Parenter Enteral Nutr Research Articles

Reprint of: Development and Evaluation of a Global Malnutrition Composite Score.

Reprint of: Development and Evaluation of a Global Malnutrition Composite Score.

IATROGENIC PNEUMOMEDIASTINUM AND PNEUMOTHORAX AFTER SMALL-BORE FEEDING TUBE PLACEMENT IN A PATIENT WITH EHLERS-DANLOS SYNDROME

IATROGENIC PNEUMOMEDIASTINUM AND PNEUMOTHORAX AFTER SMALL-BORE FEEDING TUBE PLACEMENT IN A PATIENT WITH EHLERS-DANLOS SYNDROME

New Drugs on the Horizon for Functional and Motility Gastrointestinal Disorders

New Drugs on the Horizon for Functional and Motility Gastrointestinal Disorders

Development and Evaluation of a Global Malnutrition Composite Score

Development and Evaluation of a Global Malnutrition Composite Score

Early enteral nutrition after lower gastrointestinal surgery: impact on hospital stay and complications.

British Journal of Community NursingVol. 25, No. 7 Cochrane CornerEarly enteral nutrition after lower gastrointestinal surgery: impact on hospital stay and complicationsPreethy D'Souza, Rovan D'Souza, Vishnu RenjithPreethy D'SouzaE-mail Address: preethy.d'[email protected]Research Associate, Social Sciences Research Unit, Department of Social Sciences, University College London Institute of Education, LondonSearch for more papers by this author, Rovan D'SouzaConsultant, Vascular and General Surgery, Royal Free Hospital, LondonSearch for more papers by this author, Vishnu RenjithLecturer, School of Nursing and Midwifery, Royal College of Surgeons in Ireland—Medical University of BahrainSearch for more papers by this authorPreethy D'Souza; Rovan D'Souza; Vishnu RenjithPublished Online:2 Jul 2020https://doi.org/10.12968/bjcn.2020.25.7.356AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Herbert G, Perry R, Andersen HK et al.. Early enteral nutrition within 24 hours of lower gastrointestinal surgery versus later commencement for length of hospital stay and postoperative complications. Cochrane Database Syst Rev. 2018; 10:CD004080. https://doi.org/10.1002/14651858.CD004080.pub3 Medline, Google ScholarBardram L, Funch-Jensen P, Jensen P, Crawford ME, Kehlet H. Recovery after laparoscopic colonic surgery with epidural analgesia and early oral nutrition and mobilisation. Lancet. 1995; 345(8952):763–764. https://doi.org/10.1016/s0140-6736(95)90643-6 Crossref, Medline, Google ScholarBurton B, Nicholson G, Hall G. Endocrine and metabolic response to surgery. Continuing Educ Anesthesia Crit Care Pain. 2004; 4(5): 144–147. https://doi.org/10.1093/bjaceaccp/mkh040 Crossref, Google ScholarCatchpole BN. Smooth muscle and the surgeon. Aust N Z J Surg. 1989; 59(3):199–208. https://doi.org/10.1111/j.1445-2197.1989.tb01502.x Crossref, Medline, Google ScholarMcSorley ST, Horgan PG, McMillan DC. The impact of preoperative corticosteroids on the systemic inflammatory response and postoperative complications following surgery for gastrointestinal cancer: a systematic review and meta-analysis. Crit Rev Oncol Haematol. 2016; 101:139–150. https://doi.org/10.1016/j.critrevonc.2016.03.011 Crossref, Medline, Google ScholarMoore FA, Moore EE, Jones TN, McCroskey BL, Peterson VM. TEN versus TPN following major abdominal trauma—reduced septic morbidity. J Trauma. 1989; 29(7):916–922. https://doi.org/10.1097/00005373-198907000-00003 Crossref, Medline, Google ScholarSchroeder D, Gillanders L, Mahr K, Hill GL. Effects of immediate postoperative enteral nutrition on body composition, muscle function, and wound healing. J Parenter Enteral Nutr. 1991; 15(4):376–383. https://doi.org/10.1177/0148607191015004376 Crossref, Medline, Google ScholarSoop M, Nygren J, Thorell A et al.. Preoperative oral carbohydrate treatment attenuates endogenous glucose release 3 days after surgery. Clin Nutr. 2004; 23(4):733–741. https://doi.org/10.1016/j.clnu.2003.12.007 Crossref, Medline, Google ScholarZhuang CL, Ye XZ, Zhang CJ et al.. Early versus traditional postoperative oral feeding in patients undergoing elective colorectal surgery: a meta-analysis of randomized clinical trials. Digestive Surg. 2013; 30:225–232. https://doi.org/10.1159/000353136 Crossref, Medline, Google Scholar FiguresReferencesRelatedDetails 2 July 2020Volume 25Issue 7ISSN (print): 1462-4753ISSN (online): 2052-2215 Metrics History Published online 2 July 2020 Published in print 2 July 2020 Information© MA Healthcare LimitedPDF download

