Duration Of Parenteral Nutrition Research Articles

The effect of minimizing central line days for very low birth weight infants through quality improvement

Blood culture proven sepsis is associated with increased mortality and morbidity. Given the extended hospitalization of very preterm infants, catheter-related blood stream infections (CRBSIs) play a substantial role in sepsis. The reported incidence of CRBSIs in neonates varies from 3.2 to 21.8 CRBSIs per 1000 catheter line days. Moreover, discrepancies in neonatal practices and potential neglect may lead to the unwarranted prolongation of central lines. This study aims to compare two distinct periods (Pre-QI vs. Post-QI) in relation to the central line insertion rate and duration, as well as blood culture proven sepsis, duration of total parenteral nutrition (TPN), and the progression of feeding. These factors are known to be associated with prolonged hospitalization and increased morbidities. A total of 210 very low birth weight infants (VLBWIs), defined as either less than 32 weeks of gestational age (GA) or weighing less than 1500 g, were admitted to the Neonatal Intensive Care Unit (NICU) at Seoul St. Mary’s Hospital, The Catholic University of Korea, between January 2020 and June 2023. Fourteen infants were excluded from the study as they did not survive beyond 1 month of life, and one was excluded due to a congenital anomaly. Consequently, the analysis included 195 VLBWIs. The Quality Improvement (QI) initiative began in January 2022, marking the division into two distinct epochs: the Pre-QI period, encompassing the years 2020 to 2021, and the Post-QI period, spanning from 2022 to 2023. The primary outcome measures included PICC insertion rates, duration, and feeding advancement or feeding-related complications. The hospital outcome measures were also compared between the two periods. A total of 195 VLBWI were included in the analysis. The birth weight was significantly lower in the pre-QI period, with an average of 1023 g compared to 1218 g (P < 0.001). Severe BPD ≥ moderate was significantly lower in the post-QI period (36.2% vs. 53.9%) (P < 0.001) along with shorter mechanical ventilation days (12 ± 29 vs. 22 ± 27) (P = 0.046). The PICC insertion rate was significantly decreased from 95.6% in pre-QI period compared to 55.2% in post-QI period (P < 0.001) along with a notable reduction in blood culture-proven sepsis (25.6% vs. 10.5%, P = 0.008). CRBSI rate was reduced from 1.3 to 1.1 per 1000 catheter days in the post-QI period. Moreover, the time required to achieve full enteral feeding of 100 mL/kg/day was significantly shorter in the post-QI (24 ± 23 vs. 33 ± 25) (P = 0.006). Multivariable logistic regression analysis for sepsis revealed that both birth weight and pre/post QI consistently demonstrated an association with lower sepsis rates in the Post-QI period. QI has the potential to reduce the burden of unnecessary interventions and blood culture proven sepsis rate along with CRBSI rate, thereby, optimizing the better care of very preterm babies.

The impact of early caloric intake on growth parameters in extremely preterm neonates

Introduction: Even though adequate caloric intake is essential for the promotion of growth in extremely premature infants, this is rarely achieved. We investigated how total caloric intake in the first week of life and other events during the hospitalization impact head circumference and weight at 36 weeks of corrected age in extremely preterm infants. Patients and methods: The study sample consisted of extremely preterm infants treated at Osijek University Hospital Centre, born between January 2018 and December 2020. Records were collected regarding nutritional data, sex, gestational age, birth weight and head circumference, invasive respiratory support, bacterial infection, necrotizing enterocolitis, postnatal steroids, need for supplemental oxygen at 36 weeks gestation, day of introduction of enteral nutrition, duration of parenteral nutrition, length of stay, hemodynamically significant patent ductus arteriosus, cystic periventricular leukomalacia and retinopathy of prematurity. Results: The study cohort included 30 infants. At 36 weeks gestation for weight, median Z scores were -1.63 (IQR -2.34 to -1.15; 95% CI -2.09 to -1.52), and for head circumference were -1.32 (IQR 2.37 to - 0.81; 95% CI -1.75 to -0.91). Median energy intake on the first day of life was 33.42 kcal/kg, and 80.78 kcal/kg on day 7. Early caloric intake was not correlated with changes in Z scores for head circumference and weight at 36 weeks of gestation. Other factors influenced changes in head circumference and weight Z scores, namely: gestational age, respiratory support during the first week, need for additional O2 at 36 weeks, and retinopathy of prematurity requiring intervention. Conclusion: In our cohort of premature infants at 36 weeks corrected age other factors, not primarily total caloric intake influenced growth parameters.

An exploratory study of clinical factors associated with IGF-1 and IGFBP-3 in preterm infants.

