1
|
Pinho JL, Freitas RGBDON, Nogueira RJN. Parenteral nutrition customization in pediatrics: A descriptive cohort study. JPEN J Parenter Enteral Nutr 2024. [PMID: 39380300 DOI: 10.1002/jpen.2694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 09/18/2024] [Accepted: 09/19/2024] [Indexed: 10/10/2024]
Abstract
OBJECTIVES The main objective of this study was to analyze the reasons for customizing parenteral nutrition (PN) in pediatric patients admitted to a quaternary hospital. METHODS We performed a descriptive cohort study on 264 hospitalized children receiving PN. Anthropometric, biochemical, and hospitalization data were collected from patient records. Unequivocal reasons for customizing PN were defined as situations precluding prescription of a standard adult/teenager PN and included renal and/or liver failure, energy-protein adequacy, and elevated mineral and triglyceride levels. RESULTS A total of 264 patients, with a median age of 2.2 years (IQR: 0.3-9.0 years), comprising intensive care (n = 216; 81.8%) and malnourished (n = 91; 36.1%) patients, were evaluated. In the first 48 h, 87.9% (n = 232) of the sample required customized PN for energy-protein adequacy (210 of 232), maintained over subsequent days in most cases. Among patients requiring second individualization, mineral disturbance was the main reason observed, especially within the first 4 days of PN use (n = 21; 60%). Unequivocal reasons for customizing PN occurred in 97.4% (n = 226) of cases in the first 48 h; 96.2% (n = 177) of cases on the fourth day; and 90.1% (n = 92) of cases on the seventh day of PN use. An inverse correlation was found between weight/age z score and number of second individualizations (r = -0.222; P = 0.002). CONCLUSION Customized PN proved essential, especially for younger, malnourished, and intensive care patients. Investment in training a Nutritional Multidisciplinary Therapy Team and acquiring a specific electronic system for prescribing PN is suggested.
Collapse
Affiliation(s)
- Jéssica Lavanholi Pinho
- Department of Pediatrics of the School of Medical Science, Universidade Estadual de Campinas (UNICAMP), Campinas, Brazil
| | | | | |
Collapse
|
2
|
Follett M, Bregni P, Robinson DT, Calkins KL, Cober MP, Falcigia GH, Chen Y. Commentary on guidelines for parenteral nutrition in preterm infants: Limitations reveal opportunities. JPEN J Parenter Enteral Nutr 2024; 48:524-526. [PMID: 38761120 DOI: 10.1002/jpen.2640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 04/26/2024] [Indexed: 05/20/2024]
Affiliation(s)
| | - Paola Bregni
- University of Washington, Seattle, Washington, USA
| | - Daniel T Robinson
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Kara L Calkins
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - M Petrea Cober
- College of Pharmacy, Northeast Ohio Medical University, Rootstown, Ohio, USA
| | - Gustave H Falcigia
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | | |
Collapse
|
3
|
Senterre T, van den Akker CHP, Domellof M, Saenz de Pipaon M, Arnell H, Tabbers M, Valla FV, Tomlin S, Paulsson M, Wackernagel D, Haiden N, Luukkainen P, Orfeo L, Carnielli VP, Rigo J. Safe and efficient practice of parenteral nutrition in neonates and children aged 0-18 years - The role of licensed multi-chamber bags. Clin Nutr 2024; 43:1696-1705. [PMID: 38823267 DOI: 10.1016/j.clnu.2024.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 04/11/2024] [Accepted: 05/12/2024] [Indexed: 06/03/2024]
Abstract
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.
Collapse
Affiliation(s)
- Thibault Senterre
- Baxter R&D Europe, Braine-l'Alleud, Belgium; University of Liège, Liège, Belgium.
| | - Chris H P van den Akker
- Department of Pediatrics - Neonatology, Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Amsterdam, the Netherlands; Amsterdam Reproduction and Development and Amsterdam Gastroenterology Endocrinology Metabolism Research Institutes, Amsterdam, the Netherlands.
| | - Magnus Domellof
- Department of Clinical Sciences, Umeå University, Umea, Sweden.
| | - Miguel Saenz de Pipaon
- Instituto de Investigación Sanitaria del Hospital Universitario La Paz - IdiPAZ, (Hospital Universitario La Paz - Universidad Autónoma de Madrid), Madrid, Spain.
