Search Results (666)

Background/Objectives: Refeeding syndrome (RFS) is challenging to prevent and manage in hospitalized patients receiving enteral nutrition (EN). Nebraska Medicine implemented an Electronic Medical Record (EMR) Refeeding Risk Order Set (RROS) to standardize prevention measures, including structured electrolyte monitoring, thiamine supplementation, and conservative EN initiation. This study evaluated whether RROS implementation reduced RFS occurrence or severity and assessed its operational impact. Methods: In this retrospective cohort study, adults receiving EN before and after RROS implementation were compared. Primary outcomes were RFS occurrence and severity; secondary outcomes included EN initiation and advancement rates, electrolyte trends, lab frequency, and electrolyte repletion. Results: RFS occurrence did not differ significantly between groups (92.3% vs. 91.3%, p = 0.694), nor did severity (p = 0.535). The post-RROS group received more electrolyte boluses on EN Day 0 (p = 0.027) and had a lower EN starting rate (15.7 vs. 18.3 mL/h, p = 0.045). Conclusions: Although the RROS did not reduce RFS occurrence or severity, integrating American Society for Parenteral and Enteral Nutrition (ASPEN)-based guidance into the EMR was highly feasible and adopted immediately. Automating electrolyte monitoring, micronutrient supplementation, and conservative feeding initiation reduces the risk of errors and promotes consistent care. These benefits improve workflow efficiency and support providers during high census periods, limited staffing, or when experience varies. Future research should explore combining EMR tools with predictive analytics to optimize early risk identification and individualized management. Full article

Background: Intestinal failure-associated liver disease (IFALD) is a serious complication in patients receiving parenteral nutrition, often exacerbated by inflammation, lipid overload, and oxidative stress. Nobiletin (NOB), a polymethoxylated flavone, is known for its anti-inflammatory and lipid-regulating properties. Methods: We employed an in vitro model using THLE-2 human hepatocytes and primary human cholangiocytes exposed to Intralipid (INT) and lipopolysaccharide (LPS) to simulate IFALD conditions. NOB was tested at non-toxic concentrations (10 and 25 µM) to assess its protective effects. MTT viability assays, multiplex bead-based immunoassays (MAGPIX), RT-qPCR, and Western blotting were used to evaluate changes in inflammation markers, gene expression, and protein signaling. Moreover, ALT and AST activities were used to assess hepatocellular injury. Results: NOB maintained high cell viability in THLE-2 hepatocytes and cholangiocytes, confirming its low cytotoxicity. NOB normalized ALT and AST activities in both tested cell lines, but the effect reached statistical significance only for ALT in cholangiocytes. Under IFALD-like conditions (LPS+INT), NOB significantly preserved metabolic activity in both cell types. In THLE-2 and cholangiocytes, NOB markedly reduced the phosphorylation of pro-inflammatory proteins JNK, NF-κB, and STAT3, indicating a broad inhibition of inflammatory signaling. Moreover, in THLE-2 cells, NOB upregulated lipid metabolism-related genes (PRKAA2, CYP7A1, and ABCA1) and decreased oxidative stress, thereby enhancing the nuclear translocation of Nrf2 and increasing SOD1 level, which supports the activation of antioxidant defenses. Conclusions: NOB exhibits hepatoprotective properties under IFALD-like conditions in vitro, likely through modulation of inflammation-related signaling and lipid metabolism pathways. Full article

Background and Clinical Significance: Superior mesenteric artery syndrome (SMAS) is a rare and often underdiagnosed cause of proximal intestinal obstruction, resulting from compression of the third portion of the duodenum between the SMA and the aorta. It typically occurs in individuals with significant weight loss due to mesenteric fat depletion. CasePresentation: We report the case of a 14.5-year-old female presented with a 6-day history of intractable vomiting and epigastric pain, on a background of intermittent vomiting over the preceding six months associated with a 7 kg unintentional weight loss, culminating in inability to tolerate oral intake. Her clinical course was complicated by a transient episode of blurred vision, numbness, and incoherent speech, initially suspected to be a neurological event. Extensive gastrointestinal and neurological investigations were inconclusive. Elevated fecal calprotectin levels raised suspicion for inflammatory bowel disease, given her family history, though endoscopy and histopathology were unremarkable. Advanced imaging ultimately demonstrated a markedly reduced aortomesenteric angle (6°) and distance (4 mm), confirming the diagnosis of SMAS. The patient was initially managed conservatively with total parenteral nutrition (TPN), achieving partial weight gain of 5 kg after 8 weeks of TPN. Due to persistent duodenal compression, surgical intervention was required. At 7-month follow-up, the patient remained symptom-free with restored nutritional status and a good weight gain. Conclusions: This case highlights the importance of considering SMAS in adolescents with chronic upper gastrointestinal symptoms and significant weight loss. Early recognition and appropriate imaging are essential to diagnosis, and timely surgical management can lead to excellent outcomes when conservative treatment is insufficient. Full article

