Parenteral Nutrition Research Articles

Assessing Practices and Challenges in Providing Nutritional Support to Neonates and Children Pre- and Post-Surgery, and its Impact on Recovery and Outcomes

ABSTRACT Background: Providing adequate nutritional support to neonates and children undergoing surgery is crucial for their recovery and overall health outcomes. However, there are various challenges associated with this, including the unique nutritional requirements of this population and the potential complications that can arise pre- and post-surgery. Materials and Methods: This study aimed to assess the practices and challenges in providing nutritional support to neonates and children both pre- and post-surgery, and to analyze its impact on recovery and outcomes. A retrospective analysis was conducted on a cohort of 200 neonates and children who underwent surgery over a two-year period. Data regarding preoperative nutritional status, types of nutritional support provided, postoperative complications, and recovery outcomes were collected and analyzed. Results: The study found that 65% of neonates and children were malnourished preoperatively, with 45% experiencing delays in initiating enteral feeding post-surgery due to complications such as gastrointestinal intolerance and surgical complications. Among those who received parenteral nutrition, 30% developed catheter-related bloodstream infections. Overall, the mean length of hospital stay was prolonged by 7 days in malnourished patients compared to adequately nourished patients. Conclusion: Effective nutritional support in neonates and children undergoing surgery is essential for optimal recovery and outcomes. However, significant challenges exist, including preoperative malnutrition, delays in initiating enteral feeding, and complications associated with parenteral nutrition. Strategies to optimize nutritional status preoperatively, minimize postoperative complications, and enhance nutritional support are imperative to improve outcomes in this vulnerable population.

Expert consensus on safety management of vascular access devices for patients with digestive system cancer (2024)

The rational selection and standardized management of vascular access devices is an urgent issue in the treatment of digestive system cancer. The purpose of this consensus is to develop solutions for the safe management of intravenous vascular access devices for patients with digestive system cancer and to provide evidence for clinical decision-making. This consensus is developed by a group of experts from multiple-disciplines in China International Exchange and Promotive Association for Medical and Health Care Clinical Nutrition Health Branch, Clinical Nutrition Branch of Chinese Nutrition Society, Chinese Society for Parenteral and Enteral Nutrition. It is based on the best current evidence and combined with Chinese clinical practice experience. The recommendations were discussed and on the following topics: how to choose vascular access devices for patients with digestive system cancer; optimal selection of puncture sites and positioning of the tip for peripherally inserted central catheters; prevention and management of complications post-central venous catheterization; strategies for prevention and treatment of central venous catheter occlusion; criteria for central venous catheter removal; indications for the use of venous port access and criteria for peripheral venous catheter in patients with digestive system cancer.

Evaluate Nurses' Application to Infection Control Measures in Total Parenteral Nutrition Administration via Neonatal Jugular Central Venous Catheter

Evaluate Nurses' Application to Infection Control Measures in Total Parenteral Nutrition Administration via Neonatal Jugular Central Venous Catheter

Circadian Sinusoidal Infusions of Total Parenteral Nutrition Are Well Tolerated and Alter Macronutrient Utilization in Mice: Pilot Data

Circadian Sinusoidal Infusions of Total Parenteral Nutrition Are Well Tolerated and Alter Macronutrient Utilization in Mice: Pilot Data

Management and Outcomes of Intestinal Atresia – A Single Institution Experience From 1947 to 2019

