Early Parenteral Nutrition Group Research Articles

Effectiveness and safety of early postpyloric feeding during therapeutic hypothermia in patients with large hemispheric infarction: A retrospective cohort study.

What kind of feeding should be provided during therapeutic hypothermia (TH) in patients with large hemispheric infarction (LHI) is not clear. Therefore, we conducted a retrospective observational study to determine whether providing early postpyloric feeding (PPF) (<24 h after admission) is beneficial or harmful for patients with this condition. This study retrospectively screened 78 patients with LHI who were treated with TH from one neurological intensive care unit (ICU). The patients were receiving either early PPF (n = 52) or early parenteral nutrition (PN) (n = 26). Data regarding 30-day mortality, neurological outcome, nutrition-related laboratory indicators, ICU hospitalization time, mechanical ventilation (MV) duration, and complications were collected. A greater number of patients who received early PPF had favorable neurologic outcome than those who received early PN (57.7% vs 30.7%, P = 0.025). The early PPF group had a lower severity of pulmonary infection than the early PN group, as measured by the Clinical Pulmonary Infection Score (7.33 ± 0.96 vs 9.42 ± 2.11, P = 0.006). The total protein and hemoglobin levels in the early PPF group were higher than those in the early PN group (59.56 ± 5.09 vs 56.52 ± 7.94 g/L, P = 0.046; 131.06 ± 19.58 vs 122.07 ± 17.72 g/L, P = 0.045). The MV duration and ICU hospitalization time were shorter in the early PPF group (13 [9;21] vs 21 [14;30] days, P = 0.006; 28 [22;36] vs 34 [33;51] days, P = 0.014). There were no significant differences in the incidence of catheter-related bloodstream infections, 30-day mortality, or nutrition intolerance between the two groups. Early PPF is an effective and safe enteral nutrition method for patients with LHI receiving TH.

Timing of parenteral nutrition initiation in critically ill children: a randomized clinical trial.

The optimal timing of parenteral nutrition (PN) initiation in critically ill children remains controversial. To identify the optimal timing of PN initiation in critically ill children. This randomized clinical trial was conducted in the pediatric intensive care unit (PICU) of Menoufia University Hospital. A total of 140 patients were randomized to receive early or late PN. The early PN group consisted of 71 well-nourished and malnourished patients who received PN on the first day of PICU admission. Malnourished (42%) and well-nourished children randomized to the late PN group (42%) started PN on the fourth versus seventh day after admission, respectively. Mechanical ventilation (MV) was the primary outcome, while PICU length of stay and mortality were secondary outcomes. Patients who received early PN started enteral feeding significantly earlier (median, 6 days; interquartile range, 2-20 days) than those not provided early PN (median, 12 days; interquartile range, 3-30 days; P<0.001) and had a significantly lower risk of feeding intolerance (5.6% vs.18.8%, P=0.035). The median time required to obtain full calories enterally was shorter in the early versus late PN group (P=0.004). Furthermore, patients in the early versus late PN group had a significantly shorter median PICU stay (P<0.001) and were less likely to require MV (P=0.018). Patients who received early PN had a lower MV need and duration than those who received later PN and had more favorable clinical outcomes in terms of morbidity.

Effect of Early Versus Delayed Parenteral Nutrition on the Health Outcomes of Critically Ill Adults: A Systematic Review.

ObjectivesThis systematic review aims to evaluate and summarise the findings of all relevant studies which identified the effect of early vs delayed parenteral nutrition (PN), early PN vs early supplemental PN and early PN vs standard care for critically ill adults.MethodsThe literature search was undertaken using PubMed, Embase, Medline, Clinical Key, and Ovid discovery databases. The reference lists of studies published from 2000 till June 2020 were hand searched.ResultOn screening 2088 articles, a total of five RCTs with 6,277 patients were included in this review. Only one clinical trial compared early PN and late PN; the results reported significantly shorter periods in intensive care unit (ICU) stay (p=0.02) and less ICU related infections (p=0.008) in the late PN group compared to the Early PN group. Two trials compared total parenteral nutrition (TPN) and enteral nutrition (EN) +TPN groups. Both found a significantly longer hospital stay duration (p<0.05 and p<0.01) with a higher mortality rate in the TPN group compared to the EN+TPN group. A statistically significant improvement was observed in patients’ quality of life receiving early PN compared to standard care (p=0.01). In contrast, no significant difference was found in the supplemental PN vs the standard care group.ConclusionThe supplemental PN patients had shorter ICU stay and lower mortality rates than TPN. However, these findings should be interpreted carefully as included studies have different initiation timing of nutritional support, and the patients’ diagnosis varied.