Inflammatory Bowel disease (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC), are chronic gastrointestinal conditions that are prone to malnutrition due to poor oral intake, intestinal compromise of nutrient absorption, and increase in metabolic demand. Screening and diagnosing malnutrition in this population is necessary to treat and prevent worsening malnutrition. The use of Oral Nutritional Therapy (ONS) can provide the macronutrients that patients need to maintain their nutrition, however their role in within stages of diseases, active disease, remission, perioperative, and maintenance in relation to other nutritional therapies, such as enteral nutrition or parenteral nutrition, is unclear. This review will highlight the principles of diagnosing malnutrition, the evidence of ONS in disease and remission states, and the role of oral vitamins in the management of IBD. Full article

Purpose: Candida bloodstream infections remain a major global health challenge, with mortality rates approaching 40%. Beyond classical immunocompromised status, recent evidence highlights additional risk factors, including iatrogenic immunosuppression, advanced age, prolonged hospitalization, exposure to broad-spectrum antibiotics, and total parenteral nutrition. While Candida albicans (C. albicans) remains the most common species in Europe and the USA, non-albicans species, particularly Nakaseomyces glabratus (N. glabratus), Candida tropicalis (C. tropicalis), and Candida parapsilosis (C. parapsilosis), are emerging worldwide. Methods: This retrospective observational cohort study was conducted at the University Hospital “San Giovanni di Dio e Ruggi d’Aragona” in Salerno, Italy, from January 2015 to December 2024. It included all patients with at least one positive blood culture for Candida species. Demographic data, hospital ward of admission, and antifungal susceptibility profiles were collected and analyzed using SPSS software (IBM SPSS Statistics for Mac, version 30 (IBM Corp., Armonk, NY, USA)). Results: The incidence rate is 48.7 new isolates per one thousand patient-days, with a trend of increasing episodes over time among a total of 364 patients. Most cases occurred in medical wards (59.5%), where patients were older (median age 76 (17). C. albicans accounted for 57.9% of isolates, and a significant association was found between species distribution and hospital unit (p < 0.05). Resistance to fluconazole, voriconazole, and amphotericin B increased among C. albicans, with similar trends in N. glabratus and C. parapsilosis. Conclusions: This large single-center cohort highlights both the persistent dominance of C. albicans and the worrisome rise in resistance among C. parapsilosis. Given the aging patient population and increasing antifungal resistance, local epidemiological data are crucial to guide empirical therapy. Our findings underscore the need for multidisciplinary antifungal stewardship programs to optimize personalized treatment strategies and contain the emergence of resistant strains. Full article

Background and Objectives: Retinopathy of prematurity (ROP) remains a leading cause of preventable childhood blindness, with its severity influenced by a complex interaction between nutritional status, metabolic maturation, and systemic vulnerability. This study aimed to evaluate whether early nutritional patterns and serum metabolic parameters, including hepatic and renal biomarkers, are associated with ROP severity and whether they may serve as potential predictors of disease progression. Materials and Methods: We conducted a retrospective study on 140 preterm infants, totaling 280 eyes, admitted between 2021 and 2024 in two neonatal intensive care units (NICU). Each eye was analyzed independently according to International Classification of Retinopathy of Prematurity (ICROP) criteria. Data on the timing of enteral feeding, duration and type of nutrition, and serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), total protein, blood glucose, urea and creatinine were collected throughout the first 28 days of life. Statistical analysis included Kruskal–Wallis and Chi-square tests, with a significance threshold of p < 0.05. Results: ROP was identified in 53.57% of cases. Enteral feeding began earlier in infants without ROP, whereas delayed initiation and prolonged parenteral nutrition were associated with more advanced stages. Natural feeding decreased with increasing severity and was absent in aggressive retinopathy of prematurity (A-ROP). Severe disease stages showed higher AST, ALT, urea and creatinine levels, along with lower early total protein values. Glycemic instability was observed more frequently in stage 2 and stage 3. Conclusions: Early nutritional support, especially early enteral feeding and natural feeding, appears protective against ROP progression. Hepatic, renal and glycemic metabolic changes are closely correlated with disease severity, indicating that metabolic balance reflects overall vulnerability in preterm infants. Incorporating nutritional and metabolic assessment into routine screening may enhance early risk identification and optimize clinical monitoring. Full article