| | - Henrik Arnell
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Astrid Lindgren Children's Karolinska University Hospital, Stockholm, Sweden; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
| | - Merit Tabbers
- Amsterdam Reproduction and Development and Amsterdam Gastroenterology Endocrinology Metabolism Research Institutes, Amsterdam, the Netherlands; Department of Pediatric Gastroenterology, Hepatology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - Frederic V Valla
- Transversal dietetics and Nutrition Unit and Nutrition Unit (UTDN), Intensive Care Nutrition, Hospices Civils de Lyon, Lyon-Bron, France.
| | - Stephen Tomlin
- Pharmacy Department, Children's Medicines Centre, Great Ormond Street Hospital for Sick Children, London, UK.
| | - Mattias Paulsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
| | - Dirk Wackernagel
- Department of Neonatology, Gutenberg University, Mainz, Germany; CLINTEC, Karolinska Institutet, Stockholm, Sweden.
| | - Nadja Haiden
- Department of Neonatology, Kepler University Hospital, Linz, Austria.
| | | | - Luigi Orfeo
- Neonatal Intensive Care Unit, Isola Tiberina Hospital Gemelli Isola, Rome, Italy.
| | - Virgilio P Carnielli
- Department of Mother and Child Health, Division of Neonatology, G. Salesi Children's Hospital - Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona, Ancona, Italy; Department of Odontostomatologic and Specialized Clinical Sciences, Polytechnic University of Marche, Ancona, Italy.
| | | |
Collapse
|
4
|
Bernhard W, Böckmann KA, Minarski M, Wiechers C, Busch A, Bach D, Poets CF, Franz AR. Evidence and Perspectives for Choline Supplementation during Parenteral Nutrition-A Narrative Review. Nutrients 2024; 16:1873. [PMID: 38931230 PMCID: PMC11206924 DOI: 10.3390/nu16121873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 06/03/2024] [Accepted: 06/09/2024] [Indexed: 06/28/2024] Open
Abstract
Choline is an essential nutrient, with high requirements during fetal and postnatal growth. Tissue concentrations of total choline are tightly regulated, requiring an increase in its pool size proportional to growth. Phosphatidylcholine and sphingomyelin, containing a choline headgroup, are constitutive membrane phospholipids, accounting for >85% of total choline, indicating that choline requirements are particularly high during growth. Daily phosphatidylcholine secretion via bile for lipid digestion and very low-density lipoproteins for plasma transport of arachidonic and docosahexaenoic acid to other organs exceed 50% of its hepatic pool. Moreover, phosphatidylcholine is required for converting pro-apoptotic ceramides to sphingomyelin, while choline is the source of betaine as a methyl donor for creatine synthesis, DNA methylation/repair and kidney function. Interrupted choline supply, as during current total parenteral nutrition (TPN), causes a rapid drop in plasma choline concentration and accumulating deficit. The American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) defined choline as critical to all infants requiring TPN, claiming its inclusion in parenteral feeding regimes. We performed a systematic literature search in Pubmed with the terms "choline" and "parenteral nutrition", resulting in 47 relevant publications. Their results, together with cross-references, are discussed. While studies on parenteral choline administration in neonates and older children are lacking, preclinical and observational studies, as well as small randomized controlled trials in adults, suggest choline deficiency as a major contributor to acute and chronic TPN-associated liver disease, and the safety and efficacy of parenteral choline administration for its prevention. Hence, we call for choline formulations suitable to be added to TPN solutions and clinical trials to study their efficacy, particularly in growing children including preterm infants.
Collapse
Affiliation(s)
- Wolfgang Bernhard
- Department of Neonatology, University Children’s Hospital, 72076 Tübingen, Germany; (W.B.); (K.A.B.); (M.M.); (C.W.); (C.F.P.)
| | - Katrin A. Böckmann
- Department of Neonatology, University Children’s Hospital, 72076 Tübingen, Germany; (W.B.); (K.A.B.); (M.M.); (C.W.); (C.F.P.)
| | - Michaela Minarski
- Department of Neonatology, University Children’s Hospital, 72076 Tübingen, Germany; (W.B.); (K.A.B.); (M.M.); (C.W.); (C.F.P.)
| | - Cornelia Wiechers
- Department of Neonatology, University Children’s Hospital, 72076 Tübingen, Germany; (W.B.); (K.A.B.); (M.M.); (C.W.); (C.F.P.)
| | - Annegret Busch
- Pharmaceutical Department, University Hospital, 72076 Tübingen, Germany; (A.B.); (D.B.)
| | - Daniela Bach
- Pharmaceutical Department, University Hospital, 72076 Tübingen, Germany; (A.B.); (D.B.)
| | - Christian F. Poets
- Department of Neonatology, University Children’s Hospital, 72076 Tübingen, Germany; (W.B.); (K.A.B.); (M.M.); (C.W.); (C.F.P.)
| | - Axel R. Franz
- Department of Neonatology, University Children’s Hospital, 72076 Tübingen, Germany; (W.B.); (K.A.B.); (M.M.); (C.W.); (C.F.P.)
