Parenteral Nutrition Research Articles

A Multidisciplinary and a Comprehensive Approach to Reducing Fragility Fractures in Preterm Infants.

With advances in neonatal care, bone fractures prior to discharge from the hospital in preterm infants receiving contemporary neonatal care, are rare. Nevertheless, such fractures do occur in very low birth weight and extremely low birth weight infants who go on to develop metabolic bone disease of prematurity (MBDP), with or without secondary hyperparathyroidism. MBDP is a multifactorial disorder arising from the disruption of bone mass accrual due to premature birth, postnatal immobilisation, and loss of placental oestrogen resulting in bone loss, inadequate provision of bone minerals from enteral and parenteral nutrition, and medications that leach out bone minerals from the skeleton. All of these factors lead to skeletal demineralisation and a decrease in bone strength and an increased risk of fractures of the long bones and ribs. Secondary hyperparathyroidism resulting from phosphate supplements, or enteral/parenteral feeds with a calcium-tophosphate ratio of < 1.3:1.0 leads to subperiosteal bone resorption, cortical thinning, and further skeletal weakening. Such fractures may occur from routine handling and procedures such as cannulation. Most fractures are asymptomatic and often come to light incidentally on radiographs performed for other indications. In 2015, we instituted a comprehensive and multidisciplinary Neonatal Bone Health Programme (NBHP), the purpose of which was to reduce fragility fractures in highrisk neonates, by optimising enteral and parenteral nutrition, including maintaining calcium-tophosphate ratio ≥1.3:1, milligram to milligram, biochemical monitoring of MBDP, safe-handling of at-risk neonates, without compromising passive physiotherapy and skin-to-skin contact with parents. The at-risk infants in the programme had radiographs of the torso and limbs at 4 weeks and after 8 weeks from enrolment into the program or before discharge. Following the introduction of the NBHP, the bone fracture incidence reduced from 12.5% to zero over an 18-month period.

Peripheral parenteral nutrition: A retrospective observational study to evaluate utility and complications.

Peripheral parenteral nutrition (PPN) provides an alternative nutrition support strategy to centrally administered PN for specific patients requiring short-term PN. Previous studies have demonstrated limited use of PPN and variable complication rates. This study aimed to evaluate PPN complications and usage at this center. This was a single-center retrospective observational study of all adult patients who received at least 1 day of PPN from June 2018 to December 2023. Demographic and clinical data were collected, including complications, indications for PN and reason for PPN, duration of therapy, reason for cessation of PPN, nutrition status, energy and protein provision, and central line insertion rates. 381 patients were included, the median age was 62 (interquartile range = 28-74) years, and 235 were men (61.7%). The most common indication for PN was ileus (n = 153, 40%) followed by gastrointestinal obstruction (n = 93, 24%). The median time receiving PPN was 3 (2-4) days. Patients received a median of 65% (55%-75%) of energy and 58% (50%-69%) of protein requirements with PPN. Malnutrition was diagnosed in 47.5% (n = 181) of this cohort. Total complication rates were 8.7% (n = 33), with cannula infiltration being the most common complication (6.6%, n = 25). 213 (56%) patients proceeded to central line insertion. PPN proved to be a safe and effective therapy for short-term PN when managed by a nutrition support team. PPN has the potential to attenuate short-term nutrition deficits and prevent central venous access device insertion in selected patients, making it a valuable nutrition support therapy.

Adverse events associated with parenteral nutrition support therapy: A pharmacovigilance study.