VENOUS ACCESS DEVICE RELATED COMPLICATIONS IN ONCOLOGIC PATIENTS ENROLLED ON HOME PARENTERAL NUTRITION

Oncologic patients with important anorexia or alterated digestive tract function, for obstruction or malabsorption, may benefit by Home Parenteral Nutrition. Aim: to evaluate the incidence of venous access related complications in cancer patients undergoing HPN. We included 195 patients enrolled on HPNon the basis of ESPEN guidelines, in 2015- 2016. Incidence of complications were expressed as events per 1000 HPN days, calculated from the HPN start date until the discontinuation of home infusions or the removal of the VAD or the death of the patient. The VADs used were peripherally inserted central catheters (PICCs), subcutaneous implanted port, tunneled central catheters (TCCs) or non tunneled central catheters (NTCCs). 111 males, 84 females; median age 65 years(27-94). Median HPN duration was 106 days. A total of 208 VADs were studied: 67% PICCs, 21% ports, 9% TCCs and 3% NTCCs. Both thrombosis and tip migrations occurred only in PICCs, while infections happened in PICCs, ports and TCCs. The overall incidence of VAD related complications per 1000 HPN days was 0,73(0,27 in TCCs, 0,70 in PICCs, 1,25 in ports and null in NTCCs). HPN results to be a supportive therapy with low rate of VADs related complications. Infections are the most frequent complication and may occur in all kind of devices. Cotogni P. Catheter-related complications in cancer patients on home parenteral nutrition: a prospective study of over 51,000 catheter days. JPEN J Parenter Enteral Nutr. 2013;37(3):375-83 Vashi PG. A longitudinal study investigating quality of life and nutritional outcomes in advanced cancer patients receiving home parenteral nutrition.BMC Cancer.2014;14:593

Identifying Malnutrition in PALTC Communities

Identifying Malnutrition in PALTC Communities

Implementation of an Automated Pediatric Malnutrition Screen Using Anthropometric Measurements in the Electronic Health Record

