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Special Issue "Parenteral Nutrition"

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A special issue of Nutrients (ISSN 2072-6643).

Deadline for manuscript submissions: closed (30 November 2012)

Special Issue Editors

Guest Editor
Prof. Dr. Karen Simmer (Website)

Centre for Neonatal Research and Education, School of Paediatrics and Child health, M550, University of Western Australia, 35 Stirling highway, Perth, 6009, Australia
Fax: +9340 1266
Interests: infant nutrition; preterm infants; human milk and lactation; longchain polyunsaturated fatty acids
Guest Editor
Prof. Dr. Olivier Goulet (Website)

Pediatric Gastroenterology and Nutrition, Hôpital Necker - Enfants Malades, 149 rue de Sèvres, 75743 Paris cedex 15, France
Phone: 003306060403180
Fax: +1 44 49 25 01
Interests: tolerance and efficacy of intravenous fat emulsions; management of intestinal failure; cohort follow up of patients with intestinal failure on home parenteral nutrition; Probiotics for clinical use in pediatrics
Guest Editor
Dr. Joanne Savage

Department of Justice, Law and Society, American University, 4400 Massachusetts Avenue, NW, Washington, DC 20016-8043, USA
Interests: criminology; violent crime; causes of crime; parenting and the development of violence; media violence; persistent, chronic offending; socioeconomic factors and crime; long-term violent crime trends in Washington, D.C.

Keywords

  • parenteral nutrition
  • paediatrics
  • neonatology
  • nitrogen
  • protein
  • lipid emulsions
  • calcium
  • phosphorus
  • intestinal failure-related liver disease
  • PN-related bone disease
  • catheter-related sepsis

Published Papers (9 papers)

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Displaying articles 1-9
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Research

