-
German Medical Science : GMS E-journal Nov 2009In surgery, indications for artificial nutrition comprise prevention and treatment of catabolism and malnutrition. Thus in general, food intake should not be interrupted... (Review)
Review
In surgery, indications for artificial nutrition comprise prevention and treatment of catabolism and malnutrition. Thus in general, food intake should not be interrupted postoperatively and the re-establishing of oral (e.g. after anastomosis of the colon and rectum, kidney transplantation) or enteral food intake (e.g. after an anastomosis in the upper gastrointestinal tract, liver transplantation) is recommended within 24 h post surgery. To avoid increased mortality an indication for an immediate postoperatively artificial nutrition (enteral or parenteral nutrition (PN)) also exists in patients with no signs of malnutrition, but who will not receive oral food intake for more than 7 days perioperatively or whose oral food intake does not meet their needs (e.g. less than 60-80%) for more than 14 days. In cases of absolute contraindication for enteral nutrition, there is an indication for total PN (TPN) such as in chronic intestinal obstruction with a relevant passage obstruction e.g. a peritoneal carcinoma. If energy and nutrient requirements cannot be met by oral and enteral intake alone, a combination of enteral and parenteral nutrition is indicated. Delaying surgery for a systematic nutrition therapy (enteral and parenteral) is only indicated if severe malnutrition is present. Preoperative nutrition therapy should preferably be conducted prior to hospital admission to lower the risk of nosocomial infections. The recommendations of early postoperative re-establishing oral feeding, generally apply also to paediatric patients. Standardised operative procedures should be established in order to guarantee an effective nutrition therapy.
Topics: Germany; Humans; Nutrition Disorders; Parenteral Nutrition; Postoperative Complications; Practice Guidelines as Topic; Transplantation
PubMed: 20049072
DOI: 10.3205/000069 -
British Medical Journal Apr 1978
Topics: Critical Care; Energy Intake; Humans; Parenteral Nutrition; Parenteral Nutrition, Total
PubMed: 416871
DOI: 10.1136/bmj.1.6120.1144-d -
Advances in Nutrition (Bethesda, Md.) Mar 2022
Topics: Humans; Copper; Parenteral Nutrition; Parenteral Nutrition, Total; Nutritional Status
PubMed: 34940824
DOI: 10.1093/advances/nmab157 -
European Journal of Hospital Pharmacy :... Sep 2020For newborn and preterm infants, standardised and individual parenteral nutrition (PN) is used. PN preparation is at risk for contamination and dosing errors. The...
BACKGROUND
For newborn and preterm infants, standardised and individual parenteral nutrition (PN) is used. PN preparation is at risk for contamination and dosing errors. The quality of PN is crucial for infants and has a direct impact on their health status and safety.
PURPOSE
The aim of this study is to evaluate the physicochemical and microbial quality of PN for newborn and preterm infants prepared on a neonatal ward.
METHODS
Sampling of various individual PN prepared by nurses on a neonatal ward was performed. Formulations included maximal four electrolytes, variable dextrose and amino acid concentrations. Depending on the sample volume, up to three quality analyses were performed: (1) test for bacterial endotoxins by kinetic-chromogenic method, (2) sterility according to the European and US Pharmacopoeia, and (3) quantification of electrolytes by capillary electrophoresis and of dextrose by ultraviolet detection after enzymatic reaction of hexokinase. The concentrations obtained were evaluated based on the US and Swiss Pharmacopoeia specifications for compounded preparations and compared to the widened pharmacy specifications.
RESULTS
The composition of 86% of the 110 analysed PN prepared by nurses on the neonatal ward corresponded to their medical prescription. 14% were out of the acceptable widened pharmacy ranges. We found no microbial contamination in the samples. All PN were free from endotoxins.
CONCLUSION
Component concentrations of PN prepared on wards by nurses differed frequently and significantly from their medical prescription, and the deviation can be critical depending on the component and its mode of action. The sample size is too small to evaluate the microbial contamination.
