-
Clinical Nutrition (Edinburgh, Scotland) Dec 2023Parenteral nutrition (PN) can lead to high or even toxic exposure to aluminum (Al). We aimed to quantify concentrations of Al and other chemical elements of all-in-one...
BACKGROUND & AIMS
Parenteral nutrition (PN) can lead to high or even toxic exposure to aluminum (Al). We aimed to quantify concentrations of Al and other chemical elements of all-in-one (AIO) PN admixtures for adults prepared from commercial multichamber bags (Olimel® 5.7%, Omegaflex® special, SmofKabiven®, all with and without electrolytes) and vitamin and trace element additives over a 48-h period. Secondly, we determined the level of Al contamination resulting from admixing and infusion set use.
METHODS
We used dynamic reaction cell and kinetic energy discrimination inductively coupled plasma mass spectrometry (ICP-MS) to quantify Al, arsenic (As), cadmium (Cd), cobalt (Co), chromium (Cr), copper (Cu), iron (Fe), magnesium (Mg), manganese (Mn), molybdenum (Mo), nickel (Ni), antimony (Sb), selenium (Se), tin (Sn), vanadium (V), and zinc (Zn) in AIO PN admixtures. We extracted samples for analysis via the bag injection ports and infusion sets over a 48-h period after admixing. We compared the measured Al concentrations of AIO PN admixtures with calculated values based on the measured concentrations of individual chamber contents and additives.
RESULTS
Mean (standard deviation) baseline Al concentrations in AIO PN admixtures ranged from 10.5 (0.5) to 59.3 (11.4) μg/L and decreased slightly over the 48 h (estimate [standard error] -0.09 [0.02] μg/L/hour, p <0.001). Thus, certain products exceeded the widely accepted limit of 25 μg/L. There was no significant difference in Al concentrations between samples extracted via the bag injection ports or infusion sets (p = 0.33), nor between measured and calculated Al concentrations of AIO PN admixtures (p = 0.91).
CONCLUSION
Because certain commercially available PN admixtures for adults proved to contain excessively high levels of Al in our study, regulations and corresponding quality requirements at the authority level (e.g., Pharmacopoeia and regulatory authorities) are urgently required. Our results showed that the PN handling process (admixing and supplementing additives) or the materials of the infusion set did not lead to additional Al contamination to any extent. Moreover, calculated Al concentrations of AIO PN admixtures derived from individual chamber contents and additives are valid.
Topics: Adult; Humans; Aluminum; Trace Elements; Manganese; Copper; Parenteral Nutrition
PubMed: 38411019
DOI: 10.1016/j.clnu.2023.10.012 -
Seminars in Perinatology Oct 2023Premature births account for over 10% of live births worldwide. Bronchopulmonary dysplasia (BPD) represents a severe sequela in neonates born very prematurely and...
Premature births account for over 10% of live births worldwide. Bronchopulmonary dysplasia (BPD) represents a severe sequela in neonates born very prematurely and remains the most common chronic neonatal lung disease, often leading to serious adverse consequences in adulthood. Nutrition plays a crucial role in lung development and repair. Ongoing research has primarily focused on the pathogenesis and prevention of BPD in preterm birth. However, infants with established BPD need specialist medical care that persists throughout their hospitalization and continues after discharge. This manuscript aims to highlight the impact of growth and nutrition on BPD and highlight research gaps to provide direction for future studies. Protective practices include ensuring adequate early energy delivery through parenteral nutrition and enteral feedings while carefully monitoring total fluid intake and the use of breast milk over formula. These nutritional strategies remain the same for infants with established BPD with the addition of limiting the use of diuretics and steroids; but if employed, monitoring carefully without compromising total energy delivery. Functional nutrient supplements with a potential protective role against BPD are revisited, despite the limited evidence of their efficacy, including vitamins, trace elements, zinc, lipids, and sphingolipids. Planning post-intensive care and outpatient longitudinal nutrition support is critical in caring for an infant with established BPD.
Topics: Female; Humans; Infant; Infant, Newborn; Bronchopulmonary Dysplasia; Enteral Nutrition; Milk, Human; Nutritional Status; Premature Birth
PubMed: 37775366
DOI: 10.1016/j.semperi.2023.151818 -
Nutrition (Burbank, Los Angeles County,... Jul 2024Medical nutrition therapy is one of the core components of patient management, although its implication is still limited in Daily practice globally. Clinicians are in...
OBJECTIVES
Medical nutrition therapy is one of the core components of patient management, although its implication is still limited in Daily practice globally. Clinicians are in need of guidance that will ease the application of medical nutrition therapy. The pre- and post-graduate curriculum for medical nutrition therapy is limited in most regions, worldwide. A report that is short, clear, and having clear-cut recommendations that will guide the primary healthcare professionals in indications, choice, practical application, follow-up, and stopping parenteral nutrition (PN) would facilitate the application and success of medical nutrition therapy. KEPAN is the Clinical Enteral and Parenteral Nutrition Society of Turkey and is an active member of the European Society for Clinical Nutrition and Metabolism (ESPEN).