Background: The nutrition support of children with biliary atresia after liver transplant is affected by multiple factors, and a connection between these factors and conditions present before transplant can potentially make the nutrition support more challenging. We aim to assess the adequacy of nutrition support, specifically energy and protein, during the first week of admission to the Pediatric Intensive Care Unit (PICU) in children after liver transplant secondary to biliary atresia. Methods: We performed a retrospective cohort study of 138 patients [13.9 median (9–33.4) IQR months; 62% female] with a diagnosis of biliary atresia admitted to the PICU after liver transplantation at Texas Children’s Hospital over a 14-year study period. We obtained nutrition adequacy of enteral and parenteral nutrition support for the first week after transplant during their PICU admission. Results: Goal adequacy was reached at the end of the first week of admission when combined enteral and parenteral nutrition support was provided (median 98% for energy and 101% for protein). Infants achieved significantly higher adequacies than older children during the first week (136% < 1 year vs. 0% > 1 year, p < 0.001 for calories, and 157% < 1 year vs. 0% > 1 year for protein; p < 0.01). Conclusions: These findings highlight the complex nutritional challenges faced by this population, and strategies are needed to meet the unique needs of children after liver transplantation. Full article

Background: Artificial intelligence (AI) is increasingly used in intensive care units (ICUs) to enable personalized care, real-time analytics, and decision support. Nutritional therapy—a major determinant of ICU outcomes—often remains delayed or non-individualized. Objective: This study aimed to review current and emerging AI applications in ICU nutrition, highlighting clinical potential, implementation barriers, and ethical considerations. Methods: A narrative review of English-language literature (January 2018–November 2025) searched in PubMed/MEDLINE, Scopus, and Web of Science, complemented by a pragmatic Google Scholar sweep and backward/forward citation tracking, was conducted. We focused on machine learning (ML), deep learning (DL), natural language processing (NLP), and reinforcement learning (RL) applications for energy/protein estimation, feeding tolerance prediction, complication prevention, and adaptive decision support in critical-care nutrition. Results: AI models can estimate energy/protein needs, optimize EN/PN initiation and composition, predict gastrointestinal (GI) intolerance and metabolic complications, and adapt therapy in real time. Reinforcement learning (RL) and multi-omics integration enable precision nutrition by leveraging longitudinal physiology and biomarker trajectories. Key barriers are data quality/standardization, interoperability, model interpretability, staff training, and governance (privacy, fairness, accountability). Conclusions: With high-quality data, robust oversight, and clinician education, AI can complement human expertise to deliver safer, more targeted ICU nutrition. Implementation should prioritize transparency, equity, and workflow integration. Full article

Fisetin (3,3′,4′,7-tetrahydroxyflavone) is a naturally occurring flavonol in fruits and vegetables. It exhibits diverse biological activities, including anti-inflammatory, antioxidant, senolytic, and lipid-lowering properties. This review explores the molecular mechanisms underlying fisetin’s hepatoprotective effects and evaluates its potential application in Intestinal Failure-Associated Liver Disease (IFALD), a severe complication associated with total parenteral nutrition (TPN). IFALD is characterized by inflammation, cholestasis, steatosis, oxidative stress, and dysregulated lipid and bile acid metabolism. Fisetin modulates several key signaling pathways, including NF-κB, Nrf2, AMPK, and SIRT1, leading to reduced inflammatory cytokine expression, enhanced antioxidant defenses, and improved lipid homeostasis. Fisetin shows potential anti-fibrotic and microbiota-modulating effects. More importantly, fisetin is recognized as a potent senolytic agent, selectively activating pro-apoptotic pathways in senescent cells, which are known sources of inflammation and tissue damage. However, despite its promising pharmacological profile, the poor bioavailability of fisetin remains a significant limitation, particularly for parenteral use. Emerging drug delivery systems such as liposomes and nanoparticles offer potential solutions. Given its broad spectrum of beneficial effects and favorable safety profile, fisetin represents a compelling candidate for future studies in the prevention and management of IFALD. Full article