- Center for Pediatric Clinical Studies, University Children’s Hospital, 72076 Tübingen, Germany
| |
Collapse
|
5
|
Batteux M, Meers G, Fien B, Cortoos PJ, Cools F. The Use of Standardized Solutions Instead of Individualized Prescriptions for Parenteral Nutrition on the Neonatal Intensive Care Unit in UZ Brussel: A Feasibility Study. Clin Pediatr (Phila) 2024; 63:642-649. [PMID: 37594088 DOI: 10.1177/00099228231191924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
For parenteral nutrition (PN) of newborns, the European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) 2018 guidelines recommend standardized solutions over individual PN (IPN) solutions for most patients. This retrospective study assessed if a shift from IPN to standardized PN was feasible at the UZ Brussel. Using prescription data of 145 neonates, we calculated the nutrient provision for IPN and for standardized PN of the same volumes. We compared the macronutrient intakes with ESPGHAN 2018 recommendations to assess the feasibility. For neonates of a gestational age (GA) <32 or >36 weeks, standardized PN reached recommendations as least as fast as IPN. For neonates with a GA of 32 to 36 weeks, the administration protocol requires further adjustments as amino acid provision was lacking compared to IPN. Overall, the results support the feasibility of a shift from IPN to standardized PN at the UZ Brussel.
Collapse
Affiliation(s)
- Melanie Batteux
- Department of Hospital Pharmacy, Universitair Ziekenhuis Brussel, (UZ Brussel), Brussels, Belgium
- Department of Neonatology, Universitair Ziekenhuis Brussel, (UZ Brussel), Brussels, Belgium
| | - Garmt Meers
- Department of Hospital Pharmacy, Universitair Ziekenhuis Brussel, (UZ Brussel), Brussels, Belgium
| | - Bockstal Fien
- Department of Hospital Pharmacy, Universitair Ziekenhuis Brussel, (UZ Brussel), Brussels, Belgium
- Department of Neonatology, Universitair Ziekenhuis Brussel, (UZ Brussel), Brussels, Belgium
| | - Pieter-Jan Cortoos
- Department of Hospital Pharmacy, Universitair Ziekenhuis Brussel, (UZ Brussel), Brussels, Belgium
| | - Filip Cools
- Department of Neonatology, Universitair Ziekenhuis Brussel, (UZ Brussel), Brussels, Belgium
| |
Collapse
|
6
|
Alexander T, Asadi S, Meyer M, Harding JE, Jiang Y, Alsweiler JM, Muelbert M, Bloomfield FH. Nutritional Support for Moderate-to-Late-Preterm Infants - A Randomized Trial. N Engl J Med 2024; 390:1493-1504. [PMID: 38657245 DOI: 10.1056/nejmoa2313942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
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.).
Collapse
Affiliation(s)
- Tanith Alexander
- From Liggins Institute (T.A., S.A., J.E.H., M. Muelbert, F.H.B.), the Department of Statistics, Faculty of Science (Y.J.), and the Department of Paediatrics, Child and Youth Health (J.M.A.), University of Auckland, and the Neonatal Unit, Kidz First, Middlemore Hospital, Te Whatu Ora Counties Manukau (T.A., M. Meyer), Auckland, and Newborn Services, Starship Child Health, Te Toka Tumai Auckland, Te Whatu Ora (J.M.A.) - all in New Zealand
| | - Sharin Asadi
- From Liggins Institute (T.A., S.A., J.E.H., M. Muelbert, F.H.B.), the Department of Statistics, Faculty of Science (Y.J.), and the Department of Paediatrics, Child and Youth Health (J.M.A.), University of Auckland, and the Neonatal Unit, Kidz First, Middlemore Hospital, Te Whatu Ora Counties Manukau (T.A., M. Meyer), Auckland, and Newborn Services, Starship Child Health, Te Toka Tumai Auckland, Te Whatu Ora (J.M.A.) - all in New Zealand
| | - Michael Meyer
- From Liggins Institute (T.A., S.A., J.E.H., M. Muelbert, F.H.B.), the Department of Statistics, Faculty of Science (Y.J.), and the Department of Paediatrics, Child and Youth Health (J.M.A.), University of Auckland, and the Neonatal Unit, Kidz First, Middlemore Hospital, Te Whatu Ora Counties Manukau (T.A., M. Meyer), Auckland, and Newborn Services, Starship Child Health, Te Toka Tumai Auckland, Te Whatu Ora (J.M.A.) - all in New Zealand
| | - Jane E Harding
