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Medicina (Kaunas, Lithuania) Jul 2022Today, few clinicians are still convinced that lipids are sepsis risk factors in patients receiving parenteral nutrition. This dogma is principally based on old... (Review)
Review
Today, few clinicians are still convinced that lipids are sepsis risk factors in patients receiving parenteral nutrition. This dogma is principally based on old literature. This review deals with the most recent literature search that provided up-to-date data over the past ten years. Systematic research was performed on Pubmed, MEDLINE, and Web of Science. The recent evidence does not justify the exclusion of lipid emulsions in patients receiving parenteral nutrition for fear of bloodstream infection risk. Moreover, lipids represent a substantial proportion of the energy source providing essential fatty acids, potentially improving clinical outcomes in patients often malnourished. Understanding the actual risk factors of sepsis during parenteral nutrition is necessary to optimize patient nutritional status and care and avoid essential fatty acid deficiency. There is an urgent need to make updated nutrition training available at all levels of medical education.
Topics: Fat Emulsions, Intravenous; Fatty Acids, Omega-3; Humans; Lipids; Parenteral Nutrition; Parenteral Nutrition, Total; Sepsis
PubMed: 35888604
DOI: 10.3390/medicina58070885 -
Nutrients May 2020Malnutrition is associated with poor surgical outcomes, and therefore optimizing nutritional status preoperatively is very important. The purpose of this paper is to...
Malnutrition is associated with poor surgical outcomes, and therefore optimizing nutritional status preoperatively is very important. The purpose of this paper is to review the literature related to preoperative parenteral nutrition (PN) and to provide current evidence based guidance. A systemic online search of PubMed, Medline, and Cochrane Databases from January 1990 to February 2020 was done. Sixteen studies were included in this narrative review, including four meta-analyses and twelve clinical trials. The majority of studies have demonstrated benefits of preoperative PN on postoperative outcomes, including reduced postoperative complications (8/10 studies) and postoperative length of stay (3/4 studies). Preoperative PN is indicated in malnourished surgical patients who cannot achieve adequate nutrient intake by oral or enteral nutrition. It can be seen that most studies showing benefits of preoperative PN often included patients with upper gastrointestinal cancer and inflammatory bowel disease (10/12 studies), which gastrointestinal problems are commonly seen and enteral nutrition may be not feasible. When preoperative PN is indicated, adequate energy and protein should be provided, and patients should receive at least seven days of PN prior to surgery. The goal of preoperative PN is not weight regain, but rather repletion of energy, protein, micronutrients, and glycogen stores. Complications associated with preoperative PN are rarely seen in previous studies. In order to prevent and mitigate the potential complications such as refeeding syndrome, optimal monitoring and early management of micronutrient deficiencies is required.
Topics: Evidence-Based Medicine; Gastrointestinal Neoplasms; Humans; Inflammatory Bowel Diseases; Insurance Benefits; Length of Stay; Malnutrition; Nutrition Assessment; Nutritional Status; Parenteral Nutrition; Postoperative Complications; Practice Guidelines as Topic; Preoperative Care; Prognosis
PubMed: 32384662
DOI: 10.3390/nu12051320 -
Clinical Nutrition ESPEN Apr 2022The nutritional status of everyone represents a fundamental element to maintain a good health and it can be related to infectious agents in some disorders. Prevention,... (Review)
Review
The nutritional status of everyone represents a fundamental element to maintain a good health and it can be related to infectious agents in some disorders. Prevention, diagnosis and treatment of malnutrition should be included in the management of SARS-CoV-2 patients in order to improve both short- and long-term prognosis. In Covid patients the choice of route of administration for nutrition is closely related to respiratory autonomy. In subjects who are not mechanically ventilated or with non-invasive ventilation (NIV), spontaneous oral feeding is strongly indicated, while considering the patient's comorbidity, chewing ability and swallowing. If this is not possible or if it is not possible to meet the appropriate nutritional needs, it is necessary to resort to artificial nutrition (enteral or parenteral). Enteral nutrition (EN) is preferred to parenteral nutrition (PN) because it allows to maintain the trophism of the gastrointestinal tract, involving a lower risk of infectious complications and it is easier to manage. PN is usually used in patients in whom NE is not feasible, insufficient or contraindicated, or in patients with invasive total mechanical ventilation. Based on these considerations, it would be necessary to develop a targeted nutritional pathway in order to support the management of Covid patients. In the nutritional management of these patients, the role of the hospital pharmacists is fundamental. They collaborate with clinicians, nutritionist, dieticians and speech therapists to choose the most appropriate nutrition, based on the clinical characteristics of the patient and on the availability of nutritional formulations in the therapeutic guide.