Aim of the studyWe aimed to evaluate disease characteristics, associated malformations and surgical outcomes of congenital intestinal atresia. MethodsWe identified all patients with jejunoileal (JIA) or colonic atresia (CA) treated at the Helsinki University Children's hospital during 1947–2019 and collected clinical data retrospectively from archived and electronic medical records. ResultsOf the 180 included patients, 156 had JIA and 24 CA. Overall survival improved markedly from 34% during 1947–1977 to 93% during 1978–2019. Rate of primary anastomosis (81% in JIA, 21% in CA) remained unchanged while early surgical complications decreased (32% vs 18%, P = 0.04) and prematurity rate increased (21% vs 45%, P = 0.002) among JIA patients over time. Around half of patients had associated, mostly gastrointestinal malformations which occurred comparably in JIA and CA. During 1978–2019, 20 (21%) JIA patients, but none of CA patients, developed short bowel syndrome. Presence of type 3b atresia (n = 16) or gastroschisis (n = 14), but not the extent of intestinal resection or surgical complications, was associated with development of short bowel syndrome without decreasing survival. Shorter primary bowel resection without tapering surgery in JIA predisposed to repeated resections due to obstructive symptoms, and prolonged duration of parenteral nutrition. ConclusionSurvival of patients with JIA and CA has improved remarkably over time and is currently high despite frequent prematurity and associated malformations. In patients with JIA, apple peel atresia and gastroschisis predisposed to short bowel syndrome without jeopardizing high survival rates. Level of EvidenceIV.

Exploring Current Practices, Challenges, and Innovations in the Nutrition and Feeding of Neonates, Including the Use of Human Milk, Fortifiers, and Formula: A Clinical Study

ABSTRACT Background: Neonatal nutrition plays a crucial role in the growth and development of infants, particularly in the neonatal intensive care unit (NICU) where specialized care is essential. This study aims to explore current practices, challenges, and innovations in the nutrition and feeding of neonates, focusing on the utilization of human milk, fortifiers, and formula. Materials and Methods: A retrospective clinical study was conducted at a tertiary care NICU over a period of two years. Data were collected from medical records of neonates admitted to the unit. Information regarding feeding practices, types of milk (human milk, fortified human milk, or formula), fortification protocols, and associated clinical outcomes were analyzed. Results: A total of 150 neonates were included in the study. The majority (85%) received some form of human milk during their NICU stay, with 60% exclusively receiving human milk. Among those receiving human milk, 40% required fortification with a human milk fortifier due to inadequate growth parameters. Formula supplementation was necessary in 25% of cases due to maternal lactation insufficiency or medical contraindications to human milk. The mean duration of parenteral nutrition was 10 days, with a median time to full enteral feeds of 14 days. Infants receiving exclusively human milk demonstrated a lower incidence of necrotizing enterocolitis (NEC) compared to those receiving formula (5% vs. 12%, P < 0.05). Conclusion: Human milk remains the preferred source of nutrition for neonates in the NICU setting, associated with lower rates of NEC and improved clinical outcomes. However, fortification with human milk fortifiers or supplementation with formula is often necessary to meet the nutritional requirements of preterm infants. Further research is needed to optimize fortification protocols and improve long-term outcomes in this vulnerable population.

Enhancing Patient Safety in Delivering Parenteral Nutrition: Insights From Pharmacy Alerts and Interventions

Enhancing Patient Safety in Delivering Parenteral Nutrition: Insights From Pharmacy Alerts and Interventions

A Novel Lipid Emulsion Containing 18-Cn3 Fatty Acids Demonstrates Superior Liver Protection to SMOFlipid® in the Murine Model of Parenteral Nutrition

A Novel Lipid Emulsion Containing 18-Cn3 Fatty Acids Demonstrates Superior Liver Protection to SMOFlipid® in the Murine Model of Parenteral Nutrition

Continuous Glucose Monitoring in Adults With Short Bowel Syndrome Receiving Overnight Infusions of Home Parenteral Nutrition: Secondary Analysis of Observational Data

Continuous Glucose Monitoring in Adults With Short Bowel Syndrome Receiving Overnight Infusions of Home Parenteral Nutrition: Secondary Analysis of Observational Data

Subcutaneous edema as a potential cause of catheter failure in older inpatients receiving peripheral parenteral nutrition.