- From Liggins Institute (T.A., S.A., J.E.H., M. Muelbert, F.H.B.), the Department of Statistics, Faculty of Science (Y.J.), and the Department of Paediatrics, Child and Youth Health (J.M.A.), University of Auckland, and the Neonatal Unit, Kidz First, Middlemore Hospital, Te Whatu Ora Counties Manukau (T.A., M. Meyer), Auckland, and Newborn Services, Starship Child Health, Te Toka Tumai Auckland, Te Whatu Ora (J.M.A.) - all in New Zealand
| | - Yannan Jiang
- From Liggins Institute (T.A., S.A., J.E.H., M. Muelbert, F.H.B.), the Department of Statistics, Faculty of Science (Y.J.), and the Department of Paediatrics, Child and Youth Health (J.M.A.), University of Auckland, and the Neonatal Unit, Kidz First, Middlemore Hospital, Te Whatu Ora Counties Manukau (T.A., M. Meyer), Auckland, and Newborn Services, Starship Child Health, Te Toka Tumai Auckland, Te Whatu Ora (J.M.A.) - all in New Zealand
| | - Jane M Alsweiler
- From Liggins Institute (T.A., S.A., J.E.H., M. Muelbert, F.H.B.), the Department of Statistics, Faculty of Science (Y.J.), and the Department of Paediatrics, Child and Youth Health (J.M.A.), University of Auckland, and the Neonatal Unit, Kidz First, Middlemore Hospital, Te Whatu Ora Counties Manukau (T.A., M. Meyer), Auckland, and Newborn Services, Starship Child Health, Te Toka Tumai Auckland, Te Whatu Ora (J.M.A.) - all in New Zealand
| | - Mariana Muelbert
- From Liggins Institute (T.A., S.A., J.E.H., M. Muelbert, F.H.B.), the Department of Statistics, Faculty of Science (Y.J.), and the Department of Paediatrics, Child and Youth Health (J.M.A.), University of Auckland, and the Neonatal Unit, Kidz First, Middlemore Hospital, Te Whatu Ora Counties Manukau (T.A., M. Meyer), Auckland, and Newborn Services, Starship Child Health, Te Toka Tumai Auckland, Te Whatu Ora (J.M.A.) - all in New Zealand
| | - Frank H Bloomfield
- From Liggins Institute (T.A., S.A., J.E.H., M. Muelbert, F.H.B.), the Department of Statistics, Faculty of Science (Y.J.), and the Department of Paediatrics, Child and Youth Health (J.M.A.), University of Auckland, and the Neonatal Unit, Kidz First, Middlemore Hospital, Te Whatu Ora Counties Manukau (T.A., M. Meyer), Auckland, and Newborn Services, Starship Child Health, Te Toka Tumai Auckland, Te Whatu Ora (J.M.A.) - all in New Zealand
| |
Collapse
|
7
|
Saenz de Pipaon M, Nelin LD, Gehred A, Rossholt ME, Moltu S, Van den Akker C, van Kaam AH, Sánchez A, Khashu M, Roehr CC, Carnielli V. The role of nutritional interventions in the prevention and treatment of chronic lung disease of prematurity. Pediatr Res 2024:10.1038/s41390-024-03133-3. [PMID: 38565917 DOI: 10.1038/s41390-024-03133-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 01/20/2024] [Indexed: 04/04/2024]
Abstract
Chronic lung disease of prematurity or bronchopulmonary dysplasia (BPD) is a common complication of preterm birth. Nutrition may affect incidence and severity of BPD. In this context, the Section on Nutrition, Gastroenterology and Metabolism, the Pulmonary Section of the European Society for Paediatric Research (ESPR) and SPR have joined forces to review the current knowledge on nutritional issues related to BPD. The aim of this narrative review is to discuss the clinical implications for nutritional practice. Nutrient deficiencies may influence pathogenesis of BPD. Adequate nutrition and growth can play a crucial role in the prevention of and recovery from BPD. Optimal nutrition strategy is an important principle, especially in the early postnatal period. As optimal energy intake in infants at risk of BPD or with evolving BPD is not yet defined, further research with well-designed studies on nutritional strategies for preterm infants with BPD is urgently needed. IMPACT: Based on current evidence it seems reasonable to recommend that BPD diagnosed infants should receive an energy supply ranging from 120 to 150 Kcal/kg/d. Exclusive MOM feed with adequate fortification should be encouraged as this is associated with a significant reduction in the risk of BPD. Suboptimal nutritional delivery is often seen in preterm infants with BPD compared to controls.