Timing of parenteral nutrition is associated with adequacy of nutrient delivery and anthropometry in critically ill children: A single-center study.

The optimal timing of supplemental parenteral nutrition (PN) use in the pediatric intensive care unit (ICU) is unclear. We aimed to describe patterns of PN use in the ICU and the association between the timing of PN initiation and macronutrient delivery and anthropometry. We enrolled patients (aged <18 years) with an ICU stay >3 days were started on PN in the ICU. Initiation within 48 hours of admission was deemed as early, and duration <5 days was deemed as short. We used multivariable analysis to examine the association between PN timing and macronutrient delivery adequacy (percentage of the prescribed target that was actually delivered) and weight-for-age z-score (WAZ) over hospital stay. Ninety-five patients were included. Median (interquartile range [IQR]) time to initiate PN was 4 (1, 6) days, and in 33%, PN was initiated early. Median (IQR) PN duration was 8 (5, 14) days, and in 16.8%, duration was short. Median (IQR) adequacies for total energy and protein delivery were 55% (40, 74) and 72% (44, 81) in the early PN group compared with 29% (3, 50) and 31% (4, 47), respectively, in the late PN group (P < .001). The late PN group had a 0.50-unit greater decline in mean WAZ compared with the early PN group (95% CI, 0.11-0.89; P = .012). Late PN initiation was associated with significantly lower adequacy of macronutrient delivery and greater decline in WAZ in critically ill children. The relationship between PN timing patient outcomes must be further examined.

Long-term developmental effect of withholding parenteral nutrition in paediatric intensive care units: a 4-year follow-up of the PEPaNIC randomised controlled trial

The PEPaNIC randomised controlled trial, which recruited 1440 critically ill infants and children in 2012-15, showed that withholding parenteral nutrition for 1 week (late-parenteral nutrition), compared with early supplementation within 24 h of admission to the paediatric intensive care unit (early-parenteral nutrition), prevented infections, accelerated recovery, and improved neurocognitive development assessed 2 years later. Because several neurocognitive domains can only be thoroughly assessed from age 4 years onwards, we aimed to determine the effect of late-parenteral nutrition versus early-parenteral nutrition on physical, neurocognitive, and emotional and behavioural development 4 years after randomisation. This is a preplanned, blinded, 4-year follow-up study of participants included in the PEPaNIC trial (done at University Hospitals Leuven, Belgium; Erasmus Medical Centre Sophia Children's Hospital, Rotterdam, Netherlands; and Stollery Children's Hospital, Edmonton, AB, Canada) and of matched healthy children. Studied outcomes were anthropometrics; health status; parent-reported or caregiver-reported executive functions, and emotional and behavioural problems; and clinical tests for intelligence, visual-motor integration, alertness, motor coordination, and memory. Through multivariable linear and logistic regression analyses, after imputation for missing values (≤30%) and adjustment for risk factors, we investigated the effect of early-parenteral nutrition versus late-parenteral nutrition. This trial is registered with ClinicalTrials.gov, NCT01536275. Between March 8, 2016, and Nov 8, 2019, 684 children from the original PEPaNIC trial (356 from the late-parenteral nutrition group and 328 from the early-parenteral nutrition group) were assessed for neurocognitive development at 4-years follow-up. Compared with the control group (369 healthy children), children who had critical illness had lower height (β-estimate -2·11 [95% CI -3·15 to -1·06]; p<0·0001) and head circumference (-0·42 [-0·67 to -0·18]; p=0.00077); and worse health status (eg, hospital admission odds ratio 4·27 [95% CI 3·12 to 5·84]; p<0·0001), neurocognitive (eg, parent-reported or caregiver-reported total executive functioning β-estimate 3·57 [95% CI 1·95 to 5·18], p<0·0001; total intelligence quotient -7·35 [-9·31 to -5·39], p<0·0001), and parent-reported or caregiver-reported emotional and behavioural developmental outcomes (internalising 2·73 [1·19 to 4·28], p=0·00055; externalising 1·63 [0·19 to 3·08], p=0·027; and total behavioural problems 2·95 [1·44 to 4·46], p=0·00013), adjusted for risk factors. Outcomes were never worse in the late-parenteral nutrition group compared with the early-parenteral nutrition group, but patients in the late-parenteral nutrition group had fewer parent-reported or caregiver-reported internalising (β-estimate -1·88 [95% CI -3·69 to -0·07]; p=0·042), externalising (-1·73 [-3·43 to -0·03]; p=0·046), and total emotional and behavioural problems (-2·44 [-4·22 to -0·67]; p=0·0070) than patients who had received early-parenteral nutrition, after adjusting for risk factors, and were no longer different from healthy controls for these outcomes. Omitting early parenteral nutrition use for critically ill children did not adversely affect long-term outcomes 4 years after randomisation and protected against emotional and behavioural problems, further supporting the deimplementation of early parenteral nutrition. European Research Council, Methusalem, Flanders Institute for Science and Technology, Research Foundation Flanders, Sophia Foundation, Stichting Agis Zorginnovatie, Erasmus Trustfonds, and the European Society for Clinical Nutrition and Metabolism.