Background/Objectives: Cefoperazone–sulbactam is frequently prescribed to older inpatients for severe infections but has been associated with coagulation abnormalities, particularly among individuals with malnutrition or hepatic dysfunction. Early identification of at-risk patients remains challenging. To develop and validate a clinically interpretable model for predicting cefoperazone–sulbactam-related coagulation abnormalities in elderly inpatients and to provide practical tools for bedside risk estimation. Methods: We conducted a retrospective, dual-center study of 485 patients aged ≥ 60 years treated at Fuxing Hospital and Xuanwu Hospital of Capital Medical University who received cefoperazone–sulbactam for ≥72 h. Baseline clinical and demographic variables were analyzed using univariate and multivariable logistic regression to identify independent risk factors. Ten supervised machine-learning models were trained and evaluated using area under the ROC curve (AUC), accuracy, sensitivity, specificity, precision, and F1-score. SHapley Additive exPlanations (SHAP) were applied to assess model interpretability. A nomogram was constructed from the final logistic regression model, and a web-based calculator was developed for clinical use. Results: Multivariable analysis identified age ≥ 75 years, hypoproteinemia, total parenteral nutrition, insomnia, and recent oral antibiotic use as independent predictors of coagulation abnormalities. Among machine-learning models, LightGBM achieved the best overall performance by AUC and balanced classification metrics. SHAP analyses provided individualized and global explanations of feature contributions, facilitating clinical interpretation. The nomogram and web calculator enable rapid, patient-specific risk estimation. Conclusions: An interpretable machine-learning approach, complemented by a nomogram and web calculator, accurately stratifies the risk of cefoperazone–sulbactam-induced coagulation abnormalities in elderly inpatients. These tools may support personalized risk evaluation and earlier preventive interventions in routine care. The web-based calculator facilitates rapid bedside risk estimation and may help guide earlier monitoring and preventive interventions in routine care. Full article

Background/Objectives: Although morbidity and mortality are more pronounced in extremely and very preterm infants, there is also considerable morbidity in preterm infants of more advanced gestations. Delivery via cesarean section is associated with a higher risk of perinatal complications even when performed electively. Our aim was to examine the possible contribution of prenatal and perinatal factors to the risk for respiratory morbidity in a population of late-preterm and early-term infants delivered with a high rate of elective cesarean section. Methods: In a retrospective cohort study, all late-preterm and early-term infants (34 to 38 completed weeks of gestation) that were admitted with respiratory distress to the Neonatal Intensive Care Unit of the University Hospital of Patras over a recent period of two years were included in the study. Results: In the study period, 489 infants of all gestations were admitted to the neonatal unit, of whom 221 were born between 34 and 38 + 6 gestational weeks. Ventilated infants had a significantly lower incidence of antenatal corticosteroids (41%) compared to non-ventilated infants (51%, p = 0.036) and a higher duration of parenteral nutrition [4 (1–6) days] compared to non-ventilated infants [2 (1–3) days, p < 0.001]. The incidence of late-onset sepsis was higher in the ventilated infants (26%) compared to the non-ventilated ones (8%, p < 0.001). Conclusions: Late preterm and early term infants who were invasively ventilated had less often received antenatal corticosteroids and had a higher incidence of late-onset sepsis compared to those who were not ventilated. Full article

The central venous catheter (CVC) is essential in the management of pediatric patients, allowing the administration of medications, parenteral nutrition, and other treatments. However, its use carries a high risk of central-line-associated bloodstream infections (CLABSI) and catheter-related bloodstream infections (CRBSI). Advanced chlorhexidine-impregnated dressings have been developed to reduce bacterial colonization, but their effectiveness in the pediatric population remains uncertain. The aim of this review is to evaluate the effectiveness of chlorhexidine-impregnated dressings compared to standard dressings in reducing CLABSI, CRBSI, and CVC colonization in pediatric patients. Randomized clinical trials published between 2005 and 2021 in PubMed, CINAHL, and Embase, in Italian or English, were selected. Methodological quality was assessed using the Joanna Briggs Institute (JBI) checklist. Relevant data were extracted and summarized in tables. Four studies, including a total of 733 pediatric patients (367 intervention, 366 control), were included. None reported a statistically significant reduction in CLABSI/CRBSI with the use of chlorhexidine-impregnated dressings. However, two studies showed a significant reduction in catheter colonization in the intervention group. Current evidence does not support a superior effect of chlorhexidine-impregnated dressings in preventing CLABSI/CRBSI in pediatric patients, although they may reduce catheter colonization. Randomized trials with larger samples and specific methodologies are needed to clarify the true clinical impact. Full article