Nutrition evaluation and intervention in hospitalized pediatric patients is critical, because undernutrition negatively impacts physical and cognitive development, wound healing, immune function, mortality, and quality of life. 1 Brinksma A. Sanderman R. Roodbol P.F. et al. Malnutrition is associated with worse health-related quality of life in children with cancer. Support Care Cancer. 2015; 23: 3043-3052 Crossref PubMed Scopus (56) Google Scholar , 2 Co-Reyes E. Li R. Huh W. Chandra J. Malnutrition and obesity in pediatric oncology patients: Causes, consequences, and interventions. Pediatr Blood Cancer. 2012; 59: 1160-1167 Crossref PubMed Scopus (59) Google Scholar , 3 Lange B.J. Gerbing R.B. Feusner J. et al. Mortality in overweight and underweight children with acute myeloid leukemia. JAMA. 2005; 293: 203-211 Crossref PubMed Scopus (216) Google Scholar , 4 Mehta N.M. Corkins M.R. Lyman B. et al. Defining pediatric malnutrition: A paradigm shift toward etiology-related definitions. JPEN J Parenter Enteral Nutr. 2013; 37: 460-481 Crossref PubMed Scopus (378) Google Scholar Multiple, validated pediatric nutrition screening tools are available, yet no consensus on the ideal tool exists. 5 Chourdakis M. Hecht C. Gerasimidis K. et al. Malnutrition risk in hospitalized children: Use of 3 screening tools in a large European population. Am J Clin Nutr. 2016; 103: 1301-1310 Crossref PubMed Scopus (86) Google Scholar , 6 Elia M. Stratton R.J. Considerations for screening tool selection and role of predictive and concurrent validity. Curr Opin Clin Nutr Metabol Care. 2011; 14: 425-433 Crossref PubMed Scopus (56) Google Scholar , 7 Gerasimidis K. Keane O. Macleod I. Flynn D.M. Wright C.M. A four-stage evaluation of the Paediatric Yorkhill Malnutrition Score in a tertiary paediatric hospital and a district general hospital. Br J Nutr. 2010; 104: 751-756 Crossref PubMed Scopus (133) Google Scholar , 8 Joosten K.F. Hulst J.M. Nutritional screening tools for hospitalized children: Methodological considerations. Clin Nutr. 2014; 33: 1-5 Abstract Full Text Full Text PDF PubMed Scopus (79) Google Scholar , 9 McCarthy H. Dixon M. Crabtree I. Eaton-Evans M.J. McNulty H. The development and evaluation of the Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP(c)) for use by healthcare staff. J Hum Nutr Dietetics. 2012; 25: 311-318 Crossref Scopus (113) Google Scholar Generally, the aims of the nutrition screening process are identification of current nutrition status and determination of a need for further nutrition assessment and intervention. 8 Joosten K.F. Hulst J.M. Nutritional screening tools for hospitalized children: Methodological considerations. Clin Nutr. 2014; 33: 1-5 Abstract Full Text Full Text PDF PubMed Scopus (79) Google Scholar , 10 Hartman C. Shamir R. Hecht C. Koletzko B. Malnutrition screening tools for hospitalized children. Curr Opin Clin Nutr Metabol Care. 2012; 15: 303-309 Crossref PubMed Scopus (70) Google Scholar Nutrition screening tools include, but are not limited to, dietary intake, anthropometrics, comorbid disease state, and subjective assessment of body habitus. 8 Joosten K.F. Hulst J.M. Nutritional screening tools for hospitalized children: Methodological considerations. Clin Nutr. 2014; 33: 1-5 Abstract Full Text Full Text PDF PubMed Scopus (79) Google Scholar , 10 Hartman C. Shamir R. Hecht C. Koletzko B. Malnutrition screening tools for hospitalized children. Curr Opin Clin Nutr Metabol Care. 2012; 15: 303-309 Crossref PubMed Scopus (70) Google Scholar These manual screening tools require variable time commitments for completion by nurses, physicians, or dietitians. 8 Joosten K.F. Hulst J.M. Nutritional screening tools for hospitalized children: Methodological considerations. Clin Nutr. 2014; 33: 1-5 Abstract Full Text Full Text PDF PubMed Scopus (79) Google Scholar , 10 Hartman C. Shamir R. Hecht C. Koletzko B. Malnutrition screening tools for hospitalized children. Curr Opin Clin Nutr Metabol Care. 2012; 15: 303-309 Crossref PubMed Scopus (70) Google Scholar In addition, nutrition screens are typically completed once on admission and do not continue repeatedly throughout an admission. Likewise, most traditional screens are not applicable when patients cross care environments such as transitioning from the inpatient to an outpatient setting. Although the general consensus is that nutrition screening is important, no universal, standardized approach exists for pediatric inpatients. 10 Hartman C. Shamir R. Hecht C. Koletzko B. Malnutrition screening tools for hospitalized children. Curr Opin Clin Nutr Metabol Care. 2012; 15: 303-309 Crossref PubMed Scopus (70) Google Scholar

Nutrition Screening: Coding after Discharge Underestimates the Prevalence of Undernutrition

Nutrition Screening: Coding after Discharge Underestimates the Prevalence of Undernutrition

Does short Bowel Syndrome Increase the risk of Malign Transformation in the Intestine.