Early parenteral nutrition in neonates with congenital diaphragmatic hernia.

The ideal nutritive strategy for a neonate with congenital diaphragmatic hernia (CDH) has not been elucidated. The purpose of this study was to investigate the efficacy of early parenteral nutrition (PN) in CDH neonates. Thirty-five CDH neonates admitted to a single hospital from January 2005 to December 2014 were retrospectively reviewed. For the first 4 years of the study period, neonates received non-early PN (n-EPN) (2005-2008, amino acids [AA] <1.0g/kg/day, no lipids administered). After the transitional period (TP) (2009-2011, AA 1.0-2.5g/kg/day, lipid 1.0g/kg/day), early PN (EPN) (2011-2014, AA ≥3.0g/kg/day, lipid 1.0g/kg/day) was performed. We investigated the clinical effect of PN for growth-associated clinical variables and the outcomes. The first day of AA administration was late in the n-EPN period (6.0 ± 4.6, 0.0 ± 0.8, 0.1 ± 0.3 ; n-EPN, TP, EPN: in order). The final day of PN (11.0 ± 3.7, 9.2 ± 4.0, 12.4 ± 3.9) and the first day of enteral feeding (4.5 ± 1.9, 4.3 ± 1.4, 4.5 ± 3.2), the first day of full milk feeding (100 mL/kg/day) (10.8 ± 5.4, 9.2 ± 2.3, 11.5 ± 3.5) were statistically equal in every period. The date and body weight at discharge showed no significant differences among the three groups, but the weight-gain rate from birth to discharge was higher in the EPN group than in the n-EPN group (P = 0.023). The rate of inhaled nitric oxide (NO) gas administration and the duration of ventilation showed no significant differences among the three groups. Severe PN-associated liver disease was not noted during the observation period. Early PN for CDH neonates promotes weight gain in the neonatal intensive-care unit. The long-term efficacy and safety of EPN for CDH neonates should be elucidated by additional studies.

Outcomes of Delaying Parenteral Nutrition for 1 Week vs Initiation Within 24 Hours Among Undernourished Children in Pediatric Intensive Care

Undernourishment has been associated with poor outcomes of critical illness in children. The effects of withholding parenteral nutrition (PN) for 1 week in undernourished critically ill children are unknown. To assess the outcome effects of withholding PN for 1 week in undernourished critically ill children. This is a subanalysis of the randomized clinical trial Pediatric Early vs Late Parenteral Nutrition in Intensive Care Unit (PEPaNIC; N = 1440), which focused on the subgroup of pediatric intensive care unit (PICU) patients identified as undernourished on admission. Children included in the PEPaNIC trial were enrolled between June 18, 2012, and July 27, 2015. Undernourishment was defined as weight-for-age z score less than -2 in children younger than 1 year, and body mass index-for-age z score less than -2 in children 1 year or older. Data analysis was conducted from August 3, 2017, to July 6, 2018. Patients were randomized to initiation of supplemental PN within 24 hours (early PN) or after 1 week (late PN) when enteral nutrition was insufficient. Primary end points were risk of new infections acquired in the PICU and time to live PICU discharge, assessed via multivariable logistic regression and Cox proportional hazard analyses, adjusted for risk factors. A total of 289 of 1440 children (20.1%), term newborn to age 17 years, were identified as undernourished, of whom 150 of 717 patients (20.9%) were in the late PN group and 139 of 723 patients (19.2%) were in the early PN group. On admission, characteristics were similar among the treatment groups. Mean (SD) weight z scores were -3.33 (1.18) in the late PN group and -3.21 (1.09) in the early PN group. Compared with well-nourished PICU patients, undernourishment on admission was associated with lower likelihood of an earlier live PICU discharge (adjusted hazard ratio, 0.86; 95% CI, 0.75-0.99; P = .03). Among undernourished PICU patients, late PN reduced the risk of new infections by 11.0% (adjusted odds ratio, 0.39; 95% CI, 0.19-0.78; P = .01), and shortened the duration of PICU stay by a median of 2 days (earlier live PICU discharge: adjusted hazard ratio, 1.37; 95% CI, 1.06-1.75; P = .01). The safety outcomes mortality, incidence of hypoglycemia during the first week, and incidence of weight deterioration during PICU stay were similar between the treatment groups. In undernourished critically ill children, withholding PN for 1 week was clinically superior to early PN. ClinicalTrials.gov Identifier: NCT01536275.