Background: Nutritional support in patients receiving extracorporeal membrane oxygenation (ECMO) is a clinical challenge. Hemodynamic instability and concerns about gut perfusion delay enteral nutrition (EN), resulting in frequent use of total parenteral nutrition (TPN). This study aimed to compare nutritional practices in patients on venoarterial (VA) vs. venovenous (VV) ECMO, and to evaluate the associations between prolonged TPN use, feeding status, circuit change frequency, length of stay, and survival. Methods: Retrospective cohort study of ECMO patients in a quaternary pediatric intensive care unit. Nutritional variables included route and amount of nutrition delivery. The primary outcome was the nutrition type (enteral vs. parenteral) in association with ECMO mode (VV vs. VA). Secondary outcomes included associations between nutrition variables (TPN by Day 14, lack of EN by Day 5 or 7) and circuit changes, ECMO duration, ICU/hospital length of stay (LOS), and mortality. Analyses by Mann–Whitney and chi-square tests. Multivariable Poisson regression was used to identify independent predictors of circuit change frequency. Results: Patients on VV ECMO achieved higher enteral intake than those on VA ECMO. Persistent need for TPN by Day 14 was associated with longer PICU LOS, hospital LOS, and ECMO duration and was independently associated with 71% higher circuit change frequency. Survival did not differ significantly by TPN duration or early EN exposure. Conclusions: VV ECMO patients received higher enteral nutrition. Persistent need for TPN by day 14 was associated with worse outcomes. These findings underscore the need for standardized, evidence-based feeding strategies in this population. Full article

Background and Objectives: Catheter-related bloodstream infections (CRBSIs) are one of the most severe complications in children with intestinal failure (IF) who require long-term parenteral nutrition (PN). Taurolidine–citrate solution (TCS), with proven antimicrobial and antibiofilm properties, has been proposed as a promising alternative to heparin locks for preventing infection. The aim is to evaluate the efficacy and safety of the TCS in reducing the rates of CRBSI and pathogen-specific infections in pediatric patients with indwelling central venous catheters (CVCs) who are receiving PN. Materials and Methods: This retrospective study included 48 pediatric IF patients treated at an intestinal rehabilitation and transplantation center in Türkiye. Patients received either TCS or heparinized saline (0.9% saline solution containing 100 IU of heparin) as a catheter lock. Infection data were extracted from medical records and expressed as events per 1000 catheter days. Group comparisons were performed using non-parametric tests, and Poisson regression was applied to calculate rate ratios (RRs) and 95% confidence intervals (CIs). Adjusted rate ratios were obtained from a Poisson regression model that included the following variables: age, sex, diagnosis category, ostomy status, catheter type, and follow-up duration. Log(catheter-days) was incorporated as an offset term. Overdispersion was assessed and not detected. Results: The crude CRBSI rate was lower in the TCS group than in the heparinized saline group (29.4 vs. 42.8 per 1000 catheter days), though this difference was not statistically significant (p = 0.383). However, after adjustment by Poisson regression, TCS use was significantly associated with reduced infection rates (adjusted RR = 0.78, 95% CI = 0.70–0.87, p < 0.001). TCS use was also significantly associated with reduced rates of Gram-positive (RR = 0.78, p = 0.006), Gram-negative (RR = 0.48, p < 0.001) and fungal (RR = 0.63, p < 0.001) infections. No adverse events were observed among the TCS group. Conclusions: Standardized TCS lock therapy effectively and safely reduces CRBSIs in pediatric patients with IF, particularly those caused by Gram-negative and fungal organisms. These results support the use of TCS as a prophylactic option for preventing infection in long-term CVC use. Full article

Background: Candidozyma auris has emerged globally as a multidrug-resistant pathogen with high rates of colonization and potential for invasive infection. Understanding the progression from colonization to infection and associated outcomes is limited. This study aimed to describe the characteristics and outcomes of C. auris-colonized patients and identify risk factors for progression to infection. Methods: We conducted a single-center retrospective case–control study of hospitalized patients with documented C. auris colonization at a tertiary care center (2018–2024). Cases were patients who progressed to a fungal infection (infection group), while controls remained colonized (colonized group). Demographics, comorbidities, device use, prior antimicrobial exposure, microbiologic characteristics, and outcomes were compared. Results: Among 334 C. auris-colonized patients, 44 (13.2%) progressed to infection. The median age was 66.4 years. Those in the infection group had higher Charlson Comorbidity Index (5.9 ± 3.1 vs. 4.79 ± 2.7, p = 0.0112) and were more likely to have central line (90.9% vs. 71.7%, p = 0.0067), mechanical ventilation (77.3% vs. 60.34%, p = 0.0306), parenteral nutrition (6.82% vs. 1.72%, p = 0.0395), and abdominal surgery (13.64% vs. 4.83%, p = 0.0217). In multivariate analysis, abdominal surgery was the only independent predictor of infection (OR 4.08; 95% CI 1.1–15.1; p = 0.03). In-hospital mortality was significantly higher in the infection group (65.9% vs. 33.1%, p < 0.0001). Conclusions: Approximately one in eight colonized patients developed C. auris infection. Recent abdominal surgery independently predicted progression, while infection was associated with higher mortality and prolonged hospitalization, underscoring the need for targeted prevention in high-risk patients. Full article