Introduction: Intestinal adaptation after extensive resections is an augmented self-renewal process that might increase the risk of malignant transformation in the intestine. Furthermore, patients with short bowel syndrome (SBS) may also have other risk factors for colonic malignancy. Crohn’s disease and radiation enteritis are frequent reasons for resection. Patients with SBS receive medical therapy that might increase the risk of intestinal malignancy, as well. In the present study, our purpose was to determine the incidence of gastrointestinal malignancy in a cohort of adult patients with SBS. Methods: We reviewed the records of 21 adult patients with documented SBS identified from January 2000 to December 2016 in our clinic. Patients with SBS who died in the intensive care unit in early postoperative period were excluded. There were 9 men and 12 women ranging in age from 26 to 78 years. Follow-up from the time of diagnosis of SBS ranged from 6–168 months, with a mean value of 96. A total of 12 (57.1 %) patients were followed over 5 years. Serum cancer markers, contrasted abdominal computed tomography and colonoscopy at 1 year and every 2 years, or for other indications if necessary, were used as screening methods on routine outpatient controls. Results: Three of our patients with SBS died in the first year after surgery due to accompanying diseases, and these patients were also excluded from the study. Of the remaining 18 patients, 2 (11 %) patients underwent intestinal transplantation in a different hospital. Four (22 %) patients had a previous abdominal malignancy, including colorectal cancer in 2 patients. Two (11.1 %) received radiation therapy. Recurrent colon cancer was found in one patient with liver metastases. New colon cancer was found in one patient (5.5 %), a 57 year-old man with chronic fulminant Crohn’s disease. Conclusion: There are limitations to the present study, particularly related to its retrospective nature and the heterogeneity of the patient population. However, surveillance for intestinal malignancy was performed routinely. Our findings suggest that the frequency of developing a new colon cancerin patients with SBS is low and the risk of developing a new colon cancer in patients with SBS is not increased. Reference: 1. Thompson JS, Weseman RA, Mercer DF, Rochling FA, Vargas LM, Grant WJ, Langnas AN. Risk of Intestinal Malignancy in Patients With Short Bowel Syndrome. JPEN J Parenter Enteral Nutr. 2015 Sep 29. pii: 0148607115609587. [Epub ahead of print]

Corrigendum.

Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition: characteristics recommended for the identification and documentation of adult malnutrition (undernutrition). JPEN J Parenter Enteral Nutr. 2012;36:275-283. (Original DOI: 10.1177/0148607112440285 ).

Erratum.

Driscoll DF. Pharmaceutical and clinical aspects of lipid injectable emulsions [published online October 13, 2016]. JPEN J Parenter Enteral Nutr. (Original DOI: 10.1177/0148607116673187 ).

Parenteral Nutrition Trace Element Product Shortage Considerations.

Parenteral Nutrition Trace Element Product Shortage Considerations.

Medication Safety

Medication Safety

PTU-109 Immunosuppression; An Independant Risk Factor in Catheter Related Blood Stream Infections in Patients On Long Term Parenteral Nutrition?: Abstract PTU-109 Table 1

Introduction Catheter related blood stream infections (CRBSI) are a serious complication for patients on home parenteral nutrition (HPN).1 20% of patients on HPN at our institute take immunosuppressive medication. Little data is available to assess if immunosuppression confers any increased risk of CRBSI. We have therefore performed a retrospective cohort study on patients on HPN, cared for at St Mark’s Hospital (Harrow) to assess if immunosuppression increases susceptibility to CRBSI. Methods The Intestinal Failure Unit Database (a local database of all HPN patients) was interrogated between 01/01/2013 to 1/10/2015. Patients on HPN were divided into two arms; those with confirmed CRBSI and those without. The two groups were sub catagorised into immunosuppressed and non-immunosuppressed, and then catagorised by immunosuppression type and disease type. Results A total of 149 patients (227 separate episodes) (age 18–86) with CRBSI & 170 patients (age 16–85) without CRBSI were identified. The distribution of disease types was broadly similar for both groups of patients with 39 (26%) patients with IBD, 26 (17%) with mesenteric ischaemia, 30 (20%) with motility disorders & 32 (21%) with surgical complications in the CRBSI group. This compared to 44 (26%) with IBD, 23 (14%) with mesenteric ischaemia, and 14 (8%) with motility disorder & 37 (22%) with surgical complications in the non CRBSI group. 25 (17%) of the CRBSI group were immunosuppressed while 39 (23%) in the non CRBSI group were immunosuppressed. For each disease subtype CRBSI was compared against immunosuppression status (Fisher’s exact test). It was found that there was no statistical increase in risk in CRBSI with immunosuppression p = 0.07 (>0.05) (see table 1) No significant differences were seen according to the type of immunosuppression used (p = 0.6), or if patients were on dual or single immunosuppression (p = 1.0). Conclusion Although there is a clinical assumption that immunosuppression is a risk factor for developing CRBSI, our large retrospective cohort study has shown that this does not appear to be an independent risk factor in the development in patients on HPN. Reference 1 Buchman AL, Moukarzel A, Goodson B, Herzog F, Pollack P, Reyen L, Alvarez M, Ament ME, Gornbein J. Catheter-related infections associated with home parenteral nutrition and predictive factors for the need for catheter removal in their treatment. JPEN J Parenter Enteral Nutr 1994;18(4):297–302. Disclosure of Interest None Declared

Corrigendum.