Despite advances in parenteral nutrition, postnatal growth failure in very low birthweight (VLBW) preterm infants is common and associated with chronic health problems. Insulin-like growth factor 1 (IGF-1) is positively associated with improved infant growth, but factors which promote IGF-1 levels in this population have not been clearly identified. The objective of this study was to explore early factors that influence IGF-1 in VLBW preterm infants. VLBW infants were enrolled into a prospective, randomized controlled nutrition trial (N = 87). Outcome measures included IGF-1 and IGFBP-3 levels measured at 35 weeks PMA. Linear regression analyses tested the relationships between candidate clinical predictors and levels of IGF-1 and IGFBP-3. Higher protein intake, longer duration of parenteral nutrition, and lower IGFBP-3 levels at 1 week of life were associated with lower IGF-1 levels at 35 weeks PMA. Neither early markers of insulin resistance nor degree of illness were associated with IGF-1 levels at 35 weeks PMA. Optimization of early nutrient intake, and attention to route of delivery, may have a lasting influence on IGF-1/IGFBP-3, and in turn, long-term health outcomes. In very low birthweight preterm infants, early protein intake, duration of parenteral nutrition, and insulin-like growth factor binding protein 3 (IGFBP-3) levels at 1 week of life are positively associated with insulin-like growth factor 1 (IGF-1) levels at 35 weeks postmenstrual age. Data from this study highlight the influence of early nutrition on components of the endocrine axis in preterm infants. Strategies aimed at early initiation of enteral nutrition, as well as optimizing composition of parenteral nutrition, may bolster hormones involved in promoting preterm infant growth.

Associations between In-Hospital Mortality and Prescribed Parenteral Energy and Amino Acid Doses in Critically Ill Patients: A Retrospective Cohort Study Using a Medical Claims Database.

Some critically ill patients completely rely on parenteral nutrition (PN), which often cannot provide sufficient energy/amino acids. We investigated the relationship between PN doses of energy/amino acids and clinical outcomes in a retrospective cohort study using a medical claims database (≥10.5 years, from Japan, and involving 20,773 adult intensive care unit (ICU) patients on mechanical ventilation and exclusively receiving PN). Study patients: >70 years old, 63.0%; male, 63.3%; and BMI < 22.5, 56.3%. Initiation of PN: third day of ICU admission. PN duration: 12 days. In-hospital mortality: 42.5%. Patients were divided into nine subgroups based on combinations of the mean daily doses received during ICU days 4-7: (1) energy (very low <10 kcal/kg/day; low ≥10, <20; and moderate ≥20); (2) amino acids (very low <0.3 g/kg/day; low ≥0.3, <0.6; and moderate ≥0.6). For each subgroup, adjusted odds ratios (AORs) of in-hospital mortality with 95% confidence intervals (CIs) were calculated by regression analysis. The highest odds of mortality among the nine subgroups was in the moderate calorie/very low amino acid (AOR = 2.25, 95% CI 1.76-2.87) and moderate calorie/low amino acid (AOR = 1.68, 95% CI 1.36-2.08) subgroups, meaning a significant increase in the odds of mortality by between 68% and 125% when an amino acid dose of <0.6 g/kg/day was prescribed during ICU days 4-7, even when ≥20 kcal/kg/day of calories was prescribed. In conclusion, PN-dependent critically ill patients may have better outcomes including in-hospital mortality when ≥0.6 g/kg/day of amino acids is prescribed.

Primary Anastomosis Versus Stoma for Surgical Necrotizing Enterocolitis in US Children's Hospitals

IntroductionMultiple studies have documented the safety of intestinal anastomosis after resection for necrotizing enterocolitis (NEC). We sought to evaluate a large population of infants with surgical NEC and assess outcomes after primary anastomosis versus enterostomy. MethodsThe Pediatric Health Information System database was used to identify infants with Bell Stage 3 NEC who underwent an intestinal resection for acute disease between 2016 and 2021. Demographics and preoperative physiology were assessed, and nutritional, infectious, and surgical outcomes were analyzed. ResultsTwo hundred twenty-two infants at 38 children's hospitals were included. Thirty-five (15.8%) were managed with a primary anastomosis. Among infants who underwent a resection within 10 d of their first operative intervention and survived for at least 3 d, a primary anastomosis was used in 26 (13.7%). These patients were older but had similar weight and physiological status at the time of resection as those managed with an enterostomy. The incidence of wound and infectious complications, duration of parenteral nutrition and length of stay were similar after anastomosis or enterostomy. ConclusionsIn a large, geographically heterogenous population of infants with NEC, only 15.8% were managed with a primary anastomosis after intestinal resection. Survivors who underwent resection within 10 d were demographically and physiologically comparable to those who underwent enterostomy and had similar surgical outcomes. While there are clearly indications for enterostomy in some infants with NEC, these data confirm the conclusions of smaller, single-center studies that a primary anastomosis should be considered more frequently.