Malnutrition is a common problem among hospitalized older patients. Peripheral parenteral nutrition (PN) can improve patient outcomes but can also lead to complications that affect future treatment. Older inpatients, in particular, are expected to be prone to these catheter-related complications. However, the impact of peripheral PN on older inpatients has been rarely investigated. In the current study, the impact of PN on short peripheral catheters (SPCs) was evaluated by comparing signs and symptoms at the time of catheter removal between 22 patients with PN and 27 without. In addition to external clinical assessment, sonographic investigations of the SPC site were performed. The prevalence of external signs and symptoms of complications was similar between the patients (all P > 0.05). However, subcutaneous edema was found by ultrasound in > 80% of patients with PN, compared with 55.6% of those without PN (P = 0.051). Unlike cases without PN, all patients with PN who presented with external signs and symptoms developed subcutaneous edema (P = 0.022). Multivariate analysis demonstrated that administration of PN was independently associated with subcutaneous edema (adjusted odds ratio = 6.88, 95% confidence interval = 1.083-75.486, P = 0.040). For several decades, phlebitis has been the primary focus of complications related to peripheral PN in clinical settings. However, our results imply that peripheral PN causes subcutaneous edema, which can lead to catheter failure in older inpatients. This study contributes to understanding the etiology of catheter failure during peripheral PN in this population.

Are three different lipid combinations effective on the immune system in sepsis patients?

Objective: We aimed to to analyze the effect of the 3 different parenteral nutritions (MCT/LCT (long and midium chain fatty acids), LCT with omega-9 (ω-9) and MCT/LCT with ω-3 and ω-9 on the inflamatory cytokine levels in sepsis patients. This is the first study from the Southern part of Turkey. Patients and Methods: We included 30 patients, diagnosed with sepsis and took total parenteral nutrition in this study. Patients were divided into 3 randomized groups in terms of what parenteral nutrition have been taken. (Group A, B and C) Blood samples were taken and TNF-α, IL-1, IL-6 and IL-8 levels were evaluated. Adverse effects were recorded. TNF-α, IL-1β, IL-6, and IL-8 levels of were analyzed by ELISA method and each sample were studied in dublicate. Results: The median age of the patients included in the study was 52 and 24 (80%) of them were male. The SOFA score was 5 in study group. We examined IL-1, IL-6, IL-8 and TNF-α distribution on the day of the first, third and fifth days depending on time. The inflamatory cytokine levels were not found statistically significant (p > 0.05) when we compared the study groups via 3 different parenteral nutritions. Conclusion: When we compare MCT/LCT, LCT/ω-9 and MCT/LCT, ω-3, ω-9 which are given as a component of total parenteral nutrition we concluded that there was no superiority to others in terms of proinflamatory cytokin levels in sepsis and they didn’t increase proinflamatory cytokins. There is a need for more randomized controlled studies investigating the effect of lipids on the course of the disease in sepsis patients who cannot receive enteral nutrition and require TPN support.

Implementation of a Standardized Feeding Protocol in a Level III Neonatal Intensive Care Unit

Introduction: The nutritional management of preterm infants in the Neonatal Intensive Care Unit (NICU) can be challenging and can often lead to extrauterine growth restriction (EUGR). A new feeding protocol was recently established and implemented at Ascension St. John’s NICU. Objectives: 1.) To determine the association of a standardized feeding protocol in the NICU and feeding intolerance, as well as growth outcomes and the number of days on parenteral nutrition; and 2.) To determine the association of a standardized feeding protocol and the development of necrotizing enterocolitis and central line associated infections. Methods: This study was a historical cohort study done by retrospective chart review. The pre-feeding protocol period included infants <32 weeks gestation and <1500g who were in the NICU between 1/1/2018 to 12/31/2020. The post-feeding protocol period was from 1/1/2021 to 11/15/2023. Data were recorded on demographics; and measurements at birth, 34 weeks postmenstrual age, and at discharge. Nutritional milestones and clinical outcomes were collected. Statistical analysis was done using Student’s t-test, the chi-squared test, the Mann-Whitney U test and repeated measures analysis of variance. Results: A total of 243 infants were included: 158 pre-implementation and 85 post-implementation of protocol. The mean gestational age was 27.7 ± 2.3 weeks, 61.7% of infants were black and 53.5% were female; there were no significant differences by time period. Results show no statistically significant difference in growth outcomes, days when infants received nothing by mouth; necrotizing enterocolitis, or sepsis. There was a delay in fortification and reaching full feeds, longer parental nutrition and central line days, and higher number of central line associated infections in the post-implementation period. Rates of intraventricular hemorrhage, retinopathy of prematurity and pulmonary outcomes were improving. Conclusions: The data suggest that implementation of a standardized feeding protocol can improve short term morbidities in high-risk neonates. Future studies are needed to optimize feeding protocols with the goal of improving growth, nutrition, and neurodevelopmental outcomes of this high-risk population.