Collapse
Affiliation(s)
- Miguel Saenz de Pipaon
- Department of Neonatology, Instituto de Investigación Sanitaria, La Paz University Hospital-IdiPAZ (Universidad Autonoma), Madrid, Spain.
| | - Leif D Nelin
- Comprehensive Center for Bronchopulmonary Dysplasia, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Alison Gehred
- Comprehensive Center for Bronchopulmonary Dysplasia, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Madelaine E Rossholt
- Division of Paediatric and Adolescent Medicine, Department of Neonatal Intensive Care, Ullevål, Oslo University Hospital, Oslo, Norway
| | - Sissel Moltu
- Division of Paediatric and Adolescent Medicine, Department of Neonatal Intensive Care, Ullevål, Oslo University Hospital, Oslo, Norway.
| | - Chris Van den Akker
- Department of Pediatrics, Amsterdam UMC, Vrije Universiteit, University of Amsterdam, Emma Children's Hospital, Amsterdam, Netherlands
| | - Anton H van Kaam
- Department of Pediatrics, Amsterdam UMC, Vrije Universiteit, University of Amsterdam, Emma Children's Hospital, Amsterdam, Netherlands
| | - Ana Sánchez
- Department of Neonatology, Instituto de Investigación Sanitaria, La Paz University Hospital-IdiPAZ (Universidad Autonoma), Madrid, Spain
| | | | - Charles C Roehr
- National Perinatal Epidemiology Unit, Oxford Population Health, Medical Sciences Division, University of Oxford, Oxford, UK
- Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Virgilio Carnielli
- Division of Neonatology, Mother and Child Department, G. Salesi Children Hospital, Azienda Ospedaliero Universitaria delle, Ancona, Marche, Italy
| |
Collapse
|
8
|
Nguyen TD, Meers G, Cortoos PJ, Steurbaut S, Cools F. A Retrospective Study Evaluating Guideline Adherence of Neonatal Parenteral Nutrition in a Belgian Neonatal Intensive Care Unit. Cureus 2024; 16:e56654. [PMID: 38646227 PMCID: PMC11032152 DOI: 10.7759/cureus.56654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2024] [Indexed: 04/23/2024] Open
Abstract
Introduction Clinical nutrition for preterm and critically ill neonates remains a challenge. Preterms are often hemodynamically and metabolically compromised, which limits infusion volumes of nutrients and hinders achieving recommended nutrient intakes. While guidelines provide recommended ranges for parenteral nutrition (PN) intakes, they generally recommend enteral nutrition as soon as possible. Thus, in clinical practice, gradually increasing EN intakes complicates assessments of PN guideline adherence. Via a pragmatic approach, we assessed adherence to PN recommendations for macronutrients and energy as stated in the 2018 guidelines of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN). Methods In this retrospective study, we assessed the nutrition of preterm and critically ill term neonates from the neonatal intensive care unit of the University Hospital Brussels. We analyzed intakes for the first week of life, in which critically ill neonates at our center usually receive the majority of nutrients via PN. The PN-based provision of macronutrients and energy was analyzed descriptively in relation to the ESPGHAN 2018 recommendations. Results Macronutrients and energy provision gradually increased until they reached recommended or targeted values. Compared to term neonates, energy and lipid provision for preterms increased faster, while amino acid provision exceeded the ESPGHAN 2018 recommendations. Conclusions This study adds clinical practice data to the severely understudied field of the ESPGHAN 2018 PN guideline compliance. Using a pragmatic assessment of our nutrition protocols, we found the need to reduce the amount of amino acids per kg body weight per day to meet guideline recommendations.