Topics: COVID-19; Hospitals; Humans; Parenteral Nutrition; Pharmacists; SARS-CoV-2
PubMed: 35331488
DOI: 10.1016/j.clnesp.2022.02.011 -
Nutrition in Clinical Practice :... Apr 2022Parenteral nutrition (PN) is a therapy that delivers essential nutrients intravenously to patients who are unable to meet their nutrition requirements via standard... (Review)
Review
Parenteral nutrition (PN) is a therapy that delivers essential nutrients intravenously to patients who are unable to meet their nutrition requirements via standard enteral feeding. This methodology is often referred to as PN when accompanied by minimal or no enteral nutrition (EN). Although PN is lifesaving, significant complications can arise, such as intestinal failure-associated liver disease and gut-mucosal atrophy. The exact mechanism of injury remains ill defined. This review was designed to explore the available literature related to the drivers of injury mechanisms. The Farnesoid X receptor and fibroblast growth factor 19 signaling pathway seems to play an important role in gut-systemic signaling, and its alteration during PN provides insights into mechanistic links. Central line infections also play a key role in mediating PN-associated injury. Although lipid reduction strategies, as well as the use of multicomponent lipid emulsions and vitamin E, have shown promise, the cornerstone of preventing injury is the early establishment of EN.
Topics: Humans; Lipids; Liver Diseases; Parenteral Nutrition; Parenteral Nutrition, Total
PubMed: 35124837
DOI: 10.1002/ncp.10830 -
Nutrients Apr 2022Parenteral nutrition (PN) provides support for patients lacking sufficient intestinal absorption of nutrients. Historically, the need for trace element (TE)... (Review)
Review
Parenteral nutrition (PN) provides support for patients lacking sufficient intestinal absorption of nutrients. Historically, the need for trace element (TE) supplementation was poorly appreciated, and multi-TE products were not initially subjected to rigorous oversight by the United States Food and Drug Administration (FDA). Subsequently, the American Society for Parenteral and Enteral Nutrition (ASPEN) issued dosage recommendations for PN, which are updated periodically. The FDA has implemented review and approval processes to ensure access to safer and more effective TE products. The development of a multi-TE product meeting ASPEN recommendations and FDA requirements is the result of a partnership between the FDA, industry, and clinicians with expertise in PN. This article examines the rationale for the development of TRALEMENT (Trace Elements Injection 4*) and the FDA's rigorous requirements leading to its review and approval. This combination product contains copper, manganese, selenium, and zinc and is indicated for use in adults and pediatric patients weighing ≥10 kg. Comprehensive management of PN therapy requires consideration of many factors when prescribing, reviewing, preparing, and administering PN, as well as monitoring the nutritional status of patients receiving PN. Understanding patients' TE requirements and incorporating them into PN is an important part of contemporary PN therapy.
Topics: Adult; Child; Dietary Supplements; Humans; Manganese; Parenteral Nutrition; Pharmaceutical Preparations; Selenium; Trace Elements; United States
PubMed: 35565737
DOI: 10.3390/nu14091770 -
International Journal of Environmental... Jul 2021Providing adequate amounts of all essential macro- and micronutrients to preterm infants during the period of extraordinarily rapid growth from 24 to 34 weeks'... (Review)
Review
Providing adequate amounts of all essential macro- and micronutrients to preterm infants during the period of extraordinarily rapid growth from 24 to 34 weeks' postmenstrual age to achieve growth as in utero is challenging yet important, since early growth restriction and suboptimal neonatal nutrition have been identified as risk factors for adverse long-term development. Along with now well-established early parenteral nutrition, this review emphasizes enteral nutrition, which should be started early and rapidly increased. To minimize the side effects of parenteral nutrition and improve outcomes, early full enteral nutrition based on expressed mothers' own milk is an important goal. Although neonatal nutrition has improved in recent decades, existing knowledge about, for example, the optimal composition and duration of parenteral nutrition, practical aspects of the transition to full enteral nutrition or the need for breast milk fortification is limited and intensively discussed. Therefore, further prospective studies on various aspects of preterm infant feeding are needed, especially with regard to the effects on long-term outcomes. This narrative review will summarize currently available and still missing evidence regarding optimal preterm infant nutrition, with emphasis on enteral nutrition and early postnatal growth, and deduce a practical approach.
