) and neonatal intensive care. We evaluated the complication rate and cause of mortality after operative management for jejunoileal atresia. Methods: We reviewed 62 patients (36 males, 26 females) with jejuno-ileal atresia who underwent operation from 1998 to 2007. Results: There were 37 patients with jejunal atresia and 25 with ileal atresia. The average gestational age was 256±16.6 days and birth weight was 2,824±620 g. Prenatal diagnosis was performed in 45 patients (72.6%) around gestational age 27 weeks. Within 2nd day after birth, 44 patients (71%) underwent operation. Half of the jejunoileal atresia was type Ⅲa and type Ⅰ was in 8, type Ⅱ was in 3, type Ⅲb was in 12, and type Ⅳ was in 8. The operative treatment was resection & anastomosis in 59 patients and enterotomy & web excision in 3. They started feeding at 12.4±11.5 days after operation on average. The average duration of TPN was 26.7±23.5 days, and the incidence of cholestasis was 30.6%. Hospital days averaged 36.8±26 days. Early complication occurred in 14 patients (intestinal obstruction in 5, sepsis in 4, wound problem in 3, anastomosis leakage in 1, and intraabdominal abscess in 1). Late complication occurred in 7 patients (anastomosis stricture in 4 and intestinal obstruction in 3). There was only one case of mortality due to short bowel syndrome after re-operation for adhesive ileus. Conclusion: The operation for intestinal atresia was successful and aggressive management contributed to a low mortality rate.

How we managed total parenteral nutrition in our hospital in 2006–2007

Total parenteral nutrition (TPN) is an important supportive therapy for all the malnourished or at risk of malnutrition patients who meet the criteria set out in the national guideline. We analyzed and compared data for TPN administration, collected in the selected periods within 2 years. An audit in the 2006 resulted in the introduction of the proforma for TPN administration. A reudit in the 2007 aimed to assess the requirement for further changes including the introduction of Nutritional Support Team (NST). Many international studies confirm that managing parenteral nutrition by NST reduces line-related sepsis and episodes of inappropriate TPN administration. Data were collected retrospectively using a pharmacy-generated list of the all new TPN prescriptions. Thirty-one episodes of TPN administration were recorded between May and July 2007 and 53 episodes between January and May 2006. Information including demographics, duration and the person initiating TPN was collected for all cases (Table 1). A one-way analysis of variance test was used to look for statistical differences in the mean duration of TPN between two selected periods but there was no significant difference with a P value of 0.867.

Total parenteral nutrition in children and adolescents treated with high-dose chemotherapy followed by autologous haematopoietic transplants

Total parenteral nutrition (TPN) is still of great importance for haematopoietic stem cell transplantation (HSCT) patients because one of the major adverse effects of the high-dose therapy followed by HSCT is an inadequate oral nutrition intake. The aim of the study was analysis of TPN of young patients in the HSCT period. Twenty-two patients 1.8-20.8 year-old, median 5.4, treated with high-dose therapy and autologous HSCT because of malignancy were included into the study. Grafts contained 1.35-7.9 x 106, median 3.75 x 106 CD34+ cells/kg. Engraftment occurred as follows: granulocytes >0.5 x 109/l on +11 d (8-25); platelets >20 x 109/l on +23 d (12-67). Patients were given isoenergetic, isonitrogenous TPN until they consumed less than 50 % of their required diet orally. Proteins intake was 0.8-2.0 g/kg per d, fats intake 1.0-3.0 g/kg per d. Total non-proteins energies-nitrogen grams index was 140:1-200:1. Supplementation of electrolytes, microelements, trace elements and vitamins was dependent on individual patient requirement. TPN duration did not correlate with CD34+ cells number but correlated with platelets reconstitution. The assessment of nutritional condition demonstrated no differences in anthropometric parameters, but increase of serum albumin levels after TPN. Requirement for P3 - was above the normal ranges and correlated positively with platelets reconstitution. Requirement for P3 - and K+ was higher in patients with mucositis than in other patients. Any complications due to TPN were observed. Adequately composed isoenergetic and isonitrogenous TPN with replacement of electrolytes according to their requirement in the early post-transplantation period allows not only improvement in nutritional status of patients but also could contribute to reconstitution of haematopoiesis.

Enteral feeding algorithm for infants with hypoplastic left heart syndrome poststage I palliation

Infants with hypoplastic left heart syndrome (HLHS) experience a high incidence of growth failure in the postoperative period following stage I palliation. Because of an increased risk of necrotizing enterocolitis in this population, clinicians may be reluctant to initiate early enteral feedings. Published guidelines for initiating and advancing enteral feedings in this population are limited. To test the safety and efficacy of an enteral feeding algorithm in infants with HLHS following stage I palliation. Single-center, prospective case series with historical comparisons. Pediatric cardiovascular intensive care unit in tertiary care children's hospital. The study group consisted of consecutive patients > or =35 wks gestational age and weight > or =2 kg admitted to our cardiac intensive care unit over an 18-month period following stage I palliation of HLHS (n = 36). Excluded were nonsurvivors, patients supported on extracorporeal membrane oxygenation or those with a history of NEC or fetal intervention. These data were compared with a similar cohort of patients admitted to the cardiac intensive care unit over an 18-month period before the implementation of the feeding algorithm (n = 27). A feeding algorithm was implemented in the study group in the postoperative period for initiation and advancement of enteral nutrition. The median duration of total parenteral nutrition was significantly higher in the control group (116 vs. 51 hrs; p = 0.03) compared with the study group. The median time to achieve recommended daily allowance of calories defined as 108 kcal/kg per day was significantly reduced in the study group (9 vs. 13 days; p = 0.01). Despite the rapid advancement of enteral feedings on the algorithm, there was no incidence of NEC in the study group compared with 11% in the control group. The use of an enteral feeding algorithm is a safe and effective means of initiating and advancing enteral nutrition in infants with HLHS following stage I palliation.