Expert Panel Opinion on Nutritional Management of Sarcopenia in Cancer Patients

Sarcopenia is a widely prevalent skeletal muscle condition that progresses over time and is associated with adverse outcomes. It is characterized by an accelerated loss of muscle mass and functional ability. Proposed causes of sarcopenia include aging, physical inactivity, malnutrition, hormonal disturbances, inflammation, and neurodegenerative changes. According to the IAPEN INDIA (India Association for Parenteral and Enteral Nutrition), nutritional management should be integrated into the diagnostic process for all chronic diseases, including cancer. Studies recommend aggressive nutritional management, providing an energy intake of >30 kcal/kg/day and protein intake of >1.2g/kg/day for patients with sarcopenia. Published literature suggests that adequate intake of antioxidants, such as vitamin D, E, and C, along with Omega-3 fatty acids, creatine, and L-carnitine, might be beneficial for preserving and improving sarcopenia, and functional outcomes. In summary, nutritional management complemented with resistance exercise, under strict supervision, is key to preventing and treating sarcopenia in cancer patients.

Assessment of preoperative short-term parenteral nutrition in gastric cancer surgery.

Assessment of preoperative short-term parenteral nutrition in gastric cancer surgery.

Complication Rates of Peripherally Inserted Central Catheters in Oncologic Versus Non-Oncologic Patients

ObjectivesPeripherally inserted central catheters are commonly used in cancer patients and provide vascular access for the administration of chemotherapy, antibiotics, or parenteral nutrition. Besides many advantages, they represent a source of possible complications such as catheter related blood stream infection, catheter occlusion, or thrombosis. In this study, the catheter-related complication rate between oncologic and non-oncologic patients was compared. MethodsThis retrospective cohort-study included 411 patients who underwent their first catheter placement at the Vienna General Hospital—Medical University of Vienna from January 2013 to June 2018. Patient demographics and catheter-related parameters were collected and statistically analyzed using a competing risk model. ResultsMean catheter dwell time was 27.75 days. The overall complication rate was 7.54% (2.72 per 1000 catheter days). Underlying malignant disease (hazard ratio: 0.351, 95% confidence interval [CI]: 0.133-0.929, P = .035) and chemotherapy administration (hazard ratio: 2.837, 95% CI: 1.088-7.394, P = .033) were significantly associated with the occurrence of any kind of complication. Catheter related blood stream infection was observed among 11 (2.68%) patients and again significantly associated with chemotherapy administration (hazard ratio: 4.545, 95% CI: 1.178-17.539; P = .028). Thrombosis was found in 7 (1.70%) patients and occlusion in 13 (3.16%) cases. Conclusions and implications for nursing practiceChoice of venous access is an interdisciplinary decision with emphasis on patient participation. In oncologic patients, our data suggests that the benefits of peripherally inserted central catheters regarding costs, invasiveness, and accessibility might be outweighed by the higher rate of complications associated with the device. This becomes even more important in a community care setting, where standardized handling procedures and patient education play a pivotal role in device safety.