Non-Graft-versus-Host Disease Enterocolitis Following Cord Blood Transplantation is Real, with Poorly Understood Pathophysiology, and Requires Distinct Management, with Eventual Resolution without Immune Suppression

Enterocolitis is common after cord blood transplantation (CBT) and a specific, non-graft-versus-host disease (GVHD) entity with specific histopathologic features ("cord colitis") has been described in some cases in selected series. Immune suppression is not without risk, and we have used it only when biopsy features are consistent with classical GVHD. In the absence of biopsy features of classical GVHD, our management of intestinal failure has been supportive, and we have withdrawn immune suppression to allow immune reconstitution and better prevent relapse of malignant disease and reduce infectious complications. We evaluated our approach over an 11-year period in a retrospective study of all patients at our large pediatric CBT center who experienced intestinal failure necessitating endoscopy and biopsy in the post-CBT period. We conducted a blinded histopathologic review of gastrointestinal (GI) biopsy specimens from all patients who had undergone GI endoscopy for intestinal failure in the post-CBT period. Patient records were evaluated to determine clinical HSCT course and outcome data, including mortality, relapse, and infection, as well as the duration of immune suppression and parenteral nutrition. Out of 144 patients who underwent CBT during the study period, 25 (17%) experienced intestinal failure requiring endoscopy. Thirteen patients were diagnosed with acute GVHD after blinded review of biopsy specimens, and 12 patients had non-GVHD enterocolitis. Management in the absence of GVHD on GI biopsy is supportive, with withdrawal of immune suppression in patients with malignant disease and continuing in accordance with institutional practice in those with nonmalignant disease. Compared with the GVHD cohort, the non-GVHD enterocolitis cohort had superior overall survival (91% versus 41%; P = .04) and a shorter duration of immune suppression (mean, 112 days versus 180 days; P = .049), reflecting these different management approaches. These results demonstrate that different histopathologic findings in those with intestinal failure after CBT likely indicates a different etiology from GVHD and mandates a different clinical management strategy to achieve optimal clinical outcomes.

Zegocractin to Reduce the Severity of Asparaginase Associated Pancreatitis in Children with Acute Lymphoblastic Leukemia: Results of the Phase 1 Portion of the Crspa Study

INTRODUCTION Asparaginase-associated pancreatitis (AAP) is one of the most severe and dreaded complications during therapy of childhood acute lymphoblastic leukemia (ALL). It is characterized by intense abdominal pain, nausea/ vomiting, and systemic inflammatory response syndrome. AAP can result in chronic complications such as insulin dependence, exocrine pancreatic insufficiency, and chronic pain. These symptoms are more common when pancreatic necrosis or pancreatic pseudocysts develop immediately after AAP. Treatment for AAP has historically been limited to supportive care. However, a novel calcium release activated calcium channel blocker, zegocractin (formerly CM4620), currently in clinical trials in adults with pancreatitis, may reduce the severity of AAP. We thus developed the phase 1/2 CRSPA study to identify the recommended phase 2 dose (RP2D) of zegocractin in children and young adults with AAP during ALL treatment. METHODS To investigate the characteristics of AAP in the absence of zegocractin, we retrospectively evaluated patients treated on the Total Therapy XVI study (T16) who developed pancreatitis within 30 days of receiving asparaginase (AAP). In the CRSPA trial, patients with ALL experiencing AAP were offered trial enrollment and provided informed consent/ assent. Participants underwent initial CT either prior to or on day 1 of CRSPA therapy. Zegocractin was administered as a 4-hour infusion on days 1-4 starting at dose level 1 (30mg/m 2 on day 1 and 42mg/m 2 on days 2-4), with dose limiting toxicities (DLT) defined as any CTCAE grade 3-5 toxicity not attributable to either pancreatitis or ALL therapy. Planned dose escalation was guided by a Keyboard design. The primary efficacy endpoint of the study focused on the occurrence of pancreatic necrosis or pseudocyst on CT after day 28. RESULTS Among 598 patients treated on T16, 51 (8.5%) developed AAP. The mean age at AAP onset was 10.3 (range 2.2-21.4) years; 34 were male and 17 were female. 9 received low-risk therapy while the remainder were on standard- or high-risk therapy. Adequate follow-up imaging was available for 39 patients. Of these, 22 (56% of those with imaging, 43% of all AAP patients) had peri-pancreatic fluid collections (PPFC; N=18) and/or pancreatic necrosis (N=14). Mean hospitalization was 12.1 days (range 2-70), mean ICU time in the 11 (21.6%) patients requiring ICU care was 5.1 days (1-9), and mean duration of total parenteral nutrition (TPN) in the 27 (52.9%) patients needing it was 37.7 days (3-153). Among the 9 patients (median age 8.8, range 3.1-17.6 years) treated in the first cohort of the Keyboard design phase 1 portion of CRSPA, 1 had a DLT (infusion reaction during dose 1) characterized by ill feeling and shortness of breath. The infusion was stopped and diphenhydramine was administered with symptomatic improvement. However, the symptoms recurred and worsened as the patient's AAP symptoms worsened. The event was retrospectively felt to be related to AAP rather than study medication, but it remained as a DLT. None of the other 8 patients treated at dose level 1 experienced a DLT. Pharmacokinetic analysis indicated that drug exposure at dose level 1 was at least as high as that seen in adults treated at the adult RP2D (i.e. 2 mg/kg on days 1-2 and 1.6 mg/kg on days 3-4). Because dose level 1 was well tolerated, we amended the protocol and evaluated whether there was a preliminary efficacy signal prior to dose escalation. Among the 8 patients who received all 4 doses and were evaluable for efficacy, 1 had a small PPFC and none had significant pancreatic necrosis on follow-up imaging; mean hospitalization was 6.3 days (range 5-8), 1 patient needed ICU care (3 days), and none required TPN. To further assess preliminary efficacy, CTs from the T16 cohort were matched on sex and age with CRSPA patients at a 2:1 ratio and were evaluated by a blinded radiologist. The mean CT severity index was 5.4 in the historical controls vs. 2.4 in the CRSPA patients evaluable for efficacy. CONCLUSION Patients with AAP receiving supportive care in the historical T16 cohort experienced a high rate of pancreatic necrosis and pseudocyst. The CRSPA study established dose level 1 as the RP2D of zegocractin for children with ALL experiencing AAP. The phase 1 portion of the study has provided promising data on zegocractin efficacy. Moving forward, the ongoing phase 2 portion of the study will further assess and validate the efficacy of zegocractin in treating AAP.