Collapse
Affiliation(s)
- Truc-Doan Nguyen
- Department of Neonatology, University Hospital Brussels, Brussels, BEL
| | - Garmt Meers
- Department of Hospital Pharmacy, University Hospital Brussels, Brussels, BEL
| | - Pieter-Jan Cortoos
- Department of Hospital Pharmacy, University Hospital Brussels, Brussels, BEL
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, BEL
| | - Stephane Steurbaut
- Department of Hospital Pharmacy, University Hospital Brussels, Brussels, BEL
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, BEL
| | - Filip Cools
- Department of Neonatology, University Hospital Brussels, Brussels, BEL
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, BEL
| |
Collapse
|
9
|
Robinson DT, Calkins KL, Chen Y, Petrea Cober M, Falciglia GH, Church DD, Mey J, Sentongo T, McKeever L. Response to "Commentary on 'Guidelines for parenteral nutrition in preterm infants: The American Society for Parenteral and Enteral Nutrition'". JPEN J Parenter Enteral Nutr 2024; 48:143-144. [PMID: 38189467 DOI: 10.1002/jpen.2579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 11/22/2023] [Indexed: 01/09/2024]
Affiliation(s)
- Daniel T Robinson
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Kara L Calkins
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | | | - M Petrea Cober
- Akron Children's Hospital, Akron, Ohio, USA
- College of Pharmacy, Northeast Ohio Medical University, Rootstown, Ohio, USA
| | - Gustave H Falciglia
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - David D Church
- Department of Geriatrics, Donald W. Reynolds Institute on Aging, Center for Translational Research in Aging & Longevity, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Jacob Mey
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Timothy Sentongo
- University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Liam McKeever
- Department of Clinical Nutrition, Rush University Medical Center, Chicago, Illinois, USA
| |
Collapse
|
10
|
Mims TS, Kumari R, Leathem C, Antunes K, Joseph S, Yen MI, Ferstl D, Jamieson SM, Sabbar A, Biebel C, Lazarevic N, Willis NB, Henry L, Yen CLE, Smith JP, Gosain A, Meisel M, Willis KA, Talati AJ, Elabiad MT, Hibl B, Pierre JF. Altered hepatic and intestinal homeostasis in a neonatal murine model of short-term total parenteral nutrition and antibiotics. Am J Physiol Gastrointest Liver Physiol 2023; 325:G556-G569. [PMID: 37753583 DOI: 10.1152/ajpgi.00129.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/18/2023] [Accepted: 09/24/2023] [Indexed: 09/28/2023]
Abstract
Parenteral nutrition (PN) prevents starvation and supports metabolic requirements intravenously when patients are unable to be fed enterally. Clinically, infants are frequently provided PN in intensive care settings along with exposure to antibiotics (ABX) to minimize infection during care. Unfortunately, neonates experience extremely high rates of hepatic complications. Adult rodent and piglet models of PN are well-established but neonatal models capable of leveraging the considerable transgenic potential of the mouse remain underdeveloped. Utilizing our newly established neonatal murine PN mouse model, we administered ABX or controlled drinking water to timed pregnant dams to disrupt the maternal microbiome. We randomized mouse pups to PN or sham surgery controls +/- ABX exposure. ABX or short-term PN decreased liver and brain organ weights, intestinal length, and mucosal architecture (vs. controls). PN significantly elevated evidence of hepatic proinflammatory markers, neutrophils and macrophage counts, bacterial colony-forming units, and evidence of cholestasis risk, which was blocked by ABX. However, ABX uniquely elevated metabolic regulatory genes resulting in accumulation of hepatocyte lipids, triglycerides, and elevated tauro-chenoxycholic acid (TCDCA) in serum. Within the gut, PN elevated the relative abundance of Akkermansia, Enterococcus, and Suterella with decreased Anaerostipes and Lactobacillus compared with controls, whereas ABX enriched Proteobacteria. We conclude that short-term PN elevates hepatic inflammatory stress and risk of cholestasis in early life. Although concurrent ABX exposure protects against hepatic immune activation during PN, the dual exposure modulates metabolism and may contribute toward early steatosis phenotype, sometimes observed in infants unable to wean from PN.NEW & NOTEWORTHY This study successfully established a translationally relevant, murine neonatal parenteral nutrition (PN) model. Short-term PN is sufficient to induce hepatitis-associated cholestasis in a neonatal murine model that can be used to understand disease in early life. The administration of antibiotics during PN protects animals from bacterial translocation and proinflammatory responses but induces unique metabolic shifts that may predispose the liver toward early steatosis.