Prevalence of small intestinal bacterial overgrowth in intestinal failure syndrome: A systematic review and meta-analysis.

Patients with intestinal failure (IF) have abnormal intestinal anatomy, secretion, and dysmotility, which impairs intestinal homeostatic mechanisms and may lead to small intestinal bacterial overgrowth (SIBO). We conducted a systematic review and meta-analysis to determine the prevalence of SIBO in patients with IF and to identify risk factors for SIBO. MEDLINE (PubMed) and Embase electronic databases were searched from inception to December 2023 for studies that reported the prevalence of SIBO in IF. The prevalence rates, odds ratio (OR), and 95% confidence intervals of SIBO in IF and the risk factors for SIBO in IF were calculated using random effects model. Final dataset included nine studies reporting on 407 patients with IF. The prevalence of SIBO in IF was 57.5% (95% CI 44.6-69.4), with substantial heterogeneity in this analysis (I2=80.9, P=0.0001). SIBO prevalence was sixfold higher in patients with IF who received parenteral nutrition (PN) compared with IF patients not on PN (OR=6.0, 95% CI 3.0-11.9, P=0.0001). Overall, the prevalence of SIBO in patients with IF using PPI/acid-suppressing agents (72.0%, 95% CI 57.5-83.8) was numerically higher compared with IF patients not using these agents (47.6%, 95% CI 25.7-70.2). This systematic review and meta-analysis suggests that there is an increased risk of SIBO in patients with IF and that PN, and potentially, the use of PPI/acid-suppressing agents is risk factors for SIBO development in patients with IF. However, the quality of evidence is low and can be attributed to lack of case-control studies and clinical heterogeneity seen in the studies.

Effects of parenteral nutrition + best supportive nutritional care vs. best supportive nutritional care alone on quality of life in patients with pancreatic cancer—a secondary analysis of PANUSCO

PurposeParenteral nutrition (PN) can be an effective treatment to improve the nutritional status of patients with pancreatic cancer, but the effects of PN on quality of life (QoL) are still understudied. Therefore, we aimed at investigating whether the best supportive nutritional care (BSNC) in combination with PN at home compared to BSNC alone changed QoL in patients with advanced pancreatic cancer undergoing chemotherapy over a period of 7 weeks.Methodsn = 12 patients in the PANUSCO study received nutritional counseling only (control group (CG)) and n = 9 patients were also given supportive PN (intervention group (IG)). The primary endpoint was the change of QoL (EORTC-QLQ-C30 and QLQ-PAN26) over 7 weeks between the groups.ResultsThere was a significant worsening in social functioning in IG (p = 0.031) and a significant difference between groups in change of social functioning (p = 0.020). In all other domains of QoL, there was no significant difference between groups. Within groups, there was a significant improvement in the domain weight loss in IG (p = 0.031), showing that patients were less worried about their weight being too low. Furthermore, there was a significant difference in the change of BW over time between groups (p < 0.001) with IG showing an increase (p = 0.004) and CG showing no change (p = 0.578).ConclusionThe administration of PN had in one of five domains negative consequences on QoL. The decision to administer PN should always be made individually and together with the patient, and the impact on QoL should be included in the decision to administer PN.

Nutritional aspects in patients with gastroparesis.

The purpose of this review was to highlight most recent updates on nutritional aspects in gastroparesis (GP) focusing on dietary recommendations, utilization of enteral and parenteral nutrition, endoscopic and surgical interventions. Recent data addressed eating patterns, nutritional interventions, and clarifications on the role of endoscopic and surgical interventions underlying an impact on nutritional management of GP patients. They support the importance of gastroparesis-specific diet in addition to drug therapy, and confirm the benefits of a modified low-fat, low-fiber diet. Current guidelines suggest a new approach to GP management based on predominant symptoms. Gastric peroral endoscopic pyloromyotomy (G-POEM) and surgical gastric electrical stimulator (GES) placement may be considered in individuals with nausea and vomiting before the need for jejunostomy tube placement for enteral feeding or parenteral nutrition. Current literature supports the importance of dietary interventions, focusing on low-fat and low-fiber diets, in addition to drug therapies. Severely fiber-restrictive diets may not be necessary. There is enhanced understanding when jejunal feeding should be incorporated for refractory cases with consideration of G-POEM or/and GES even before jejunal tube placement. This approach will require patient evaluation in specialized motility centers.