Risk Factors Affecting Length of Stay in Preterm Infants at Wangaya Regional General Hospital, Indonesia

Background: Advances in neonatology have led to many preterm infants being saved. Prolonged length of stay (LOS) increases the incidence of neonatal complications and even mortality, placing a significant economic burden on families and strain on healthcare systems. This study aims to determine the factors associated with LOS in preterm infants.&#x0D; Methods: This cross-sectional study involved 60 preterm babies treated at Wangaya Hospital from May 2022 to May 2023. Infants with congenital anomalies, referred from other hospitals and did not receive appropriate treatment were excluded from the study. Data were taken from the electronic medical record after obtaining ethical clearance and then analyzed using descriptive statistics and linear regression in SPSS 25. Statistical significance was considered at 0.05.&#x0D; Results: As many as 46 out of 60 preterm infants were born at moderate to late preterm gestational age. The majority of 81.7% of infants were born with a body weight of 1500-2499 grams. The median number of LOS was 7.5 days (IQR 15). Multivariate analysis of numerical independent variables obtained an equation log [LOS] = 2.902-0.066*gestational age+ 0.022*duration of parenteral nutrition (R2 = 78.1%). Meanwhile, in the categorical independent variables obtained, an equation log [LOS] = 0.398 + 0.223*very preterm + 0.144* RDS + 0.178*NEC + 0.206*prolonged antibiotics administration + 0.278*late enteral feeding + 0.148*abdominal distension + 0.144*vomiting (R2 = 87.4%).&#x0D; Conclusion: Factors influencing LOS of preterm infants are gestational age, duration of parenteral nutrition, the presence of RDS, NEC, vomiting, abdominal distension, late enteral feeding, and prolonged use of antibiotics. It is essential to carry out antenatal care for pregnant women to prevent premature birth.

Neonatal Sepsis: Insight into Incidence, Classification, Risk Factors, Causative Organisms, Pathophysiology, Prognosis, Clinical Manifestations, Complications, Systemic Examination, and Treatment