Collapse
Affiliation(s)
- Tahliyah S Mims
- Department of Nutritional Sciences, College of Agriculture and Life Science, University of Wisconsin-Madison, Madison, Wisconsin, United States
| | - Roshan Kumari
- Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - Cameron Leathem
- Department of Nutritional Sciences, College of Agriculture and Life Science, University of Wisconsin-Madison, Madison, Wisconsin, United States
| | - Karen Antunes
- Department of Nutritional Sciences, College of Agriculture and Life Science, University of Wisconsin-Madison, Madison, Wisconsin, United States
| | - Sydney Joseph
- Department of Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - Mei-I Yen
- Department of Nutritional Sciences, College of Agriculture and Life Science, University of Wisconsin-Madison, Madison, Wisconsin, United States
| | - Danielle Ferstl
- Department of Nutritional Sciences, College of Agriculture and Life Science, University of Wisconsin-Madison, Madison, Wisconsin, United States
| | - Sophia M Jamieson
- Department of Nutritional Sciences, College of Agriculture and Life Science, University of Wisconsin-Madison, Madison, Wisconsin, United States
| | - Austin Sabbar
- Department of Nutritional Sciences, College of Agriculture and Life Science, University of Wisconsin-Madison, Madison, Wisconsin, United States
| | - Claudia Biebel
- Department of Nutritional Sciences, College of Agriculture and Life Science, University of Wisconsin-Madison, Madison, Wisconsin, United States
| | - Nikolai Lazarevic
- Department of Nutritional Sciences, College of Agriculture and Life Science, University of Wisconsin-Madison, Madison, Wisconsin, United States
| | - Nathaniel B Willis
- Department of Nutritional Sciences, College of Agriculture and Life Science, University of Wisconsin-Madison, Madison, Wisconsin, United States
| | - Lydia Henry
- Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - Chi-Liang E Yen
- Department of Nutritional Sciences, College of Agriculture and Life Science, University of Wisconsin-Madison, Madison, Wisconsin, United States
| | - Joseph P Smith
- Department of Pharmacy, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin, United States
| | - Ankush Gosain
- Department of Pediatric Surgery, Children's Hospital of Colorado, Denver, Colorado, United States
| | - Marlies Meisel
- Department of Immunology, University of Pittsburg, Pittsburg, Pennsylvania, United States
| | - Kent A Willis
- Division of Neonatology, Department of Pediatrics, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Ajay J Talati
- Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - Mohammad T Elabiad
- Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - Brianne Hibl
- Department of Comparative Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - Joseph F Pierre
- Department of Nutritional Sciences, College of Agriculture and Life Science, University of Wisconsin-Madison, Madison, Wisconsin, United States
- Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, United States
| |
Collapse
|
11
|
De Cloet J, Simal I, Benoot K, Goossens L. Assessment of the Adherence to ESPGHAN 2018 Guidelines in the Neonatal Intensive Care Unit of the Ghent University Hospital: A Retrospective Study. Nutrients 2023; 15:nu15102324. [PMID: 37242209 DOI: 10.3390/nu15102324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 05/02/2023] [Accepted: 05/14/2023] [Indexed: 05/28/2023] Open
Abstract
Parenteral nutrition (PN) is a standard of care for preterm infants in the first postnatal days. The European Society of Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) has updated their guideline recommendations on PN in 2018. However, data on actual 2018 guideline adherence in clinical practice are sparse. In this retrospective study, conducted at the neonatal intensive care unit (NICU) of Ghent University Hospital, we analyzed the ESPGHAN 2018 PN guideline adherence and growth for 86 neonates admitted to the NICU. Analyses were stratified by birth weight (<1000 g, 1000 to <1500 g, ≥1500 g). We documented the provisions for enteral nutrition (EN) and PN, and we tested the combined EN and PN provisions for ESPGHAN 2018 adherence. The nutrition protocols showed a high adherence to PN guidelines in terms of carbohydrate provisions, yet lipid provisions for EN and PN often exceeded the recommended maximum of 4 g/kg/d; although, PN lipid intakes maxed out at 3.6 g/kg/d. Protein provisions tended to fall below the recommended minimum of 2.5 g/kg/d for preterm infants and 1.5 g/kg/d for term neonates. The energy provisions also tended to fall below the minimum recommendations, especially for neonates with a birth weight (BW) < 1000 g. Over a mean PN duration of 17.1 ± 11.4 d, the median weekly Fenton Z-scores changes for length, weight, and head circumference were positive for all BW groups. Future studies have to assess how protocols adapt to current guidelines, and how this affects short- and long-term growth across different BW groups. In conclusion, the reported findings provide real-world evidence regarding the effect of ESPGHAN 2018 PN guideline adherence, and they demonstrate how standardized neonatal PN solutions can safeguard stable growth during NICU stays.