METHOD
In this study, we present the KEPAN PN consensus report on optimal PN use in medical nutrition therapy as outlined by the works of academicians experienced in the clinical application of PN (nine working group academicians and 10 expert group academicians).
RESULTS
This report provides 22 clear-cut recommendations in a question-answer format.
CONCLUSIONS
We believe that this report could have a significant impact on the optimum use of PN in the context of medical nutrition therapy when clinicians manage everyday patients.
Topics: Humans; Parenteral Nutrition; Consensus; Turkey
PubMed: 38593671
DOI: 10.1016/j.nut.2024.112424 -
The Medical Journal of Malaysia Jul 2023Malnutrition is one of the most frequent effects of an enterocutaneous fistula (ECF). There are some factors that contribute to it including inadequate intake, fluid... (Review)
Review
Malnutrition is one of the most frequent effects of an enterocutaneous fistula (ECF). There are some factors that contribute to it including inadequate intake, fluid loss via fistula and underlying disease. The role of nutrition is very important as a part of ECF therapy to give adequate nutrition, maintain fluid and electrolyte state and increase the likelihood of fistula closure spontaneously. Therefore, it is anticipated that adequate nutrition management will lower morbidity and mortality while enhancing clinical results. Nutritional requirements and nutritional route, whether oral, enteral and parenteral nutrition in ECF management, are influenced by the anatomical, physiological and aetiology of the fistula. The purpose of this review was to highlight the evidence based on nutritional therapy in ECF patients by calling attention to nutritional route selection based on the anatomy and physiology fistula to prevent malnutrition.
Topics: Humans; Enteral Nutrition; Parenteral Nutrition; Intestinal Fistula; Malnutrition; Intestine, Small
PubMed: 37518930
DOI: No ID Found -
Journal of Clinical Medicine Nov 2023Hyperammonemia syndrome is a complication that has been reported to occur in 1-4% of lung transplant patients with mortality rates as high as 60-80%, making detection... (Review)
Review
Hyperammonemia syndrome is a complication that has been reported to occur in 1-4% of lung transplant patients with mortality rates as high as 60-80%, making detection and management crucial components of post-transplant care. Patients are treated with a multimodal strategy that may include renal replacement therapy, bowel decontamination, supplementation of urea cycle intermediates, nitrogen scavengers, antibiotics against , protein restriction, and restriction of parenteral nutrition. In this review we provide a framework of pharmacologic mechanisms, medication doses, adverse effects, and available evidence for commonly used treatments to consider when initiating therapy. In the absence of evidence for individual strategies and conclusive knowledge of the causes of hyperammonemia syndrome, clinicians should continue to design multimodal regimens based on suspected etiologies, institutional drug availability, patient ability to tolerate enteral medications and nutrition, and availability of intravenous access.
PubMed: 38002590
DOI: 10.3390/jcm12226975 -
Nutrition in Clinical Practice :... Aug 2023
Topics: Humans; Parenteral Nutrition; Enteral Nutrition
PubMed: 37138449
DOI: 10.1002/ncp.11006 -
Journal of Visceral Surgery Oct 2023Malnutrition in visceral surgery is frequent; it calls for screening prior to an operation, and its postoperative occurrence should be sought out and prevented, if... (Review)
Review
Malnutrition in visceral surgery is frequent; it calls for screening prior to an operation, and its postoperative occurrence should be sought out and prevented, if possible. Organization of an individualized nutritional support strategy is based on systematic nutritional assessment and adapted to the type of surgery, the objectives being to forestall malnutrition and to reduce induced morbidity (immunosuppression, delayed wound healing, anastomotic fistulas…). Nutritional support is part and parcel of enhanced recovery after surgery (ERAS), and has shown effectiveness in the field of visceral surgery. Oral feeding should always be privileged to the greatest possible extent, complemented if necessary by nutritional supplements. If nutritional support is required, enteral nutrition should be favored over parenteral nutrition. As for the role of pharmaco-nutrition or immuno-nutrition, it remains ill-defined. Lastly, each type of visceral surgery entails specific modifications of the anatomy of the digestive system and is liable to have specific functional consequences, which should be known and taken into account in view of effectively tailoring nutritional support.