Parenteral nutrition (PN) plays a crucial role in nutrition support therapy, yet data on related adverse events (AEs) in practical settings are scarce. To address this, we analyzed AE signals associated with PN treatment from the United States Food and Drug Administration Adverse Event Reporting System (FAERS) database. We extracted data from the FAERS database, covering the period from the first quarter (Q1) of 2004 to Q1 of 2024. Drug names and AEs were standardized. We then conducted disproportionality analyses using four different algorithms to evaluate the association between PN and its associated AEs. We collected a total of 48,890,925 reports from the FAERS database, of which 1642 involved PN-related AEs. After categorization, we identified 21 system organ classes (SOCs), and hepatobiliary disorders were the only significant SOC across all four algorithms. At the preferred term (PT) level, we identified 99 PTs that showed significant disproportionality in all four algorithms. Fat overload syndrome, fatty acid deficiency, parenteral nutrition-associated liver disease (PNALD), Malassezia infection, and Pantoea agglomerans infection were the most prominent PTs. In addition, several potential new AE signals included nervous, cardiac, immune, psychiatric, blood, renal, urinary, and eye disorders. Our study identified several common and rare PN-related AEs reported in the FAERS database. Patients and healthcare providers should remain vigilant about these AEs. Understanding the risks of PN therapy and establishing practical procedures can help reduce AEs.

Optimising healing through enteral and parenteral nutrition in critical illness.

Optimising healing through enteral and parenteral nutrition in critical illness.

Nutrition support in children discharged from the pediatric intensive care unit: A bi-national prospective cohort study (ePICUre).

The role of nutrition in the recovery of critically ill children has not been investigated and current nutrition provision in the post-pediatric intensive care unit (PICU) period is unknown. The primary objective of this study was to describe ward nutrition support in children following PICU discharge. Children up to 18 years admitted to one of nine PICUs over a 2-week period with a length of stay >48 h were enrolled. Data were collected on the first full ward day following PICU discharge and on Days 7, 14, 21, and 28 following PICU admission. Data points included oral intake, enteral (EN) and parenteral nutrition (PN) support, and oral and EN energy and protein provision. Among the 108 children, on the first full ward day 75/108 (69%) children received EN, 54/108 (50%) oral intake, and 8/108 (7%) PN. Of those receiving oral nutrition only on the first full ward day (25/108; 23%), 9/25 (36%) received <50% of their estimated energy and protein requirements. Of those provided EN only, and where nutrition targets were known, on the first full ward day 8/46 (17%) and 7/46 (15%) met <75% of their estimated energy and protein requirements, respectively. On Day 28, this increased to 4/12 (33%) and 5/12 (42%). In this study of ward-based nutrition support, key findings included consistent use of EN and PN up to at least 28 days following PICU admission, and a high proportion of children receiving EN or oral intake only not meeting their estimated energy and protein requirements.

41 Neonatal outcomes with exclusive breast milk in infants with gastroschisis: A systematic review and meta-analysis

Abstract Background Infants with gastroschisis may experience prolonged stays in hospital as they transition from parenteral nutrition to enteral feeds. Some studies suggest that patients who receive exclusive breast milk experience better outcomes than those who receive supplemental or exclusive formula. These findings are inconsistent and the evidence for exclusive breast milk remains uncertain. Objectives To systematically review and meta-analyze the effectiveness of exclusive breast milk in infants with gastroschisis. Design/Methods We searched Medline, Embase, and Cochrane without language restriction from inception until June 2023. Manual searches of trial registries and reference lists of relevant articles were also performed. We included studies that assessed the effectiveness of exclusive breast milk compared to formula among infants with gastroschisis. Title, abstract, full-text screening, and data extraction were completed by two independent reviewers. The Newcastle-Ottawa Scale was used to assess the risk of bias. Our outcomes of interest were time to full enteral feeds, days of parenteral nutrition, length of stay, necrotizing enterocolitis (NEC), cholestasis, and mortality. RevMan was used to meta-analyze treatment effects using a random effects model whenever possible. Summary statistics were reported as relative risk (RR) with 95% confidence intervals (95% CI). Results We identified 130 studies of which six were selected for review. All included studies were observational and retrospective. Only 3 studies (n=3211 participants) reported outcome data that were amenable to meta-analysis. All participants received exclusive breast milk (n=1009) or supplemental or exclusive formula (n=2202). Exposure to exclusive breast milk was associated with a lower risk of mortality compared to those who received formula (unadjusted RR=0.36; 95% CI: 0.13-0.96, 2 studies, n=3157, I2=0%). Exposure to exclusive breast milk was not associated with a decrease in NEC (unadjusted RR=0.20; 95% CI: 0.03-1.14; 3 studies, n=3211, I2=0%). The primary source of bias among included studies was lack of adjustment for confounders. We identified one randomized controlled trial comparing exclusive breast milk to formula. This study was stopped due to low recruitment. Conclusion The use of exclusive breast milk among infants with gastroschisis may be associated with a reduction in mortality; however, this estimate is based on small numbers from observational studies. Estimates may change as more data become available. Further research is needed to establish best feeding practices, including the role of human donor milk.