Background: Neonatal sepsis is a clinical syndrome of bacteremia with systemic signs and is the most important cause of neonatal death in developing country. Mortality increase with delay in diagnosis and initiation of antibiotics. So, improvements in diagnosis and management of sepsis can significantly decrease the sepsis complications and improve its outcome. Objectives: The current review aims to high light on the incidence of neonatal sepsis, classification, risk factors, causative organisms, pathophysiology, prognosis, clinical manifestations, complications, systemic examination, and treatment. The incidence of neonatal sepsis varies among the different geographic areas, the highest being registered in Africa and Asia and the lowest in the U.S.A and Australia. The sepsis has been classified as early-onset sepsis (EOS) and the late-onset sepsis. Late-onset infections onset after 1 month of life, which occurs particularly in VLBW preterm infants or term infants requiring prolonged neonatal intensive care for other chronic problems. Neonatal sepsis includes maternal risk factors and neonatal risk factors. Septic or traumatic risk factors delivery, maternal poverty, pre-eclampsia, cardiac disease and diabetes mellitus are significant risk factors. Prolonged rupture of fetal membranes before the onset of labour, chorio-amnionitis, and maternal genitourinary tract infections have been significantly associated with a wide range of adverse perinatal and maternal outcomes, including miscarriage, stillbirth, preterm birth, fetal growth restriction, neonatal and puerperal sepsis, neonatal encephalopathy and neonatal and maternal mortality. Improvement in the socio-economic status of the population and availability of affordable antenatal care would reduce the incidence of neonatal septicemia. Amniocentesis, cervical cerclage, transcervical chorionic villus sampling, or percutaneous blood sampling, can permit entry of skin or vaginal organisms, causing amnionitis and secondary fetal infection. Infection of skin abrasions after use of obstetric forceps increases the risk of infection in neonates. Infant birth weight is inversely related to risk of early- onset sepsis. Prematurity and low birth weights are the most important neonatal factors predisposing to infection. Endotracheal intubation, insertion of an umbilical vessel catheter, or both, is associated with an increased risk of bacterial infection. Prolonged intravascular access and mechanical ventilation, the use of intravenous intralipids, and the duration of total parenteral nutrition are among the proposed risk factors associated with NICU-acquired coagulase- negative staphylococcus infections. Males have an approximately two-fold higher incidence of sepsis than females. Systemic antibiotics potentiate the overgrowth of certain organisms as Staphylococcus epidermidis. Corticosteroid treatment increases the risk of invasive candidiasis among premature infants. Hospital Acquired Infections are one of the leading causes of mortality and morbidity in (NICU). Group B Streptococcus (GBS) and E. coli as the dominant early onset sepsis (EOS) pathogens and coagulase- negative staphylococci (CONS) as the dominant late onset sepsis (LOS) pathogen followed by GBS and Staph aureus. In developing countries, Gram negative organisms are more common and are mainly represented by Klebsiella, E.coli and Pseudomonas of the Gram positive organisms, Staph aureus, CONS, Streptococcus pneumoniae, and Streptococcus pyogenes are most commonly isolated. Agents that commonly cause nosocomial infection are coagulase-negative staphylococci, gram-negative bacilli, Enterococci, and S. aureus. Causative organisms are bacterial, fungal, viral, and protozoal organism's infections. Mode of infection is prenatal, natal, and postnatal infections. Soon after birth, the newborns are exposed to the "hostile world" of bacteria, viruses, fungi and parasites, so they must immediately defend themselves. Necotizing enterocolitis, Neonatal thrombocytopenia, endophthalmitis, abdominal aortic-iliac thrombosis, fatal complete atrioventricular block, and wide range of signs and symptoms that may be observed in neonates with septicemia frequently suggest a number of alternative diagnoses. Identification of infection may be made by isolating the etiologic agent from a sterile body fluid (blood, CSF, and urine), or by demonstrating endotoxin or bacterial antigen in a body fluid. Investigations are including isolation of the microorganism, blood culture, urine culture, tracheal aspirate culture, isolation of organisms from CSF, complete blood cell count, cerebrospinal fluid analysis, C-Reactive protein, and tissue release of procalcitonin. Purpose of supportive care is to normalize the temperature, stabilize the cardiopulmonary status, correct hypoglycemia, and prevent bleeding tendency. Treatment of sepsis includes antibiotics, antiviral, antifungal, intravenous immunoglobulin, granulocyte transfusion, .......

A Quality Improvement Initiative to Reduce Necrotizing Enterocolitis in Very Preterm Infants.

To reduce the incidence of necrotizing enterocolitis (NEC) among very preterm infants in the Calgary Health Region to ≤2% within 2 years. A multidisciplinary team developed key drivers for NEC. Targeted interventions included strategies to increase mothers' own milk (MOM), improve compliance with feeding regimens, standardize management of feeding intolerance, prevent intestinal microbial aberrations, and feed conservatively during blood transfusion and the treatment of patent ductus arteriosus. The outcome measure was NEC (≥ stage 2). Changes in NEC rates were examined among racial and ethnic groups. Process measures included MOM feeding at discharge, the difference between actual and expected time to reach full feeds, lowest hemoglobin, and the duration of empirical antibiotics. Growth, the rate of blood transfusion, and the duration of parenteral nutrition were balancing measures. The preintervention, intervention, and sustainment periods were January 2013 to June 2016, July 2016 to December 2018, and December 2018 to December 2021, respectively. We included 2787 infants born at ≤326/7 weeks' gestation (1105 preintervention, 763 during intervention, and 919 in sustainment). NEC decreased from 5.6% to 1.9%. Process measures indicated increased MOM feeding at discharge, improved compliance with feeding regimens, increased lowest hemoglobin levels, and shorter durations of empirical antibiotics. Balancing measures revealed improved weight Z-scores, shorter durations on parenteral nutrition, and increased rates of blood transfusion. Quality improvement initiatives to increase MOM, improve compliance with feeding regimens, feed conservatively during blood transfusion and treatment of patent ductus arteriosus, and prevent intestinal microbial aberrations were associated with reduced NEC.

Congenital duodenal obstruction repair with and without transanastomotic tube feeding: a systematic review and meta-analysis

ObjectiveTo determine the impact of transanastomotic tube (TAT) feeding in congenital duodenal obstruction (CDO).DesignSystematic review with meta-analysis.PatientsInfants with CDO requiring surgical repair.InterventionsTAT feeding following CDO repair versus no TAT feeding.Main...