Long-term developmental effects of withholding parenteral nutrition for 1 week in the paediatric intensive care unit: a 2-year follow-up of the PEPaNIC international, randomised, controlled trial

The paediatric early versus late parenteral nutrition in critical illness (PEPaNIC) multicentre, randomised, controlled trial showed that, compared with early parenteral nutrition, withholding supplemental parenteral nutrition for 1 week in the paediatric intensive care unit (PICU; late parenteral nutrition) reduced infections and accelerated recovery from critical illness in children. We aimed to investigate the long-term impact on physical and neurocognitive development of early versus late parenteral nutrition. In this preplanned 2-year follow-up study, all patients included in the PEPaNIC trial (which was done in University Hospitals Leuven, Belgium; Erasmus Medical Centre-Sophia Children's Hospital, Rotterdam, Netherlands; and Stollery Children's Hospital, Edmonton, AB, Canada) were approached for possible assessment of physical and neurocognitive development compared with healthy children who were matched for age and sex, and who had never been admitted to a neonatal ICU or a PICU. Assessed outcomes comprised anthropometric data; health status; parent-reported or caregiver-reported executive functions and emotional and behavioural problems; and tests for intelligence, visual-motor integration, alertness, motor coordination, inhibitory control, cognitive flexibility, and memory. To address partial responses among the children tested, we did multiple data imputation by chained equations before univariable and multivariable linear and logistic regression analyses adjusted for risk factors. This trial is registered with ClinicalTrials.gov, number NCT01536275. At the 2-year follow-up, 60 (8%) of 717 children who received late parenteral nutrition and 63 (9%) of 723 children who received early parenteral nutrition had died (p=0·81). 68 (9%) of 717 children who received late and 91 (13%) of 723 children who received early parenteral nutrition were too disabled for neurocognitive assessment (p=0·059), and 786 patients (395 assigned to late and 391 assigned to early parenteral nutrition) consented for testing. 786 patients and 405 healthy control children underwent long-term outcome testing between Aug 4, 2014, and Jan 19, 2018, and were included in the imputation model for subsequent multivariable analyses. Late parenteral nutrition did not adversely affect anthropometric data, health status, or neurological functioning, and improved parent-reported or caregiver-reported executive functioning (late vs early parenteral nutrition β estimate -2·258, 95% CI -4·012 to -0·504; p=0·011), more specifically inhibition (-3·422, -5·171 to -1·673; p=0·0001), working memory (-2·016, -3·761 to -0·270; p=0·023), and meta-cognition (-1·957, -3·694 to -0·220; p=0·027). Externalising behavioural problems (β estimate -1·715, 95% CI -3·325 to -0·106; p=0·036) and visual-motor integration (0·468, 0·087 to 0·850; p=0·016) were also improved in the late parenteral nutrition group compared with the early parenteral nutrition group. After Bonferroni correction for multiple comparisons, the effect on inhibitory control remained significant (p=0·0001). Withholding early parenteral nutrition for 1 week in the PICU did not negatively affect survival, anthropometrics, health status, and neurocognitive development, and improved inhibitory control 2 years after PICU admission. European Research Council Advanced Grant, Methusalem programme provided by the Flemish Government, Flemish Agency for Innovation by Science and Technology (IWT), Research Foundation Flanders (FWO), Sophia Children's Hospital Foundation (SSWO), Stichting Agis Zorginnovatie, Erasmus Trustfonds, and European Society for Parenteral and Enteral Nutrition (ESPEN) research grant.