PubMed: 37587003
DOI: 10.1016/j.jviscsurg.2023.06.008 -
JPEN. Journal of Parenteral and Enteral... Aug 2023Lipid injectable emulsions have been in clinical use for over 60 years. The first product launched was Intralipid, which consisted of an emulsion of soybean oil in water... (Review)
Review
Lipid injectable emulsions have been in clinical use for over 60 years. The first product launched was Intralipid, which consisted of an emulsion of soybean oil in water for intravenous administration. It was a key source of essential fatty acids and an alternative source of energy for patients with gastrointestinal dysfunction requiring long-term parenteral nutrition. With clinical experience, a condition known as parenteral nutrition-associated liver disease (PNALD), or intestinal failure-associated liver disease (IFALD), was observed, with a focus on carbohydrate and fat energy. Modifying the daily doses and infusion rates had some salutary effects, but PNALD persisted. Subsequently, on closer inspection of the fatty acids profile and phytosterol concentrations, degradation products arising from chemical and physical stability issues of the available lipid injectable emulsions were implicated. Recently, the US Food and Drug Administration convened an online workshop entitled "The Role of Phytosterols in PNALD/IFALD," with an emphasis on (1) the multifactorial pathophysiology of PNALD/IFALD, (2) risk associated with phytosterols, and (3) regulatory history. The scope of this review includes the multifactorial pathophysiology of PNALD/IFALD as it relates to the pharmaceutical aspects of the various lipid injectable emulsions on the market, with respect to potential proinflammatory components, as well as physical and chemical stability issues that may also affect products' safe intravenous administration to patients.
Topics: Humans; Emulsions; Fat Emulsions, Intravenous; Fish Oils; Parenteral Nutrition; Liver Diseases; Soybean Oil; Liver Failure; Intestinal Diseases; Phytosterols
PubMed: 37070817
DOI: 10.1002/jpen.2507 -
The New England Journal of Medicine Apr 2024Most moderate-to-late-preterm infants need nutritional support until they are feeding exclusively on their mother's breast milk. Evidence to guide nutrition strategies... (Randomized Controlled Trial)
Randomized Controlled Trial Comparative Study
BACKGROUND
Most moderate-to-late-preterm infants need nutritional support until they are feeding exclusively on their mother's breast milk. Evidence to guide nutrition strategies for these infants is lacking.
METHODS
We conducted a multicenter, factorial, randomized trial involving infants born at 32 weeks 0 days' to 35 weeks 6 days' gestation who had intravenous access and whose mothers intended to breast-feed. Each infant was assigned to three interventions or their comparators: intravenous amino acid solution (parenteral nutrition) or dextrose solution until full feeding with milk was established; milk supplement given when maternal milk was insufficient or mother's breast milk exclusively with no supplementation; and taste and smell exposure before gastric-tube feeding or no taste and smell exposure. The primary outcome for the parenteral nutrition and the milk supplement interventions was the body-fat percentage at 4 months of corrected gestational age, and the primary outcome for the taste and smell intervention was the time to full enteral feeding (150 ml per kilogram of body weight per day or exclusive breast-feeding).
RESULTS
A total of 532 infants (291 boys [55%]) were included in the trial. The mean (±SD) body-fat percentage at 4 months was similar among the infants who received parenteral nutrition and those who received dextrose solution (26.0±5.4% vs. 26.2±5.2%; adjusted mean difference, -0.20; 95% confidence interval [CI], -1.32 to 0.92; P = 0.72) and among the infants who received milk supplement and those who received mother's breast milk exclusively (26.3±5.3% vs. 25.8±5.4%; adjusted mean difference, 0.65; 95% CI, -0.45 to 1.74; P = 0.25). The time to full enteral feeding was similar among the infants who were exposed to taste and smell and those who were not (5.8±1.5 vs. 5.7±1.9 days; P = 0.59). Secondary outcomes were similar across interventions. Serious adverse events occurred in one infant.
CONCLUSIONS
This trial of routine nutrition interventions to support moderate-to-late-preterm infants until full nutrition with mother's breast milk was possible did not show any effects on the time to full enteral feeding or on body composition at 4 months of corrected gestational age. (Funded by the Health Research Council of New Zealand and others; DIAMOND Australian New Zealand Clinical Trials Registry number, ACTRN12616001199404.).
Topics: Female; Humans; Infant; Infant, Newborn; Male; Amino Acids; Breast Feeding; Enteral Nutrition; Gestational Age; Glucose; Infant, Premature; Milk, Human; Parenteral Nutrition; Smell; Taste; Nutritional Support; Parenteral Nutrition Solutions; Adiposity
PubMed: 38657245
DOI: 10.1056/NEJMoa2313942 -
NeoReviews Jul 2023Intestinal failure is the anatomic or functional loss of intestinal function below the minimum required to absorb nutrients to maintain health and growth. Parenteral...
Intestinal failure is the anatomic or functional loss of intestinal function below the minimum required to absorb nutrients to maintain health and growth. Parenteral nutrition is the main supportive therapy for children with intestinal failure, but if serious complications develop, intestinal transplantation may be needed to sustain life. Referral to a multidisciplinary intestinal rehabilitation team and an extensive evaluation are necessary steps before listing for transplantation. Immunosuppression is part of life-long therapy after transplantation, and children continue to have high medical needs. Serious complications include acute cellular rejection, graft-versus-host disease, infection, and post-transplant lymphoproliferative disease. However, intestinal transplantation has led to improved outcomes in recent years and is a viable life-saving option for many children with intestinal failure.
Topics: Humans; Child; Intestinal Failure; Graft vs Host Disease; Parenteral Nutrition; Referral and Consultation
PubMed: 37391657
DOI: 10.1542/neo.24-6-e431