Efficacy and Safety of Synbiotics in Patients Undergoing Autologous Hematopoietic Stem Cell Transplantation: A Randomized, Double-blinded, Placebo-controlled Pilot Study.

Objective High-dose chemotherapy with autologous hematopoietic stem cell transplantation (auto-HSCT) is an effective treatment option for relapsed and refractory aggressive malignant lymphoma. However, patients frequently experience treatment-induced gastrointestinal symptoms. Synbiotics, including live microorganisms and nondigestible food ingredients, reportedly ameliorate chemotherapy-induced mucosal damage. In this study, we assessed the efficacy and safety of synbiotics in patients undergoing auto-HSCT. Methods This randomized, double-blinded study included patients with malignant lymphoma eligible for auto-HSCT. The patients were randomly assigned to either a synbiotic group receiving Bifidobacterium longum (BB536) and guar gum or a placebo group receiving a placebo containing dextrin. The supplements were administered twice daily from the start of conditioning chemotherapy up to 28 days after auto-HSCT. The primary endpoint was the duration of total parenteral nutrition (TPN). Results In total, 12 patients were included and randomized. The median duration of TPN was 15 (range, 12-33) days in the synbiotic group and 17.5 (range, 0-32) days in the placebo group. The median duration of grade ≥3 diarrhea was shorter in the synbiotic group than in then placebo group (2.5 vs. 6.5 days), as was the duration of hospital stay (31.5 vs. 43 days). The oral intake and quality of life regarding diarrhea and anorexia improved in the synbiotic group after engraftment. Synbiotic infections, including bacteremia, were not observed. Conclusion Synbiotics may reduce gastrointestinal toxicity, thereby reducing nutritional problems and improving the quality of life of patients undergoing auto-HSCT, without severe adverse events.

Clinical Observation in Premature Babies with Feeding Intolerance

Objective: Feeding intolerance (FI) is a digestive disorder that manifests itself with gastric residue, abdominal distension, and vomiting, especially in preterm infants, and often causes a prolongation of the transition to full enteral feeding. Nutrition strategy is a significant clinical challenge for neonatologists. It is tried to treat feeding intolerance with methods such as minimal enteral nutrition and slow increase in sustenance, probiotic use, prevention/treatment of NEC and sepsis, and use of specially formulated foods, but these methods are only partially effective.&#x0D; Methods: Babies under 32 weeks and 1500 g hospitalized in Konya City Hospital between August 2020 and January 2022 were evaluated retrospectively. Babies with and without feeding intolerance were divided into two groups, and their demographic and clinical conditions were examined. The treatment modalities of the group with feeding intolerance were evaluated.&#x0D; Results: Of the 86 patients in the study, 36 were included in the FI group, and 50 were in the healthy control group. Late neonatal sepsis and duration of parenteral nutrition were found to be statistically significantly higher in the group with feeding intolerance compared to the control group (p

Food intolerance in premature babies: possibilities of additional diagnostics

Due to the immaturity of the digestive system and gastrointestinal motility the preterm infants have a critical challenge in establishing adequate enteral nutrition, which is a frequent cause of gastrointestinal complications such as food intolerance and necrotizing enterocolitis. Modern clinical methods of assessing the maturity of the intestines and the child's readiness for enteral nutrition are subjective, this slows down the expansion of enteral nutrition, increases the duration of parenteral nutrition, and accordingly , period of a child`s hospitalizing. Objective methods of diagnosis are needed, which would contribute to the effective diagnosis and monitoring of food intolerance in preterm infants. Therefore, the purpose of our review was to search and summarize literature data on objective methods of diagnosing impaired food tolerance in premature baby, which could to provide daily monitoring, would be safe, cost-effective and easily accessible. Results and their discussion. Accordingly, three leading and most promising methods of examining the newborns gastrointestinal tract were analyzed. The were ultrasound examination (absence or reverse diastolic blood flow in the umbilical artery, high pulsation index in the fetal venous duct, indicators of blood flow in the upper mesenteric artery of the newborn), near-infrared spectroscopy (estimation of oxygen saturation of splanchnic tissue), and auscultation of intestinal sounds (phonoenterogram). Each of these methods has advantages and disadvantages, but to solve these existing problems, there has been recently an increasing amount of research on the bowel sounds using (namely their computerized assessment) as a new diagnostic tool. New research and further study of intestinal murmurs in premature newborns of different gestational ages with the development of clear criteria for data interpretation are needed to assess the maturity of the gastrointestinal tract, to create a diagnosis plan of food intolerance, and to develop an algorithm for early intervention.