The choice and curative effect analysis of early postoperative nutritional support for severe traumatic brain injury patients

Objective To explore the differences of curative effect and short-term prognosis to severe traumatic brain injury patients with three different early postoperative nutritional supports. Methods A retrospective study was performed on 60 severe traumatic brain injury patients received in Neurosurgical Intensive Care Unit of Northern Jiangsu People's Hospital from July 2014 to July 2016. A total of 60 cases were randomly divided into the early enteral nutrition support therapy group, the early parenteral nutrition group, and the early compound nutrition group.The clinical indicators such as basic clinical characteristics before treatment, the nutrition data in two weeks, the length of stay in the Neurosurgical Intensive Care Unit, complications and GCS scores between the three groups were observed and analyzed. Results The indicators of early compound nutrition group were fasting blood-glucose (5.74±0.64) mmol/L, pre-albumin(203.80±10.45) mg/L, total serum protein(61.99±1.34) g/L, blood hemoglobin (114.53±2.69) g/L, C-reactive protein(0.37±0.06) mg/dl. The length of stay in Neurosurgical Intensive Care Unit was (11.6±0.42) days in the compound nutrition group while those in the early enteral nutrition group was (13.20±0.42) days and those in the early parenteral nutrition group was(14.65±0.42) days. The postoperative complications of the compound nutrition group were significantly lower than other two groups. The GCS scores of early compound nutrition group was(11.40±1.60), which was the best in three groups. The differences were statistically significant (P<0.05). Conclusions Early compound nutrition support has an exact curative effect on postoperative severe traumatic brain injury patients in Neurosurgical Intensive Care Unit. It can obviously improve the nutrition status of patients with less complications, shorter length of stay in Neurosurgical Intensive Care Unit, higher safety and lower degree of coma, worth clinical promotion. Key words: Nutritional support; Severe traumatic brain injury; Early enteral nutrition; Parenteral nutrition; Comparative effectiveness research

Effects of Early and Late Parenteral Nutrition on Clinical Outcomes in Very Low Birth Weight Preterm Infants: A Systematic Review and Meta-analysis

Background: Parenteral Nutrition (PN) provided to the Very Low Birth Weighti¼ˆVLBWi¼‰premature infants should be resulted in gradually development as of the other fetuses following the same gestational age. Even after providing the proven beneficial parenteral nutrition supplements, VLBW infants are often presents with the unfavorable results; the main reason behind it is the decision of the administration of parenteral nutrition, whether it is in early life or later days. Objective: The objective of this study is to explore the effect of early and late parenteral nutrition in the VLBW premature infants. In this study we hypothesize that early parenteral nutrition is associated with comparatively beneficial outcomes. Methods: The PubMed (PubMed Central), Medline, and Google Scholar databases were searched from 1993 to 2013. Methodological quality assessment was based on the PRISMA guidelines. Data analysis were conducted with RevMan 5.3 Results: Ten studies including thirteen trials met our inclusion criteria. The aggregate results of trials showed that early parenteral nutrition was well tolerated by VLBW preterm infants and there was significant reduction in sepsis (RR=0.82, 95% CI=0.69~0.98, P=0.03) Conclusion: Comparison made between the patients provided early and late parenteral nutrition, the development and reduction of clinical disease were significantly lower in the early parenteral nutrition group. The cost-effectiveness of these preparations, however, needs to be further explored. The poor qualities of studies call into a question and robustness of the analysis.

Withholding parenteral nutrition during critical illness increases plasma bilirubin but lowers the incidence of biliary sludge

Cholestatic liver dysfunction (CLD) and biliary sludge often occur during critical illness and are allegedly aggravated by parenteral nutrition (PN). Delaying initiation of PN beyond day 7 in the intensive care unit (ICU) (late PN) accelerated recovery as compared with early initiation of PN (early PN). However, the impact of nutritional strategy on biliary sludge and CLD has not been fully characterized. This was a preplanned subanalysis of a large randomized controlled trial of early PN versus late PN (n = 4,640). In all patients plasma bilirubin (daily) and liver enzymes (alanine aminotransferase [ALT], aspartate aminotransferase [AST], gamma-glutamyl transpeptidase [GGT], alkaline phosphatase [ALP], twice weekly; n = 3,216) were quantified. In a random predefined subset of patients, plasma bile acids (BAs) were also quantified at baseline and on days 3, 5, and last ICU-day (n = 280). Biliary sludge was ultrasonographically evaluated on ICU-day 5 (n = 776). From day 1 after randomization until the end of the 7-day intervention window, bilirubin was higher in the late PN than in the early PN group (P < 0.001). In the late PN group, as soon as PN was started on day 8 bilirubin fell and the two groups became comparable. Maximum levels of GGT, ALP, and ALT were lower in the late PN group (P < 0.01). Glycine/taurine-conjugated primary BAs increased over time in ICU (P < 0.01), similarly for the two groups. Fewer patients in the late PN than in the early PN group developed biliary sludge on day 5 (37% versus 45%; P = 0.04). Tolerating substantial caloric deficit by withholding PN until day 8 of critical illness increased plasma bilirubin but reduced the occurrence of biliary sludge and lowered GGT, ALP, and ALT. These results suggest that hyperbilirubinemia during critical illness does not necessarily reflect cholestasis and instead may be an adaptive response that is suppressed by early PN.