Surveillance of esophageal injury after atrial fibrillation catheter ablation.

Atrial-esophageal fistula following ablation procedures for atrial fibrillation (AF) remains a major concern. There is no standardized approach to minimize the risk and morbidity of this serious complication. The objective of this study was to present the 7-year experience of systematic endoscopic surveillance of esophageal injury after AF catheter ablation. This was a retrospective single-center registry of systematic endoscopic evaluations after consecutive AF ablation procedures performed from 2016 to 2022. A total of 677 AF ablation procedures with controlled esophagogastroduodenoscopy (EGD) were analyzed during that period. Most patients were male (71%) with paroxysmal AF (71%). Radiofrequency with electroanatomical mapping was the main ablation approach for 633 patients (93.5%). Esophageal temperature monitoring was performed using a single sensor in 220 patients (34.3%) and a multisensor probe in 296 patients (46%). Most of the patients presented no esophageal lesions (75,7%). Severe lesions (Kansas-city-classification KCC 2B) were found in 46 (6.8%) of them, requiring a new EGD in 7days. KCC2B lesions were persistent in 3 patients, 2 of whom had ulcers during healing and 1 patient with a deep ulcer of 10mm who was admitted to the hospital and underwent fasting and parenteral nutrition. The ulcer healed in the second week after the procedure. Both esophageal temperature monitoring strategies were equivalent at preventing thermal lesions. Additionally, a greater left atrium (LA) was associated with a lower incidence of esophageal ulcer (P = 0.028). Most of the lesions spontaneously healed. The incidence of esophageal injury after ablation was 24.3%. Most (72%) were mild lesions that required no therapeutic intervention. A larger left atrium (LA) was correlated with a lower incidence of thermal lesions. Early endoscopy can help diagnose severe esophageal lesions and may provide additional information for the surveillance of esophageal injury after AF ablation.

A study of professional practices, attitudes and barriers to blended tube feeding in Australia and New Zealand.

This study investigates the utilisation of blended tube feeding by health professionals in Australia and New Zealand, assessing factors influencing its implementation following the Australasian Society of Parenteral and Enteral Nutrition blended tube feeding consensus statement. A cross-sectional survey was conducted targeting health professionals across Australia and New Zealand. The survey comprised 35-questions including multiple choice, Likert scales and open-ended responses, to gain insights into blended tube feeding practices and perspectives. The effect of the health professional factors on outcomes was explored in pairs with a series of Chi-squared tests. Odds ratios (ORs) were calculated using standard univariate logistic regression. An exploratory content analysis was used to code the open-ended text responses to the survey questions which were then categorised and further synthesised into overarching themes. Out of 89 health professionals who completed the survey, the majority were dietitians, 63% reported managing fewer than five patients using blended tube feeding within their services. Parental request was the leading reason for adoption. Notable barriers included clinician time constraints, resource limitations and a lack of formal guidelines. Some health professionals considered the primary risk associated with blended tube feeding to be poor growth and/or weight loss. Professional development was pivotal in increasing confidence and advocating for blended tube feeding, with significant correlations observed between blended tube feeding training and clinical practice. This study emphasises the essential role of education, resource availability and institutional policy in promoting blended tube feeding practices for health professionals. Findings suggest that focusing on professional development and standardised resources could significantly enhance knowledge, confidence and competence of health professionals in blended tube feeding application. The outcomes point towards the need for a coordinated approach to support evidence-based blended tube feeding practices, aligning with the Australasian Society of Parenteral and Enteral Nutrition blended tube feeding resources and recommendations.