Epidemiology, Risk Factors, and Outcomes of Health Care-Associated Infections in the Neonatal Intensive Care Unit: 6-Year Surveillance at a University Hospital in Türkiye

Abstract Objective Health care-associated infections (HAIs) are important causes of morbidity and mortality in neonatal intensive care units (NICUs). This study aimed to evaluate the frequency of HAIs and related factors in the NICU. Methods HAIs detected and monitored by daily active surveillance by the Infection Control Team at Necmettin Erbakan University Faculty of Medicine NICU between January 1, 2017 and December 31, 2022 were evaluated retrospectively. There were a total of 43 incubators in our hospital's NICU (19 secondary level units and 24 tertiary level). Between 2017 and 2022, there was an average of 982 admissions to the NICU per year. Results A total of 5,895 newborns and 74,726 patient days were monitored in the study. The average HAIs rate for all study years was 3.4% and the incidence density was 2.68 per thousand patient days. The highest HAI rate was in newborns with birth weights &lt; 750 g. A total of 201 HAIs were detected in 172 patients. Bloodstream infection (BSI) was the most frequent HAI. The most frequent pathogens were Klebsiella spp. (44.8%), methicillin-resistant coagulase-negative staphylococci (CoNS) (24.4%), and Acinetobacter spp. (11.6%). Note that 88.5% of Enterobacterales were extended-spectrum beta-lactamase producers, and 26% of Klebsiella spp. were carbapenem-resistant. No colistin resistance was detected in Pseudomonas aeruginosa and Acinetobacter spp. Methicillin resistance was detected in 86.5% of CoNS and 50% of Staphylococcus aureus. The vancomycin resistance rate in Enterococcus spp. was 40%. Note that 16.7% of Candida spp. were fluconazole-resistant; no resistance to caspofungin was found. The most common risk factors for development of HAI were prematurity, umbilical catheter use, total parenteral nutrition, and mechanical ventilation. The mortality rate in patients with HAIs was 20.9%. Conclusion HAIs, including those caused by multidrug-resistant Gram-negative bacteria, are an important problem in our hospital, and also globally. Active surveillance should be continued, and changes over the years evaluated. Infection control programs should be executed by determining the risk and mortality factors attributed to infection and their implementation should be closely monitored. These practices will increase success in the fight against HAIs and antimicrobial resistance.

Intensive care unit-acquired weakness and mechanical ventilation: A reciprocal relationship

Intensive care unit-acquired weakness (ICU-AW; ICD-10 Code: G72.81) is a syndrome of generalized weakness described as clinically detectable weakness in critically ill patients with no other credible cause. The risk factors for ICU-AW include hyperglycemia, parenteral nutrition, vasoactive drugs, neuromuscular blocking agents, corticosteroids, sedatives, some antibiotics, immobilization, the disease severity, septicemia and systemic inflammatory response syndrome, multiorgan failure, prolonged mechanical ventilation (MV), high lactate levels, older age, female sex, and pre-existing systemic morbidities. There is a definite association between the duration of ICU stay and MV with ICU-AW. However, the interpretation that these are modifiable risk factors influencing ICU-AW, appears to be flawed, because the relationship between longer ICU stays and MV with ICU-AW is reciprocal and cannot yield clinically meaningful strategies for the prevention of ICU-AW. Prevention strategies must be based on other risk factors. Large multicentric randomized controlled trials as well as meta-analysis of such studies can be a more useful approach towards determining the influence of these risk factors on the occurrence of ICU-AW in different populations.