Topics: Drug Contamination; Electrophoresis, Capillary; Humans; Infant Health; Infant, Newborn; Infant, Premature; Nurse's Role; Parenteral Nutrition; Parenteral Nutrition Solutions; Quality Control
PubMed: 32839262
DOI: 10.1136/ejhpharm-2018-001788 -
Nutrients Feb 2023The need for high quality evidence is recognized for optimizing practices of parenteral nutrition (PN). The purpose of the present systematic review is to update the... (Review)
Review
The need for high quality evidence is recognized for optimizing practices of parenteral nutrition (PN). The purpose of the present systematic review is to update the available evidence and investigate the effect of standardized PN (SPN) vs. individualized PN (IPN) on protein intake, immediate morbidities, growth, and long-term outcome in preterm infants. A literature search was performed on articles published in the period from 1/2015 to 11/2022 in PubMed and Cochrane database for trials on parenteral nutrition in preterm infants. Three new studies were identified. All new identified trials were nonrandomized observational trials using historical controls. SPN may increase weight and occipital frontal circumference gain and lower the value of maximum weight loss. More recent trials suggest that SPN may easily increase early protein intake. SPN may reduce the sepsis incidence, but overall, no significant effect was found. There was no significant effect of standardization of PN on mortality or stage ≥2 necrotizing enterocolite (NEC) incidence. In conclusion SPN may improve growth through higher nutrient (especially protein) intake and has no effect on sepsis, NEC, mortality, or days of PN.
Topics: Infant; Infant, Newborn; Humans; Infant, Premature; Sepsis; Weight Loss; Parenteral Nutrition; Incidence; Enterocolitis, Necrotizing
PubMed: 36904223
DOI: 10.3390/nu15051224 -
German Medical Science : GMS E-journal Nov 2009Guidelines for Parenteral Nutrition were prepared by the German Society for Nutritional Medicine (http://www.dgem.de/), in collaboration with other medical associations... (Review)
Review
Guidelines for Parenteral Nutrition were prepared by the German Society for Nutritional Medicine (http://www.dgem.de/), in collaboration with other medical associations to provide guidance for quality assurance for parenteral nutrition (PN) practice, and to promoting health and quality of life of patients concerned. A coordination team proposed topics, working group leaders who along with working group members performed systematic literatur searches and drafted recommendations in a nominal group process. Recommendations were discussed and agreed upon in a structured consensus conference process, followed by a Delphi consensus. The current English version of the guidelines was written and updated during the period between the last quarter of 2007 and the first quarter of 2009. The recommendations of the guidelines should be reviewed, and if necessary updated five years after publication.
Topics: Germany; Humans; Nutrition Disorders; Parenteral Nutrition; Practice Guidelines as Topic
PubMed: 20049082
DOI: 10.3205/000085 -
Canadian Medical Association Journal Jan 1980
Topics: Aftercare; Arteriovenous Shunt, Surgical; Catheters, Indwelling; Gastrointestinal Diseases; Home Nursing; Humans; Parenteral Nutrition; Parenteral Nutrition, Total
PubMed: 6244886
DOI: No ID Found -
Basic & Clinical Pharmacology &... Feb 2019In this study, clinical manifestations of adverse events and frequently used medications in patients receiving parenteral nutrition (PN) in Korea were evaluated using...
In this study, clinical manifestations of adverse events and frequently used medications in patients receiving parenteral nutrition (PN) in Korea were evaluated using Korea Adverse Event Reporting System (KAERS) database records between 2011 and 2015. Amino acids, fat emulsions, carbohydrates, combinations and solutions for PN were identified as causative agents. Adverse events classified as "certain", "probable" and "possible" based on the WHO-Uppsala Monitoring Centre criteria were analysed. In total, 6439 adverse events from 4260 patients were included for analysis. Mean patient age was 54.4 ± 18.1 years and the mean number of adverse events per patient was 1.5 ± 1.1. Frequent adverse events were gastrointestinal (2159 events, 33.5%), skin/appendage (1344 events, 20.9%), general (846 events, 13.1%) and central/peripheral nervous system (716 events, 11.1%) disorders. Common clinical symptoms were nausea (1248 events, 19.4%), vomiting (558, 8.7%), pruritus (456 events, 7.1%), rash (386 events, 6.0%) and dizziness (329 events, 5.1%). The frequently reported concomitant agents were tramadol (n = 475, 3.1%), fentanyl (n = 405, 2.7%), paracetamol (n = 329, 2.2%), ketorolac (n = 322, 2.1%) and metoclopramide (n = 289 cases, 1.9%). The frequent adverse events remained consistent after accounting for concurrent medications. Our findings from a nationwide reporting system database found that gastrointestinal disorders (nausea and vomiting) were the leading adverse events, requiring further studies on their prevalence, mechanisms and therapeutic options.