Esophageal Perforation in Premature Newborns

Introduction. Esophageal perforation is a rare entity in newborns. This condition is most common in premature babies with very low and extremely low birth weight. The major cause of such pathology is considered to be iatrogenic trauma of either pharynx or esophagus, their soft tissues being delicate and tender enough to produce delamination and perforation of their wall. As a rule, this occurs as a complication of either a difficult tracheal intubation soon after birth or during some troubles with oro-/ nasogastric tube insertion. Materials and methods. During 2017 - 2022 9 newborns with esophageal perforation were treated at Childrens’ City center of neonatal surgery of St-Petersburg. All of them were premature, 2 having very low, and 7 having extremely low birth weight. The incidence of that condition appeared to be 1:1320 live births. Results and discussion. 8 from 9 patients were treated conservatively. This included adjustment of artificial lung ventilation, pain control, antibiotics, cancellation of gastric enteral feeding and administration of total parenteral nutrition. Thoraco- or laparocentesis was performed when needed (in cause of hydrothorax, pneumothorax or ascites). 2 patients died, both being born at 23th week of gestation. In both cases death occurred from polyorganic insufficiency. The mortality rate appeared to be 22 %. Conclusions. In most cases the esophageal perforation in premature babies can be treated conservatively, the efficacy of such treatment being largely dependent on early diagnosis of this complication. An important key-point in it is a radiologic control of gastric tube location.

Medication-induced changes on magnetic resonance imaging of the brain

In this review the authors focus on abnormal brain magnetic resonance imaging caused by drugs given to patients in any age group for any disease. The review includes viral infections with fever in children/infections in general, epilepsy, psychiatric diseases, multiple sclerosis, neoplasms, bone marrow/organ transplantations, total parenteral nutrition, vaccinations, oral contraceptives and other prothrombotic drugs, and gadolinium deposition. Knowledge of patients’ diseases and medications they receive is crucial to establish the correct diagnosis. The absence of these data in a referral for a brain MRI scan can result in completely wrong suspicions and unleash unnecessary, complicated, time-consuming and expensive diagnostics, causing additional stress in patients and their guardians.

Nutrition management of intestinal failure: From neonates to the elderly

Double enterostomies (DES) and necrotising enterocolitis (NEC) are prevalent in neonatal intensive care units (NICU), commonly resulting from surgical removal of diseased intestine. Sarcopenia prevalence is &gt;40% in community dwelling elderly &gt;65 yrs and is associated with poor nutritional status before/after abdominal surgery, with intestinal failure (IF) and high output stoma losses. Parenteral Nutrition (PN) is the standard of care for Type 2 IF patients with DES or enteroatmospheric fistulas (EAF), but risks catheter-related complications, infection, gut and hepatobiliary dysfunction. Chyme reinfusion therapy (CRT) is a recommended distal feeding technique that may minimise these risks.

Can a Shorter Dwell Time Reduce Infective Complications Associated with the Use of Umbilical Catheters?

Umbilical venous catheters (UVCs) are the standard of care in neonatal intensive care units (NICUs) to administer fluids, parenteral nutrition and medications, although complications may occur, including central line-associated blood stream infections (CLABSIs). However, the dwell time to reduce CLABSI risk remains an open issue. We performed a single-center retrospective study of newborns hospitalized in the Modena NICU with at least one UVC inserted over a 6-year period (period 1: January 2011-December 2013; period 2: January 2019-December 2021). We selected a non-consecutive 6-year period to emphasize the differences in UVC management practices that have occurred over time in our NICU. The UVC dwell time and catheter-related complications during the first 4 weeks of life were examined. The UVC dwell time was shorter in period 2 (median 4 days vs. 5 days, p < 0.00001). Between the two periods, the incidence of CLABSIs remained unchanged (p = 0.5425). However, in period 2, there was an increased need for peripherally inserted central catheters (PICCs) after UVC removal, with a rise in PICC infections after UVC removal (p = 0.0239). In our NICU, shortening UVC dwell time from 5 to 4 days did not decrease the UVC-related complications. Instead, the earlier removal of UVCs led to a higher number of PICCs inserted, possibly increasing the overall infectious risk.