PARENTERAL NUTRITION IN VERY LOW BIRTH WEIGHT INFANTS. WHEN TO START?

Objective: To assess the effects of parenteral nutrition (PN) initiation time in very low birth weight neonates on: the birth weight recovery time, enteral nutrition (EN) initiation time, duration of hospitalization, and incidence of death. Methods: This retrospective case-control study was performed in the neonatal intensive care unit (NICU) of a tertiary center: Santo Amaro Hospital, Salvador, Brazil. All infants with birth weights ≤ 1500 g who were treated in the NICU during the study period (n= 114) were included. The sample was divided in two groups: early (≤ 48 h after birth) and late (&gt; 48 h after birth) onset of PN. We also analyzed a subgroup of neonates with birth weights ≤ 750g, as well as a group for whom PN was initiated very early (≤ 24 h after birth). Results: A total of 114 neonates (n=48 / 39.8% in early PN group),were included in the study. Birth weight recovery time (9.9 ± 4.0 vs 12.8 ± 6.1, p = 0.007), lenght of hospitalization (43.2 ± 4.0 vs 71.8 ± 41.7, p = 0.007), and time of EN onset (2.2 ± 1.2 vs 7.9 ± 5.8, p &lt;0.001) , were significantly lower in the early PN onset group than in the late onset group. Lenght of hospitalization was positively correlated with the timing of EN onset (r= 0,37, p = 0,001). No significant difference in adverse outcomes: death (18.6% vs 13.6%, p = 0.6), intracranial hemorrhage (ICH) (8.3% vs 12.1%, p = 0.9 ) and patent ductus arteriosus (PDA) (8.3% vs 31.8%, p = 0.1) was obbserved between groups. Conclusion: In this study, the early initiation of nutritional support in very low birth weight neonates can reduce the length of hospitalization thereby reducing costs, without increasing the incidence of adverse effects.

Postoperative nutritional effects of early enteral feeding compared with total parental nutrition in total gastrectomy patients

Objective To compare the effect of comparion of the effect of postoperative.Methods Forty patients with total gastrectomy for gastric cancer surgery were randomly divided into groups of early parenteral nutrition (EEN) and total parental nutrition (TPN) group,20 patients in each group.Nutritional index,immune status,complication rate and postoperative intestinal function recovery time and average hospital stay were observed.Results The first day of bowel movement and time to take a normal soft diet was significantly shorter in EEN group than that in TPN group(t =5.091,7.007,all P ＜ 0.05).and the hospital stays of EEN group all so significantly shorter than TPN group (t =5.802,P ＜ 0.05).Prealbumin and transferrin were significantly reduced on post-operative day (POD)7 and were slowly recovered until POD 90.but the increased rate in EEN group was significantly faster than that in TPN group [cprealbumin:t =9.501,7.913,7.182,6.154,all P ＜ 0.05] ; transferrin:t =5.501,5.712,5.733,5.801,all P ＜ 0.05).The TLC,CD4 and CD8 are lower than before total gastrectomy on POD 7,and have been recovered to the level before surgery.The TLC level on POD 7 and 14 were significantly higher in EEN group than that in TPN group (t =5.645,5.134,all P ＜ 0.05).The PG-SGA score was lower in EEN group than that in TPN group,particularly on POD 21 (t =5.211,P ＜ 0.05).Conclusion Total gastreetomy for gastric cancer after curative resection of early enteral nutrition support can improve the postoperative intestinal function recovery and shorten the time of hospital stay for patients. Key words: Enteral nutrition; Parenteral nutrition; Gastrectomy; Stomach neoplasms