Gomez-Perez SL, Haus JM, Sheean P, et al. Measuring abdominal circumference and skeletal muscle from a single cross-sectional computed tomography image: A step-by-step guide for clinicians using National Institutes of Health ImageJ. JPEN J Parenter Enteral Nutr 2016;40:308-318. (Original DOI: 10.1177/0148607115604149).

The Relationship Between Total Parenteral Nutrition and Central Line‐Associated Blood Stream Infections

BackgroundCentral line‐associated blood stream infections (CLABSI) prevalencehas decreased significantly over the past years in part due to hospital‐level infection control initiatives. However, a large number still occur every year. Total parenteral nutrition (TPN) is a CLABSI risk factor; in a previous study, Ippolito et al. described the risk of CLBSI among patients receiving TPN in our hospital from 2007–2008 (OR=4.33, CI=2.50–7.48). In this study we aimed to describe the risk of CLABSI associated with TPN after the never event policy implementation in our hospital.MethodsWe used the Health Information Technology to Reduce Healthcare‐Associated Infection (HIT‐HAI) dataset in conjunction with electronic medical to identify patients who were discharged between January 1,2013 and December 31, 2014 and had a central venous catheter (CVC) during their stay. Patients from this dataset who also received TPN were identified using electronic medical records and ICD‐9 code. Student's t‐test and chi‐square were used to identify variables of interest and a multivariable logistic regression model was developed to assess the influence of TPN on CLABSI risk.ResultsAmong patients who received CVCs (n=12,868), 1253 received TPN, and 1106 patients developed CLABSI. Results from multivariable regression analysis show that TPN (OR, 2.20; 95% CI, 1.59–3.04) was a significant risk factor for CLABSI, controlling for Charlson index (score predicting risk of mortality based on comorbid conditions), diabetes, duration of catheterization, malignancy, HIV renal disease, surgical site infection, ICU stay, history of transplant and pneumonia.DiscussionAfter significant reductions in CLABSIs due to infection control program implementation, TPN remains a significant risk factor for CLABSI in our hospital. Although the odds ratio is smaller than found by Ippolito et al in 2007–2008, patients with CVCs receiving TPN in 2013–2014 were 2.2 times more likely to have a CLABSI than patients with CVCs who did not receive TPN. Because TPN still remains a risk factor for CLABSI, the way that TPN is currently prescribed at our hospital may need to be changed.Citation: Ippolito, P., Larson, E. L., Furuya, E. Y., Liu, J., & Seres, D. S. (2014). Utility of Electronic Medical Records to Assess the Relationship Between Parenteral Nutrition and Central Line–Associated Bloodstream Infections in Adult Hospitalized Patients. JPEN J Parenter Enteral Nutr. 2015 Nov;39(8):929–34Support or Funding InformationThis study was funded by National Institutes of Health/National Institute of Nursing Research Grant #R01NR010822 and Training Grant #HL007343 Significant Risk Factors Associated with CLABSI Multivariable analysis Risk Factors p‐value OR 95% CI TPN <.0001 2.199 1.589–3.044 Charlson index 0.8431 0.997 0.963–1.032 Duration of catheterization <.0001 1.024 1.020–1.028 Diabetes 0.7679 1.023 0.880–1.188 Malignancy 0.0003 1.403 1.165–1.688 HIV 0.0005 2.266 1.431–3.589 Renal disease <.0001 2.881 2.480–3.348 Surgical site infection 0.0039 1.743 1.195–2.541 History of transplant <.0001 0.241 0.155–0.376 ICU stay <.0001 1.427 1.240–1.641 Pneumonia 0.1369 1.186 0.947–1.484 CLABSI, central line‐associated blood stream infection; HIV, human immunodeficiency virus; ICU, intensive care unit; TPN, total parenteral nutrition

G183(P) Learning together study days: cross specialty education to improve children and young people’s health