Application of ultrasound-guided intranodal lymphangiography in the diagnosis and treatment of chylous ascites after abdominal surgery

PurposeChylous leakage is a serious and challenging postoperative complication. The purpose of this study was to explore the application of ultrasound-guided intranodal lymphangiography in the diagnosis and treatment of chylous ascites following abdominal surgery.Material and methodsTen patients with chylous ascites after abdominal surgery after ineffective conservative treatment such as low-fat diet, parenteral nutrition, and negative pressure drainage were included in this single-center retro­spective study. Of these 10 patients, 9 developed chylous ascites after liver surgery, and 1 after a radical gastrectomy.ResultsLymphangiography was successfully performed in all 10 patients. The average dosage of lipiodol used was 4.5 ml (range 3.5-7.0 ml). No procedure-related complications were observed after excluding unrelated factors. During lymphangiography, lipiodol leakage was directly observed in 3 cases, and in the other 5 cases, it was detected through abdominal computed tomography post-lymphangiography. Chylous ascites resolved solely through lymphangiography in 6 patients without requiring additional surgical intervention.ConclusionsLymphangiography may help identify leakage sites in patients with chylous ascites unresponsive to conservative treatment and could potentially be effective in treating chylous ascites following abdominal surgery.

Outcomes following the adoption of standard parenteral nutrition in preterm infants: a whole-population non-concurrent control study

ObjectiveTo evaluate the impact of a quality improvement project of the adoption of standard parenteral nutrition (SPN) in preterm infants.DesignRetrospective, multicentre, whole-population, non-concurrent control study using data from the UK...

The Role of Parenteral Nutrition in Cancer in Indian Settings

Background: Almost 50% of patients with cancer suffer from malnutrition during their first hospital visit. However, it is often overlooked and undiagnosed and is associated with morbidity, mortality, poor tolerance to treatment, and treatment outcomes. Guidelines recommend supportive nutrition from the early stages of cancer treatment. However, in clinical practice, nutritional support is often prescribed only as an end-of-life intervention or is not prescribed at all; moreover, the use of parenteral nutrition (PN) is not well-defined. There are limited practical guidelines on the use of PN in patients with cancer. Methods: A multidisciplinary group of specialists in India formulated this consensus to guide oncologists on the judicious use of PN in Indian settings. It includes general and cancer-specific recommendations on the use of PN, supplemental PN (SPN), composition of PN, and monitoring patients to prevent adverse events associated with PN. Recommendations: The risk of malnutrition should be assessed at the very first presentation of a patient with cancer. These patients’ nutritional requirements are largely like those of the healthy population. Nutritional assessment of all cancer patients should begin at diagnosis and repeated regularly to initiate and monitor early nutritional intervention, before the general status is severely compromised. Oncologists and nutritionists need to be educated about using the appropriate nutrition support options according to the guidelines. While EN should be the preferred form of nutritional support, in specific circumstances PN might be a better option. Early PN in specific settings provides additional benefits, and is particularly important in some types of cancers. SPN as an additional nutritional support to EN can improve treatment tolerability and quality-of-life of patients with cancer. Education is also necessary for awareness about preventing and managing adverse effects of PN, which is the major reason for poor adoption of PN.