Jump to: Review

Open AccessArticle Developing and Implementing All-in-One Standard Paediatric Parenteral Nutrition
Nutrients 2013, 5(6), 2006-2018; doi:10.3390/nu5062006
Received: 10 January 2013 / Revised: 7 February 2013 / Accepted: 6 May 2013 / Published: 5 June 2013
Cited by 2 | PDF Full-text (317 KB) | HTML Full-text | XML Full-text
Abstract
Parenteral nutrition (PN) is a feeding mode suitable for children that do not achieve requirements via the enteral route. For this intervention to be successful, healthcare professionals require: knowledge on nutrient requirements; access to an aseptic compounding facility; and a system that [...] Read more.
Parenteral nutrition (PN) is a feeding mode suitable for children that do not achieve requirements via the enteral route. For this intervention to be successful, healthcare professionals require: knowledge on nutrient requirements; access to an aseptic compounding facility; and a system that ensures adequate and safe delivery of PN. Previously, it was thought that individualised PN was the “gold standard” for delivering nutrients to children; however, studies have highlighted concerns regarding inadequate delivery of nutrients, prescribing and compounding errors. We, therefore, set out to develop and implement all-in-one (AIO) paediatric PN solutions. Through a systematic approach, four AIO PN solutions were developed: birth–two months of age (Ped 1); two months–10 kg (Ped 2); 11–15 kg (Ped 3); and 16–30 kg (Ped 4). We implemented them with the help of a teaching pack, over a one month time period, and reviewed usage at six months. At that time, five children initially received standard PN without electrolyte changes; but after a few days, electrolytes needed amendments, and three required individualised PN. A change to AIO PN is feasible and safe; however, some may require electrolyte changes, and there will always be those that will require individualised PN. Full article
(This article belongs to the Special Issue Parenteral Nutrition)
Open AccessArticle Aluminum Exposure in Neonatal Patients Using the Least Contaminated Parenteral Nutrition Solution Products
Nutrients 2012, 4(11), 1566-1574; doi:10.3390/nu4111566
Received: 17 September 2012 / Revised: 16 October 2012 / Accepted: 23 October 2012 / Published: 2 November 2012
Cited by 5 | PDF Full-text (432 KB) | HTML Full-text | XML Full-text
Abstract
Aluminum (Al) is a contaminant in all parenteral nutrition (PN) solution component products. Manufacturers currently label these products with the maximum Al content at the time of expiry. We recently published data to establish the actual measured concentration of Al in PN [...] Read more.
Aluminum (Al) is a contaminant in all parenteral nutrition (PN) solution component products. Manufacturers currently label these products with the maximum Al content at the time of expiry. We recently published data to establish the actual measured concentration of Al in PN solution products prior to being compounded in the clinical setting [1]. The investigation assessed quantitative Al content of all available products used in the formulation of PN solutions. The objective of this study was to assess the Al exposure in neonatal patients using the least contaminated PN solutions and determine if it is possible to meet the FDA “safe limit” of less than 5 μg/kg/day of Al. The measured concentrations from our previous study were analyzed and the least contaminated products were identified. These concentrations were entered into our PN software and the least possible Al exposure was determined. A significant decrease (41%–44%) in the Al exposure in neonatal patients can be achieved using the least contaminated products, but the FDA “safe limit” of less than 5 μg/kg/day of Al was not met. However, minimizing the Al exposure may decrease the likelihood of developing Al toxicity from PN. Full article
(This article belongs to the Special Issue Parenteral Nutrition)
Open AccessArticle Preresection Obesity Increases the Risk of Hepatobiliary Complications in Short Bowel Syndrome
Nutrients 2012, 4(10), 1358-1366; doi:10.3390/nu4101358
Received: 28 June 2012 / Revised: 11 September 2012 / Accepted: 18 September 2012 / Published: 26 September 2012
Cited by 3 | PDF Full-text (363 KB) | HTML Full-text | XML Full-text
Abstract
Patients developing the short bowel syndrome (SBS) are at risk for hepatobiliary disease, as are morbidly obese individuals. We hypothesized that morbidly obese SBS individuals would be at increased risk for developing hepatobiliary complications. We reviewed 79 patients with SBS, 53 patients with initial body mass index (BMI) < 35 were controls. Twenty-six patients with initial BMI > 35 were the obese group. Obese patients were more likely to be weaned off parenteral nutrition (PN) (58% vs. 21%). Pre-resection BMI was significantly lower in controls (26 vs. 41). BMI at 1, 2, and 5 years was decreased in controls but persistently increased in obese patients. Obese patients were more likely to undergo cholecystectomy prior to SBS (42% vs. 32%) and after SBS (80% vs. 39%, p < 0.05). Fatty liver was more frequent in the obese group prior to SBS (23% vs. 0%, p < 0.05) but was similar to controls after SBS (23% vs. 15%). Fibrosis (8% vs. 13%) and cirrhosis/portal hypertension (19% vs. 21%) were similar in obese and control groups. Overall, end stage liver disease (ESLD) was similar in obese and control groups (19% vs. 11%) but was significantly higher in obese patients receiving PN (45% vs. 14%, p < 0.05). Obese patients developing SBS are at increased risk of developing hepatobiliary complications. ESLD was similar in the two groups overall but occurs more frequently in obese patients maintained on chronic PN. Full article
(This article belongs to the Special Issue Parenteral Nutrition)
Open AccessArticle Low Zinc Status and Absorption Exist in Infants with Jejunostomies or Ileostomies Which Persists after Intestinal Repair
Nutrients 2012, 4(9), 1273-1281; doi:10.3390/nu4091273
Received: 11 July 2012 / Revised: 7 August 2012 / Accepted: 5 September 2012 / Published: 12 September 2012
Cited by 2 | PDF Full-text (321 KB) | HTML Full-text | XML Full-text
Abstract
There is very little data regarding trace mineral nutrition in infants with small intestinal ostomies. Here we evaluated 14 infants with jejunal or ileal ostomies to measure their zinc absorption and retention and biochemical zinc and copper status. Zinc absorption was measured [...] Read more.
There is very little data regarding trace mineral nutrition in infants with small intestinal ostomies. Here we evaluated 14 infants with jejunal or ileal ostomies to measure their zinc absorption and retention and biochemical zinc and copper status. Zinc absorption was measured using a dual-tracer stable isotope technique at two different time points when possible. The first study was conducted when the subject was receiving maximal tolerated feeds enterally while the ostomy remained in place. A second study was performed as soon as feasible after full feeds were achieved after intestinal repair. We found biochemical evidence of deficiencies of both zinc and copper in infants with small intestinal ostomies at both time points. Fractional zinc absorption with an ostomy in place was 10.9% ± 5.3%. After reanastamosis, fractional zinc absorption was 9.4% ± 5.7%. Net zinc balance was negative prior to reanastamosis. In conclusion, our data demonstrate that infants with a jejunostomy or ileostomy are at high risk for zinc and copper deficiency before and after intestinal reanastamosis. Additional supplementation, especially of zinc, should be considered during this time period. Full article
(This article belongs to the Special Issue Parenteral Nutrition)