Topics: Adolescent; Adult; Adverse Drug Reaction Reporting Systems; Aged; Confounding Factors, Epidemiologic; Databases, Factual; Drug-Related Side Effects and Adverse Reactions; Female; Humans; Male; Middle Aged; Nausea; Parenteral Nutrition; Republic of Korea; Retrospective Studies; Vomiting; Young Adult
PubMed: 30133153
DOI: 10.1111/bcpt.13116 -
Current Opinion in Gastroenterology Mar 2014Nutrition in the critically ill patient remains a controversial topic. Most clinicians have viewed nutrition as part of patient care but not as a therapeutic... (Review)
Review
PURPOSE OF REVIEW
Nutrition in the critically ill patient remains a controversial topic. Most clinicians have viewed nutrition as part of patient care but not as a therapeutic intervention. Recent studies have looked at type and timing of nutrition to determine whether they affect important clinical outcomes.
RECENT FINDINGS
Large-scale, multicentre randomized trials have found that supplemental parenteral nutrition has a deleterious effect in comparison to enteral nutrition alone. Use of early parenteral nutrition in critically ill patients in whom enteral nutrition was contraindicated did not significantly improve clinical outcomes. Also, low-dose or trophic enteral nutrition has similar benefits with less gastrointestinal complications compared with early full dose caloric feedings. The timing of early nutrition has been defined in most large-scale studies as beginning within 48 h of intubation, though some earlier studies used a 24-h cut-off point with some improved outcomes.
SUMMARY
Although not strong, the best available data suggest that critically ill patients should be started on enteral tube feeds within 48 h of intubation whenever possible. The use of parenteral nutrition should be limited within the first 6 days, and not used to augment caloric intake. Finally, similar benefits are seen in patients receiving minimal enteral feeds versus full caloric enteral nutrition.
Topics: Critical Care; Critical Illness; Enteral Nutrition; Humans; Intensive Care Units; Parenteral Nutrition; Time Factors
PubMed: 24464030
DOI: 10.1097/MOG.0000000000000047 -
BMC Pediatrics Aug 2022Despite the wide use of parenteral nutrition (PN) in neonatal intensive care units (NICU), there is limited evidence regarding the optimal time to commence PN in term...
BACKGROUND
Despite the wide use of parenteral nutrition (PN) in neonatal intensive care units (NICU), there is limited evidence regarding the optimal time to commence PN in term and late preterm infants. The recommendations from the recently published ESPGHAN/ESPEN/ESPR/CPEN and NICE guidelines are substantially different in this area, and surveys have reported variations in clinical practice. The aim of this randomised controlled trial (RCT) is to evaluate the benefits and risks of early versus late PN in term and late preterm infants.
METHODS/DESIGN
This study is a single-centre, non-blinded RCT in the NICU of Perth Children's Hospital, Western Australia.A total of 60 infants born ≥34 weeks of gestation who have a high likelihood of intolerance to enteral nutrition (EN) for at least 3-5 days will be randomised to early (day 1 or day 2 of admission) or late commencement (day 6 of admission) of PN after informed parental consent. In both groups, EN will be commenced as early as clinically feasible. Primary outcomes are plasma phenylalanine and plasma F-isoprostane levels on Day 4 and Day 8 of admission. Secondary outcomes are total and individual plasma amino acid profiles, plasma and red blood cell fatty acid profiles, in-hospital all-cause mortality, hospital-acquired infections, length of hospital/NICU stay, z scores and changes in z scores at discharge for weight, height and head circumference, time to full EN, duration of respiratory (mechanical, non-invasive) support, duration of inotropic support, the incidence of hyper and hypoglycaemia, incidence of metabolic acidosis, liver function, blood urea nitrogen, and C-reactive protein (CRP).
DISCUSSION
This RCT will examine the effects of early versus late PN in term and late preterm infants by comparing key biochemical and clinical outcomes and has the potential to identify underlying pathways for beneficial or harmful effects related to the timing of commencement of PN in such infants.
TRIAL REGISTRATION
ANZCTR; ACTRN12620000324910 (3rd March 2020).
Topics: Enteral Nutrition; Humans; Infant, Newborn; Infant, Premature; Intensive Care Units, Neonatal; Parenteral Nutrition; Parenteral Nutrition, Total; Randomized Controlled Trials as Topic
PubMed: 36042439
DOI: 10.1186/s12887-022-03569-8