Important practical aspects in the management of patients with shot bowel syndrome and intestinal failure

Short bowel syndrome is a gastrointestinal disorder resulting from massive resection of the small intestine. The most common causes of resection are acute mesenteric ischemia, Crohn’s disease, abdominal trauma, adhesive intestinal obstruction, intestinal malignancies, and radiation enteritis. Short bowel syndrome with intestinal failure is characterized by severe malabsorption-m aldigestion accompanied by abdominal pain, diarrhea, dehydration, and progression of protein-energy malnutrition. Many patients with SBS develop long-term clinical complications over time due to altered bowel anatomy and physiology or various therapeutic interventions such as parenteral nutrition and central venous catheterization. This review focuses on the most important aspects of diagnosis, treatment, and prevention of several complications that can occur in this patient population, including macronutrient and micronutrient imbalances, diarrhea, fluid and electrolyte imbalances, metabolic bone disease, biliary disorders, bacterial overgrowth in the small intestine, and complications related to venous access. The main therapeutic strategies for SBS with intestinal failure are: special diet, enteral nutritional support with semi-elemental mixtures, parenteral nutrition, oral rehydration, antimicrobal and antidiarrheal drugs, enzymes. Administration of glucagon-like peptide 2 analog, teduglutide, is clinically effective in reducing dependence on parenteral nutrition and improving quality of life. Management of patients with SBS with intestinal failure is a complex long-term process which requires dynamic clinical and laboratory monitoring.

Personalized Nutrition in the Pediatric ICU: Steering the Shift from Acute Stress to Metabolic Recovery and Rehabilitation.

Nutrition significantly impacts the outcomes of critically ill children in intensive care units (ICUs). Due to the evolving metabolic, neuroendocrine, and immunological disorders associated with severe illness or trauma, there are dynamically changing phases of energy needs requiring tailored macronutrient intake. This study aims to assess the changing dietary needs from the acute phase through recovery, provide recommendations for implementing evidence-based strategies to ensure adequate energy and nutrient provision in pediatric ICUs, and optimize patient outcomes. A comprehensive search of the MEDLINE-PubMed database was conducted, focusing on randomized controlled trials, meta-analyses, and systematic reviews related to the nutrition of critically ill children. The study highlights recent guidelines using the GRADE approach, supplemented by relevant adult studies, current clinical practices, challenges, gaps in knowledge, and future directions for research aimed at improving nutritional interventions. Early personalized, incremental enteral feeding helps mitigate the negative energy balance during the acute phase, aids organ function restoration in the stabilization phase, and supports growth during the recovery phase and beyond. Conversely, early full nutritional support, high protein doses, or isolated micronutrient administration have not demonstrated benefits due to anabolic resistance in these patients. Moreover, early parenteral nutrition during the acute phase may suppress autophagy and lead to worse outcomes. Accurate assessment of nutritional status and monitoring of daily energy and protein needs are crucial. Strong evidence supports the establishment of a dedicated nutritional team and the implementation of individualized nutritional protocols in the ICU to reduce morbidity and mortality in critically ill children.

Clinical analysis of bleeding and thrombotic events in haematological-oncology patients with severe thrombocytopenia and a high risk of thrombosis