Early use of supplemental parenteral nutrition in critically ill patients: Results of an international multicenter observational study*

To evaluate the effect of using supplemental parenteral nutrition compared to early enteral nutrition alone on nutritional and clinical outcomes. A multicenter, observational study. Two hundred twenty-six intensive care units from 29 Countries. Mechanically ventilated critically ill adult patients that remained in the intensive care unit for >72 hrs and received early enteral nutrition within 48 hrs from admission. Data were collected on patient characteristics and daily nutrition practices for up to 12 days. Patient outcomes were recorded after 60 days. We compared the outcomes of patients who received early enteral nutrition alone, early enteral nutrition + early parenteral nutrition, and early enteral nutrition + late parenteral nutrition (after 48 hrs of admission). Cox regression analyses were conducted to determine the effect of feeding strategy, adjusted for other confounding variables, on time to being discharged alive from hospital. A total of 2,920 patients were included in this study; 2562 (87.7%) in the early enteral nutrition group, 188 (6.4%) in the early parenteral nutrition group, and 170 (5.8%) in the late parenteral nutrition group. Adequacy of calories and protein was highest in the early parenteral nutrition group (81.2% and 80.1%, respectively) and lowest in the early enteral nutrition group (63.4% and 59.3%) (p < .0001). The 60-day mortality rate was 27.8% in the early enteral nutrition group, 34.6% in the early parenteral nutrition group, and 35.3% in the late parenteral nutrition group (p = .02). The rate of patients discharged alive from hospital was slower in the group that received early parenteral nutrition (unadjusted hazard ratio 0.75, 95% confidence interval 0.59-0.96) and late parenteral nutrition (hazard ratio 0.64, 95% confidence interval 0.51-0.81) (p = .0003) compared to early enteral nutrition. These findings persisted after adjusting for known confounders. The supplemental use of parenteral nutrition may improve provision of calories and protein but is not associated with any clinical benefit.

When Early Enteral Feeding Is Not Possible in Critically Ill Patients

Early enteral nutrition (EN) is the preferred strategy for feeding the critically ill; however, it is not always possible to initiate EN within the recommended 24 to 48 hours. When these situations arise, controversy exists whether to start feeding early via the parenteral route or to delay feeding until EN can be provided. A multicenter, international, observational study examined nutrition practices in intensive care units (ICUs). Eligible patients were critically ill patients with a medical diagnosis who remained in the ICU for >72 hours and received EN >48 hours after admission. Data were collected on site, including patient characteristics, daily nutrition practices, and outcomes at 60 days. Nutrition and clinical outcomes were compared between 3 groups of patients: (1) early parenteral nutrition (PN) (<48 hours after admission) and late EN (>48 hours after admission), (2) late PN and late EN, and (3) late EN and no PN. Of the 703 patients who met our inclusion criteria, 541 (77.0%) medical patients received late EN and no PN. In patients receiving late EN and PN, 83 (11.8%) received early PN and 79 (11.2%) received late PN. Adequacy of calories and protein from total nutrition was highest in the early PN group (74.1% ± 21.2% and 71.5% ± 24.9%, respectively) and lowest in the late EN group (42.9% ± 21.2% and 38.7% ± 21.6%) (P < .001). The proportion of patients dead or remaining in hospital was significantly higher for early PN compared with late EN and PN (unadjusted hazard ratio for early PN = 0.55; 95% confidence interval, 0.37-0.83, P = .015). However, this difference did not remain significant (P = .65) after adjustment for baseline characteristics. The results suggest that initiating PN early, when it is not possible to feed enterally early, may improve provision of calories and protein but is not associated with better clinical outcomes compared with late EN or PN.

Impact of early parenteral nutrition completing enteral nutrition in adult critically ill patients (EPaNIC trial): a study protocol and statistical analysis plan for a randomized controlled trial

BackgroundFor critically ill patients treated in intensive care units (ICU), two feeding strategies are currently being advocated, one by American/Canadian and the other by European expert guidelines. These guidelines differ particularly in the timing of initiating parenteral nutrition (PN) in patients for whom enteral nutrition (EN) does not reach caloric targets.Methods/DesignThe EPaNIC trial is an investigator-initiated, non-commercial, multi-center, randomized, controlled, clinical trial with a parallel group design. This study compares early (European guideline) versus late (American/Canadian guideline) initiation of PN when EN fails to reach a caloric target. In the early PN group, PN is initiated within 24-48 hours after ICU admission to complete early enteral nutrition (EN) up to a calculated nutritional target. In the late PN group, PN completing EN is initiated when the target is not reached on day 8. In both groups, the same early EN protocol is applied. The study is designed to compare clinical outcome (morbidity and mortality) in the 2 study arms as well as to address several mechanistical questions. We here describe the EPaNIC study protocol and the statistical analysis plan for the primary report of the clinical results.DiscussionThe study has been initiated as planned on august 01 2007. One interim analysis advised continuation of the trial. The study will be completed in February 2011.Trial RegistrationClinicalTrials (NCT): NCT00512122