Review

Jump to: Research

Open AccessReview The Need for Evidence Based Nutritional Guidelines for Pediatric Acute Lymphoblastic Leukemia Patients: Acute and Long-Term Following Treatment
Nutrients 2013, 5(11), 4333-4346; doi:10.3390/nu5114333
Received: 24 July 2013 / Revised: 16 September 2013 / Accepted: 18 October 2013 / Published: 31 October 2013
Cited by 5 | PDF Full-text (250 KB) | HTML Full-text | XML Full-text
Abstract
High survival rates for pediatric leukemia are very promising. With regard to treatment, children tend to be able to withstand a more aggressive treatment protocol than adults. The differences in both treatment modalities and outcomes between children and adults make extrapolation of [...] Read more.
High survival rates for pediatric leukemia are very promising. With regard to treatment, children tend to be able to withstand a more aggressive treatment protocol than adults. The differences in both treatment modalities and outcomes between children and adults make extrapolation of adult studies to children inappropriate. The higher success is associated with a significant number of children experiencing nutrition-related adverse effects both in the short and long term after treatment. Specific treatment protocols have been shown to deplete nutrient levels, in particular antioxidants. The optimal nutrition prescription during, after and long-term following cancer treatment is unknown. This review article will provide an overview of the known physiologic processes of pediatric leukemia and how they contribute to the complexity of performing nutritional assessment in this population. It will also discuss known nutrition-related consequences, both short and long term in pediatric leukemia patients. Since specific antioxidants have been shown to be depleted as a consequence of therapy, the role of oxidative stress in the pediatric leukemia population will also be explored. More pediatric studies are needed to develop evidence based therapeutic interventions for nutritional complications of leukemia and its treatment. Full article
(This article belongs to the Special Issue Parenteral Nutrition)
Open AccessReview Standardised Parenteral Nutrition
Nutrients 2013, 5(4), 1058-1070; doi:10.3390/nu5041058
Received: 4 February 2013 / Revised: 18 March 2013 / Accepted: 19 March 2013 / Published: 28 March 2013
Cited by 4 | PDF Full-text (382 KB) | HTML Full-text | XML Full-text
Abstract
Parenteral nutrition (PN) has become an integral part of clinical management of very low birth weight premature neonates. Traditionally different components of PN are prescribed individually considering requirements of an individual neonate (IPN). More recently, standardised PN formulations (SPN) for preterm neonates [...] Read more.
Parenteral nutrition (PN) has become an integral part of clinical management of very low birth weight premature neonates. Traditionally different components of PN are prescribed individually considering requirements of an individual neonate (IPN). More recently, standardised PN formulations (SPN) for preterm neonates have been assessed and may have advantages including better provision of nutrients, less prescription and administration errors, decreased risk of infection, and cost savings. The recent introduction of triple-chamber bag that provides total nutrient admixture for neonates may have additional advantage of decreased risk of contamination and ease of administration. Full article
(This article belongs to the Special Issue Parenteral Nutrition)
Open AccessReview Parenteral Nutrition Additive Shortages: The Short-Term, Long-Term and Potential Epigenetic Implications in Premature and Hospitalized Infants
Nutrients 2012, 4(12), 1977-1988; doi:10.3390/nu4121977
Received: 12 October 2012 / Revised: 29 November 2012 / Accepted: 30 November 2012 / Published: 7 December 2012
Cited by 11 | PDF Full-text (349 KB) | HTML Full-text | XML Full-text
Abstract
Nutrition support practitioners are currently dealing with shortages of parenteral nutrition micronutrients, including multivitamins (MVI), selenium and zinc. A recent survey from the American Society of Enteral and Parenteral Nutrition (ASPEN) indicates that this shortage is having a profound effect on clinical [...] Read more.