Background: Haematological patients with severe thrombocytopenia and high thrombotic risk face challenges related to balancing bleeding and thrombosis risks. This study investigated factors associated with bleeding and thrombosis in high-risk haematological oncology patients with severe thrombocytopenia not receiving anticoagulant therapy and characterized their clinical features when both events occurred. Methods: A total of 446 haematological oncology patients with Caprini scores ≥ 5 were included from July 2022 to June 2023 at Mianyang City Central Hospital. Those not receiving prophylactic anticoagulants due to an admission platelet count < 50 × 109/L were studied. Patients were categorized into bleeding/nonbleeding and thrombotic/nonthrombotic groups on the basis of hospital course. Relevant clinical data were collected, and univariate/multivariate logistic regression was used to analyse the influencing factors. The platelet count at admission was assessed via ROC curves for thrombosis prediction. Results: In the bleeding group, higher proportions of patients with leukaemia, myeloid tumours, lung infections, and a central venous catheter (CVC) with two lumens were observed, along with shorter catheter durations, lower initial and minimum platelet counts during hospitalization, and prolonged plasminogen times (all P < 0.05). The thrombotic group had a greater thrombosis history, initial platelet count, use of two venous catheter lumens, parenteral nutrition, sedation, and autologous haematopoietic stem cell transplantation (Auto-HSCT), with a lower leukaemia proportion (P < 0.05). Logistic regression identified lymphoma type and minimum platelet count as bleeding protective factors and the Charlson Comorbidity Index (CCI) score as an independent risk factor. Thrombosis history, two venous catheter lumens, and sedation were risk factors for thrombosis. The median platelet count was lower at bleeding and thrombosis than at admission (P = 0.007). The platelet count at admission had predictive value for thrombosis, especially severe thrombocytopenia, with an AUC of 0.735 (95% CI 0.613–0.858, P = 0.003) and a cut-off value of 42.5 × 109/L. Conclusions: For haematological neoplasm patients with a high risk of venous thromboembolism (VTE), severe thrombocytopenia and high CCI scores, risk prevention and control of bleeding take precedence over thrombosis prophylaxis. Prophylactic anticoagulation is still recommended for patients with lymphoma assessed at high risk for VTE and with platelet counts of at least 42.5 × 109/L.

Malnutrition risk screening in adult oncology outpatients: An ASPEN systematic review and clinical recommendations.

Malnutrition screening is not widely practiced in outpatient cancer centers. This review aims to determine the validity of malnutrition screening tools and provide recommendations for clinical use. Studies identified by a systematic review assessed the general validity of screening tools in adult oncology outpatients from five databases through 2022. The American Society for Parenteral and Enteral Nutrition (ASPEN) convened a working group of members from the Academy of Nutrition and Dietetics, Academy of Oncology Nurse and Patient Navigators, American Cancer Society, American Society for Clinical Oncology, American Society for Nutrition, American Society for Radiation Oncology, Association of Cancer Care Centers, and Oncology Nursing Society to answer the following questions: (1) should clinicians screen for malnutrition, (2) which malnutrition screening tools are recommended, and (3) what are the clinical applications for malnutrition risk screening in adult oncology outpatients? Twenty of 738 studies met the criteria and were reviewed. Six screening tools with specific cut-points demonstrated validity and are recommended, including the Mini Nutritional Assessment (≤23.5), Malnutrition Screening Tool (MST; MST ≥ 2 and patient-led MST ≥ 2), Malnutrition Universal Screening Tool (MUST; MUST ≥ 1 and MUST ≥ 2), Nutrition Risk Screening-2002 (NRS-2002; NRS-2002 ≥ 2 and NRS-2002 ≥ 3), NUTRISCORE ≥ 5, and Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF; PG-SGA SF ≥ 7 and PG-SGA SF ≥ 8). Six screening tools are valid for malnutrition risk identification in oncology ambulatory settings and recommended before treatment initiation and regularly thereafter, depending on treatment course. Research is needed to understand to what extent early diagnosis and management of malnutrition improves the clinical care of oncology patients.

Machine Learning-Based Approach towards Identification of Pharmaceutical Suspensions Exploiting Speckle Pattern Images

Parenteral artificial nutrition (PAN) is a lifesaving medical treatment for many patients worldwide. Administration of the wrong PAN drug can lead to severe consequences on patients’ health, including death in the worst cases. Thus, their correct identification, just before injection, is of crucial importance. Since most of these drugs appear as turbid liquids, they cannot be easily discriminated simply by means of basic optical analyses. To overcome this limitation, in this work, we demonstrate that the combination of speckle pattern (SP) imaging and artificial intelligence can provide precise classifications of commercial pharmaceutical suspensions for PAN. Towards this aim, we acquired SP images of each sample and extracted several statistical parameters from them. By training two machine learning algorithms (a Random Forest and a Multi-Layer Perceptron Network), we were able to identify the drugs with accurate performances. The novelty of this work lies in the smart combination of SP imaging and machine learning for realizing an optical sensing platform. For the first time, to our knowledge, this approach is exploited to identify PAN drugs.