Effects of early enteral nutritional supplementation on prognosis of patients with cysphagia following acute stroke

Objective To study the effects of early enteral nutritional supplementation on prognosis of patients with dysphagia following acute stroke.Methods 139 patients with dysphagia after acute stroke were randomly divided into early enteral nutrition group(EEN,n=69)and early parenteral nutrition group(EPN,n=70).Two groups were treated by different nutritional support treatment on the basis of comprehensive treatment.The hospital nutrition parameters including serum albumin,midarm muscle circumference(MAMC),triceps skinfold thickness(TSF)and weight and incidence rate of complications including tympanites,stress-induced ulcer,pulmonary infection and death rate before therapy and 4 weeks after therapy were observed.Results After treatment of 4 weeks,serum albumin,MAMC,TSF and weight in the EEN group were better than those in the EPN group(P<0.05),and the incidence of stress-induced ulcer and pulmonary infection in the EEN group were obviously less than those in the EPN group(P<0.01).Conclusion The advantages of early enteral nutritional supplementation in patients with dysphagia following acute stroke are improve the nutritional status of the body,reduce the incidence of complications and Conducive to the rehabilitation of patients. Key words: stroke; Dysphagia; Enteral nutrition; Parenteral nutritio

Randomized, Controlled Trial of Early Intravenous Nutrition for Prevention of Neonatal Jaundice in Term and Near‐term Neonates

This study was undertaken to investigate the effects of early parenteral nutrition on prevention of neonatal jaundice in term and near-term neonates who could not be enterally fed. Seventy-two infants were randomized into 2 groups: the early parenteral nutrition group (group 1) received 1.0 g/kg/d amino acids beginning within the first day and 1.0 g/kg/d lipid added the next day. The conventional nutrition group (group 2) started on a solution containing 10% glucose and electrolytes in the first 72 hours of life, followed by 0.5 g/kg/d amino acids and lipid. Amino acids and lipid were each increased by 0.5 g/kg/d to a maximum of 3.0 g/kg/d in both groups. Main outcome measures were energy intake; serum bilirubin levels at 24, 48, and 72 hours; need for phototherapy; and duration of phototherapy. Higher energy intake was achieved after the first day in group 1. Daily serum bilirubin levels did not significantly differ between groups. Nine patients in each group required phototherapy. The initiation times of phototherapy were 92.9 hours +/- 25.5 in group 1 and 83.1 hours +/- 28.5 in group 2. Durations of phototherapy were 37.3 hours +/- 11.1 in group 1 and 52.0 hours +/- 20.7 in group 2. There were no significant differences in the requirement, initiation time, and duration of phototherapy. Early parenteral nutrition has no proven benefit in terms of therapy requirement or severity and duration of neonatal jaundice compared with conventional parenteral nutrition in term and near-term infants who could not be enterally fed.

Early Parenteral Nutrition in Patients Unconscious Because of Acute Drug Poisoning

The author studied the clinical and laboratory effects of early parenteral nutrition (EPN) in patients who were comatose as a result of acute drug poisoning. All patients were unconscious at the time of admission and entry into the study and received our usual conservative therapy for the first 24 hours. Alternate patients received an EPN solution containing amino acids and glucose. Volume, composition, and caloric content of the EPN solution were calculated separately for each patient according to weight and height nomograms. It was found that the group receiving EPN (n = 46) normalized their nitrogen balance sooner and demonstrated a consistent decrease in their creatine Phosphokinase level. Serum amino acid values in patients treated with EPN did not change significantly during the treatment trial. The control group (n = 40) demonstrated a significantly lower serum amino acid concentration on the third day of treatment (p &lt;.001), had significantly more pneumonias (p &lt;.05), and their hospitalization time was significantly longer (.01 &lt; p &lt;.05) than the EPN group. There were significantly fewer instances of disseminated intravascular coagulation in the group receiving EPN (p &lt;.05).