Aims The UK is lagging behind the majority of Europe in children and young people’s health outcomes. 1 One possible hypothesis for this is the lack of integration between primary, secondary and tertiary care. The World Health Organisation supports effective inter-professional education as it enables effective and collaborative practice. 2 There is published evidence that inter-professional learning can lead to better patient care and safety, reduced mortality rates and better use of specialist health resources. 3–5 Methods Following focus group work and a pilot study day, the authors created three study days: Child and Adolescent Mental Health, Public Health and Adolescent Sexual Health. These are areas where good care crosses traditional medical specialties and health care professions. Royal College curricula were analysed to define learning outcomes. The study days were advertised to paediatric, GP and relevent specialty trainees as well as other children’s and young people’s health professionals. Each day featured a mix of lecture and small group case based learning. Results The three days were attended by 163 trainees (85 paediatric, 52 GP, 26 other). We received pre and post course online feedback from 85 (53%) and 104 (64%) trainees respectively. Across the three days the proportion of delegates who strongly agreed with the statement ‘My learning is enhanced when I learn with health care professionals from different specialties’ increased from 40.7 to 60.2% (Tables 1 and 2). Conclusions This series demonstrates that it is both desirable and feasible to offer cross specialty inter-professional education in Children and Young People’s health and that it not only increases confidence and knowledge in the individual subject areas but also improves the delegates’ own perceptions of learning in the wider cross specialty team. References Wolfe I, Thompson M, Gill P, et al . Health services for children in Western Europe. Lancet 2013; 381 (9873):1224–1234 WHO Framework for Action on Interprofessional Education {$} Collaborative Practice 2010 Simmonds S, Coid J, Joseph P, et al . Community mental health team management in severe mental illness: a systematic review. Br J Psychiatry 2001; 178 :497–502 Naylor CJ, Griffiths RD, Fernandez RS. Does a multidisciplinary total parenteral nutrition team improve outcomes? A systematic review. J Parenter Enteral Nutr . 2004; 28 :251–258 Holland R, Battersby J, Harvey I, et al . Systematic review of multidisciplinary interventions in heart failure. Heart 2005; 91 :899–906

American society for parenteral and enteral nutrition (a.s.p.e.N.) standards of practice for nutrition support pharmacists.

American society for parenteral and enteral nutrition (a.s.p.e.N.) standards of practice for nutrition support pharmacists.

PO-0581 Nutrition During Therapeutic Hypothermia In Neonates

Adequate nutrition during therapeutic cooling for ischaemic injury in the newborn is important in minimising long-term neurological morbidity. 1 National TOBY guidelines suggest enteral feeds may be ‘cautiously introduced’ during cooling following the correction of biochemical and metabolic disturbances. 2 However, it has been suggested that neonates exposed to hypoxic injury are at increased risk of developing necrotizing enterocolitis (NEC) and so feeds should be withheld until re-warming. 3 A national survey was performed to gain insight into current approaches towards enteral feeding during therapeutic cooling. Methods Hospitals were contacted by telephone and asked standardised questions about nutritional practice during cooling. 42 of the 47 units to provide cooling in the UK supplied information. Results 67% of hospitals had no guidelines or had guidelines that failed to provide information with regards to starting enteral feeds during cooling. 79% do not give enteral nutrition during cooling. Of these, 24% of guidelines cited risk of NEC/GI complications as justification. 70% offered no reasoning for the recommendation. In these units, 45% began patients on TPN (± lipids), while 55% provide only IV fluids. No units give full enteral nutrition, however 21% of units provide trophic feeds, preferentially using expressed breast milk most frequently at a rate of 1 mL 1–4 hly, with supplemental IV fluids and no adjunctive TPN. Conclusion This survey concludes that there is no uniform approach to nutrition during therapeutic cooling in neonates within the UK. Further research and subsequent guideline development is essential to ensure optimal treatment is given to this patient group. References 1 JY Ting, D Manhas, SM Innis, S Albersheim, Elevated Triglycerides Levels in Two Infants With Hypoxic-ischemic Encephalopathy Undergoing Therapeutic Hypothermia and Receiving Parenteral Nutrition. JPEN J Parenter Enteral Nutr . 2013 Jul 26, Epub ahead of print 2 The UK TOBY Cooling Register – Clinician’s Handbook Available: https://www.npeu.ox.ac.uk/tobyregister/docs Accessed: 07/04/2014 3 R Mosalli, Whole Body Cooling for Infants with Hypoxic-Ischemic Encephalopathy, J Clin Neonatol . 2012 Apr-Jun; 1(2): 101–106