Topics: Female; Humans; Infant; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature; Milk, Human; Parenteral Nutrition; Prospective Studies
PubMed: 34300000
DOI: 10.3390/ijerph18147544 -
Clinical Nutrition (Edinburgh, Scotland) Jul 2024Parenteral nutrition (PN) is recognized as a complex high-risk therapy. Its practice is highly variable and frequently suboptimal in pediatric patients. Optimizing care... (Review)
Review
Parenteral nutrition (PN) is recognized as a complex high-risk therapy. Its practice is highly variable and frequently suboptimal in pediatric patients. Optimizing care requires evidence, consensus-based guidelines, audits of practice, and standardized strategies. Several pediatric scientific organizations, expert panels, and authorities have recently recommended that standardized PN should generally be used over individualized PN in the majority of pediatric patients including very low birth weight premature infants. In addition, PN admixtures produced and validated by a suitably qualified institution are recommended over locally produced PN. Licensed multi chamber bags are standardized PN bags that comply with Good Manufacturing Practice and high-quality standards for the finished product in the frame of their full manufacturing license. The purpose of this article is to review the practical aspects of PN and the evidence for using such multi-chamber bags in pediatric patients. It highlights the safety characteristics and the limitations of the different PN practices and provides some guidance for ensuring safe and efficient therapy in pediatric patients.
Topics: Humans; Infant, Newborn; Parenteral Nutrition; Infant; Child; Child, Preschool; Adolescent; Parenteral Nutrition Solutions; Infant, Premature; Practice Guidelines as Topic; Infant, Very Low Birth Weight
PubMed: 38823267
DOI: 10.1016/j.clnu.2024.05.023 -
Archives of Disease in Childhood Apr 2020To investigate the physical and chemical compatibility of pentoxifylline (PTX) with a range of parenteral medications used in neonatal intensive care.
OBJECTIVE
To investigate the physical and chemical compatibility of pentoxifylline (PTX) with a range of parenteral medications used in neonatal intensive care.
DESIGN
PTX and drug solutions were combined in glass vials, inspected for physical incompatibility and evaluated on the basis of PTX concentrations for chemical compatibility.
RESULTS
No precipitation, colour change or turbidity was observed in any of the test mixtures. The PTX concentration was approximately 5.5% lower when combined with undiluted calcium gluconate injection (100 mg/mL). The PTX concentration ratios for all other combinations, including diluted calcium gluconate injection (50 mg/mL), were in the range of 99.5%-102%.
CONCLUSION
In simulated Y-site conditions, PTX was found to be compatible with 15 parenteral medications and six total parenteral nutrition solutions. Based on PTX concentration tests, it would be prudent to avoid mixing PTX with undiluted calcium gluconate injection.
Topics: Chemical Phenomena; Fat Emulsions, Intravenous; Humans; Infusions, Intravenous; Intensive Care, Neonatal; Parenteral Nutrition; Pentoxifylline; Pharmaceutical Preparations; Pharmaceutical Solutions; Vasodilator Agents
PubMed: 31871042
DOI: 10.1136/archdischild-2019-317912 -
ESMO Open Jul 2020
Topics: Cost-Benefit Analysis; Parenteral Nutrition; Parenteral Nutrition, Total
PubMed: 32661187
DOI: 10.1136/esmoopen-2020-000831 -
Journal of Perinatology : Official... Jan 2023Intestinal failure in neonatal and pediatric populations can be debilitating for patients and difficult to manage for clinicians. Management strategies include referral... (Review)
Review
Intestinal failure in neonatal and pediatric populations can be debilitating for patients and difficult to manage for clinicians. Management strategies include referral to an intestinal rehabilitation center, small volume trophic feeds to stimulate the intestine with cautious advancement of enteral nutrition using a standardized and evidence-based feeding protocol, and supplemental parenteral nutrition to optimize an infant's growth and nutrition. In this review, we discuss the causes of intestinal failure, parenteral nutrition strategies, enteral feeding initiation and advancement protocols, as well as the challenges in feeding an infant with intestinal failure.
Topics: Infant, Newborn; Child; Infant; Humans; Infant, Premature; Intestinal Failure; Neonatologists; Parenteral Nutrition; Enteral Nutrition
PubMed: 36127395
DOI: 10.1038/s41372-022-01504-4