Effect of SMOF lipid emulsion on physical growth and extrauterine growth retardation in very preterm infants: Insights from a multicenter retrospective cohort study

ObjectiveThe aim of this study was to investigate the effects of soybean, medium-chain triacylglycerols (MCTs), olive oil, and fish oil (SMOF) on short-term clinical outcomes, physical growth, and extrauterine growth retardation (EUGR) in very preterm infants. MethodsThis was a multicenter retrospective cohort study of very preterm infants hospitalized in neonatal intensive care units at five tertiary hospitals in China between January 2021 and December 2021. According to the type of fat emulsion used in parenteral nutrition (PN), eligible very preterm infants were divided into the MCTs/long-chain triacylglycerol (MCT/LCT) group and SMOF group. Change in weight z-score (weight Δz) between measurements at birth and at 36 wk of postmenstrual age or at discharge, the incidence of EUGR, and short-term clinical outcomes between the two groups were compared and analyzed. ResultsWe enrolled 409 very preterm infants, including 205 in the MCT/LCT group and 204 in the SMOF group. Univariate analysis showed that infants in the SMOF group had significantly longer duration of invasive mechanical ventilation and PN, longer days to reach total enteral nutrition, and a higher proportion of maximum weight loss than those in MCT/LCT group (all P < 0.05). After adjusting for the confounding variables, multifactorial logistic regression analysis of short-term clinical outcomes showed that SMOF had protective effects on PN-associated cholestasis (odds ratio [OR], 0.470; 95% confidence interval [CI], 0.266–0.831) and metabolic bone disease of prematurity (OR, 0.263; 95% CI, 0.078–0.880). Additionally, SMOF was an independent risk factor for lower weight growth velocity (β = –0.733; 95% CI, –1.452 to –0.015) but had no effect on the incidence of EUGR (OR, 1.567; 95% CI, 0.912 to –2.693). ConclusionCompared with MCT/LCT, SMOF can reduce the risk for PN-associated cholestasis and metabolic bone disease of prematurity in very preterm infants and has a negative effect on growth velocity but has no effect on the incidence of EUGR.

Cutoffs and Characteristics of Abnormal Bowel Dilatation in Pediatric Short Bowel Syndrome.

Although excessive intestinal dilatation associates with worsened outcomes in pediatric short bowel syndrome (SBS), little is known about the natural history and definition of pathological dilatation. We addressed fore-, mid-, and hind-gut dilatation in children with SBS, who had not undergone autologous intestinal reconstructive (AIR) surgery, in relation to controls. SBS children without history of AIR surgery (n = 59) and age-matched controls without any disclosed intestinal pathology (n = 140) were included. Maximum diameter of duodenum, small bowel (SB), and colon were measured in each intestinal contrast series during 2002 to 2020 and expressed as diameter ratio (DR) to L5 vertebrae height. Predictive ability of DR for weaning off parenteral nutrition (PN) was analyzed with Cox proportional hazards regression models using multiple cutoffs. Duodenum (DDR), SB (SBDR), and colon (CDR) DR were 53%, 183%, and 23% higher in SBS patients compared to controls ( P < 0.01 for all). The maximal DDR and SBDR measured during follow-up is associated with current PN dependence and young age. DDR correlated with SBDR ( r = 0.586, P < 0.01). Patients with maximal DDR less than 1.5, which was also the 99th percentile for controls, were 2.5-fold more likely to wean off PN ( P = 0.005), whereas SBDR and CDR were not predictive for PN duration. All segments of remaining bowel, especially SB, dilate above normal levels in children with SBS. In SBS children without AIR surgery, PN dependence and young age is associated with duodenal and small intestinal dilatation, while duodenal dilatation also predicted prolonged PN.

Clinical adaptation and the state of innate and humoral im- munity of premature infants with extremely low body weight who received oropharyngeal administration of colostrum

Breast milk is the optimal food for premature infants. However, the serious condition of premature newborns requires a complex of primary resuscitation care in the maternity unit, which makes it impossible to carry out early attachment to the breast and start breastfeeding. Currently, the neonatal community is actively discussing the immune effects of an alternative method of oropharyngeal administration of colostrum on the child’s adaptation to extrauterine existence. Purpose. To assess the clinical outcomes, the state of the monocytic immunity, the production of sIgA in coprofiltrates in premature infants with extremely low body weight who received colostrum in the first hours of life. Material and methods. 39 premature infants with extremely low body weight who received oropharyngeal administration of colostrum were examined. The expression of CD14+CD282+, CD14+CD284+, CD14+HLA-DR, CD14+CD64+, CD14+CD11b+, CD14+CD11c+ monocytes and the phagocytic ability of mononuclear cells in blood serum were determined by laser flow cytometry. The secretory IgA concentration was assessed in coprofiltrates. Results. In premature infants who did not receive oropharyngeal colostrum, there was an increase in leukocyte phagocytosis, the level of monocyte expression, which was due to an increased infectious morbidity. Mucosal immunity of children who received colostrum was characterized by an increased concentration of secretory IgA. Conclusion. It was found that children who received oropharyngeal administration of colostrum have a faster correction of transient hypoglycemia after birth, a shorter duration of parenteral nutrition, greater body weight at the time of discharge, and a decrease in the incidence of infectious pathology.