Nutrition support practitioners are currently dealing with shortages of parenteral nutrition micronutrients, including multivitamins (MVI), selenium and zinc. A recent survey from the American Society of Enteral and Parenteral Nutrition (ASPEN) indicates that this shortage is having a profound effect on clinical practice. A majority of respondents reported taking some aggressive measures to ration existing supplies. Most premature infants and many infants with congenital anomalies are dependent on parenteral nutrition for the first weeks of life to meet nutritional needs. Because of fragile health and poor reserves, they are uniquely susceptible to this problem. It should be understood that shortages and rationing have been associated with adverse outcomes, such as lactic acidosis and Wernicke encephalopathy from thiamine deficiency or pulmonary and skeletal development concerns related to inadequate stores of Vitamin A and D. In this review, we will discuss the current parenteral shortages and the possible impact on a population of very low birth weight infants. This review will also present a case study of a neonate who was impacted by these current shortages. Full article
(This article belongs to the Special Issue Parenteral Nutrition)
Open AccessReview The Use of Fish Oil Lipid Emulsion in the Treatment of Intestinal Failure Associated Liver Disease (IFALD)
Nutrients 2012, 4(12), 1828-1850; doi:10.3390/nu4121828
Received: 30 October 2012 / Revised: 11 November 2012 / Accepted: 19 November 2012 / Published: 27 November 2012
Cited by 4 | PDF Full-text (953 KB) | HTML Full-text | XML Full-text
Abstract
Since 2004, fish oil based lipid emulsions have been used in the treatment of intestinal failure associated liver disease, with a noticeable impact on decreasing the incidence of morbidity and mortality of this often fatal condition. With this new therapy, however, different [...] Read more.
Since 2004, fish oil based lipid emulsions have been used in the treatment of intestinal failure associated liver disease, with a noticeable impact on decreasing the incidence of morbidity and mortality of this often fatal condition. With this new therapy, however, different approaches have emerged as well as concerns about potential risks with using fish oil as a monotherapy. This review will discuss the experience to date with this lipid emulsion along with the rational for its use, controversies and concerns. Full article
(This article belongs to the Special Issue Parenteral Nutrition)
Open AccessReview Risk of Parenteral Nutrition in Neonates—An Overview
Nutrients 2012, 4(10), 1490-1503; doi:10.3390/nu4101490
Received: 15 July 2012 / Revised: 29 August 2012 / Accepted: 25 September 2012 / Published: 16 October 2012
Cited by 7 | PDF Full-text (361 KB) | HTML Full-text | XML Full-text
Abstract
Healthcare-associated infections (HAI) in preterm infants are a challenge to the care of these fragile patients. HAI-incidence rates range from 6 to 27 infections per 1000 patient-days. Most nosocomial infections are bloodstream infections and of these, the majority is associated with the [...] Read more.
Healthcare-associated infections (HAI) in preterm infants are a challenge to the care of these fragile patients. HAI-incidence rates range from 6 to 27 infections per 1000 patient-days. Most nosocomial infections are bloodstream infections and of these, the majority is associated with the use of central venous catheters. Many studies identified parenteral nutrition as an independent risk factor for HAI, catheter-associated bloodstream infection, and clinical sepsis. This fact and various published outbreaks due to contaminated parenteral nutrition preparations highlight the importance of appropriate standards in the preparation and handling of intravenous solutions and parenteral nutrition. Ready-to-use parenteral nutrition formulations may provide additional safety in this context. However, there is concern that such formulations may result in overfeeding and necrotizing enterocolitis. Given the risk for catheter-associated infection, handling with parenteral nutrition should be minimized and the duration shortened. Further research is required about this topic. Full article
(This article belongs to the Special Issue Parenteral Nutrition)

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