424 Early Outcomes of the Insides Chyme Reinfuser (ICR) in the Management of High-Output Stoma

Abstract Aim High-output stomas present a significant surgical, nursing, nutritional and patient challenge. Patients are at risk of complications ranging from disrupted GI and renal physiology to severe complications from vascular access. The ICR device allows chyme to be reinfused and may be a promising way to establish early enteral feeding, shorten hospital stays, and reduce complications such as significant GI losses and prolonged parenteral feeding. We aimed to investigate the early outcome of ICR in our initial cohort of patients. Method Prospective analysis of all patients using ICR from 2020-2022. Outcomes included: primary pathology, hospital stay, duration of Parenteral nutrition, albumin level, commencement and tolerance of Chyme reinfusion, and mortality. Results Eight patients used ICR. Five became independent in using the device. Four were successfully reversed with one waiting reversal. In all patients, a significant reduction in using parenteral nutrition was noted as five patients were nutritionally autonomous whilst using ICR. Although an imperfect marker, albumin levels responded to ICR use (an average improvement from 31g/L to 38g/L). One patient died due to complications from the primary pathology. Conclusions The ICR device is safe and effective. It can be used by nursing patients and most patients. Our data suggest a possible reduction in TPN use which will have financial and clinical benefits. The ICR device should be considered in selected patients. There remains considerable mortality in patients with significant co-morbidity who are left with a high-output stoma.

The Prevalence of Small for Gestational Age and Extrauterine Growth Restriction among Extremely and Very Preterm Neonates, Using Different Growth Curves, and Its Association with Clinical and Nutritional Factors.

Monitoring the growth of neonates in the Neonatal Intensive Care Unit (NICU) using growth charts constitutes an essential part of preterm infant care. Preterm infants are at increased risk for extrauterine growth restriction (EUGR) due to increased energy needs and clinical complications. This retrospective study compares the prevalence of small for gestational age (SGA) at birth and EUGR at discharge in extremely and very preterm neonates hospitalized in the NICU of a tertiary hospital in Greece, using different growth curves, and it examines the associated nutritional and clinical factors. Fenton2013 and INTERGROWTH-21st growth curves were used to calculate z-scores of birth weight (BW) and weight, length, and head circumference at discharge. The study includes 462 newborns with a mean BW of 1341.5 g and mean GA of 29.6 weeks. At birth, 6.3% of neonates were classified as SGA based on Fenton2013 curves compared to 9.3% with INTERGROWTH-21st growth curves. At discharge, 45.9% of neonates were characterized as having EUGR based on the Fenton2013 weight curves and 29.2% were characterized based οn INTERGROWTH-21st curves. Nutritional factors such as the day of initiation, attainment of full enteral feeding, and the duration of parenteral nutrition were associated with EUGR by both curves. The prevalence of SGA and EUGR neonates differs between the two growth references. This shows that further evaluation of these charts is needed to determine the most appropriate way to monitor infant growth.

Composite lipid emulsion use and essential fatty acid deficiency in pediatric patients with intestinal failure with high parenteral nutrition dependence: A retrospective cohort study.

Reports of essential fatty acid deficiency (EFAD) in patients receiving parenteral nutrition (PN) and a composite lipid (mixed oil intravenous lipid emulsion [MO ILE]) are predominantly when managed by lipid restriction. The objective of this study was to determine the prevalence of EFAD in patients with intestinal failure (IF) who are PN dependent without lipid restriction. We retrospectively evaluated patients, ages 0-17 years, followed by our intestinal rehabilitation program between November 2020 and June 2021 with PN dependency index (PNDI) of >80% on a MO ILE. Demographic data, PN composition, PN days, growth, and plasma fatty acid profile were collected. A plasma triene-tetraene (T:T) ratio >0.2 indicated EFAD. Summary statistics and Wilcoxon rank sum test evaluated to compare between PNDI category and ILE administration (grams/kilograms/day). P < 0.05 was considered significant. Twenty-six patients (median age, 4.1 years [interquartile range (IQR) = 2.4-9.6]) were included. The median duration of PN was 1367 days (IQR = 824-3195). Sixteen patients had a PNDI of 80%-120% (61.5%). Fat intake for the group was 1.7 g/kg/day (IQR = 1.3-2.0). The median T:T ratio was 0.1 (IQR = 0.1-0.2) with no values >0.2. Linoleic and arachidonic acid were low in 85% and 19% of patients, respectively; however, Mead acid was normal in all patients. This report is the largest to date on the EFA status of patients with IF on PN. These results suggest that, in the absence of lipid restriction, EFAD is not a concern when using MO ILEs in children receiving PN for IF.