Collapse
Affiliation(s)
- Joeri De Cloet
- Pharmacy Department, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Ine Simal
- Pharmacy Department, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Karel Benoot
- Pharmacy Department, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Linde Goossens
- Neonatology Department, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| |
Collapse
|
12
|
Cerdó T, García-Santos JA, Rodríguez-Pöhnlein A, García-Ricobaraza M, Nieto-Ruíz A, G. Bermúdez M, Campoy C. Impact of Total Parenteral Nutrition on Gut Microbiota in Pediatric Population Suffering Intestinal Disorders. Nutrients 2022; 14:4691. [PMID: 36364953 PMCID: PMC9658482 DOI: 10.3390/nu14214691] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 11/01/2022] [Accepted: 11/04/2022] [Indexed: 08/10/2023] Open
Abstract
Parenteral nutrition (PN) is a life-saving therapy providing nutritional support in patients with digestive tract complications, particularly in preterm neonates due to their gut immaturity during the first postnatal weeks. Despite this, PN can also result in several gastrointestinal complications that are the cause or consequence of gut mucosal atrophy and gut microbiota dysbiosis, which may further aggravate gastrointestinal disorders. Consequently, the use of PN presents many unique challenges, notably in terms of the potential role of the gut microbiota on the functional and clinical outcomes associated with the long-term use of PN. In this review, we synthesize the current evidence on the effects of PN on gut microbiome in infants and children suffering from diverse gastrointestinal diseases, including necrotizing enterocolitis (NEC), short bowel syndrome (SBS) and subsequent intestinal failure, liver disease and inflammatory bowel disease (IBD). Moreover, we discuss the potential use of pre-, pro- and/or synbiotics as promising therapeutic strategies to reduce the risk of severe gastrointestinal disorders and mortality. The findings discussed here highlight the need for more well-designed studies, and harmonize the methods and its interpretation, which are critical to better understand the role of the gut microbiota in PN-related diseases and the development of efficient and personalized approaches based on pro- and/or prebiotics.
Collapse
Affiliation(s)
- Tomás Cerdó
- Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Reina Sofia University Hospital, University of Córdoba, 14004 Córdoba, Spain
| | - José Antonio García-Santos
- EURISTIKOS Excellence Centre for Paediatric Research, Biomedical Research Centre, University of Granada, 18016 Granada, Spain
- Department of Paediatrics, School of Medicine, University of Granada, Avda. Investigación 11, 18016 Granada, Spain
- Instituto de Investigación Biosanitaria Ibs-GRANADA, Health Sciences Technological Park, 18012 Granada, Spain
| | - Anna Rodríguez-Pöhnlein
- EURISTIKOS Excellence Centre for Paediatric Research, Biomedical Research Centre, University of Granada, 18016 Granada, Spain
- Department of Paediatrics, School of Medicine, University of Granada, Avda. Investigación 11, 18016 Granada, Spain
- Instituto de Investigación Biosanitaria Ibs-GRANADA, Health Sciences Technological Park, 18012 Granada, Spain
| | - María García-Ricobaraza
- EURISTIKOS Excellence Centre for Paediatric Research, Biomedical Research Centre, University of Granada, 18016 Granada, Spain
- Department of Paediatrics, School of Medicine, University of Granada, Avda. Investigación 11, 18016 Granada, Spain
- Instituto de Investigación Biosanitaria Ibs-GRANADA, Health Sciences Technological Park, 18012 Granada, Spain
| | - Ana Nieto-Ruíz
- EURISTIKOS Excellence Centre for Paediatric Research, Biomedical Research Centre, University of Granada, 18016 Granada, Spain
- Department of Paediatrics, School of Medicine, University of Granada, Avda. Investigación 11, 18016 Granada, Spain
- Instituto de Investigación Biosanitaria Ibs-GRANADA, Health Sciences Technological Park, 18012 Granada, Spain
| | - Mercedes G. Bermúdez
- EURISTIKOS Excellence Centre for Paediatric Research, Biomedical Research Centre, University of Granada, 18016 Granada, Spain
- Department of Paediatrics, School of Medicine, University of Granada, Avda. Investigación 11, 18016 Granada, Spain
- Instituto de Investigación Biosanitaria Ibs-GRANADA, Health Sciences Technological Park, 18012 Granada, Spain
| | - Cristina Campoy
- EURISTIKOS Excellence Centre for Paediatric Research, Biomedical Research Centre, University of Granada, 18016 Granada, Spain
- Department of Paediatrics, School of Medicine, University of Granada, Avda. Investigación 11, 18016 Granada, Spain
- Instituto de Investigación Biosanitaria Ibs-GRANADA, Health Sciences Technological Park, 18012 Granada, Spain
- Spanish Network of Biomedical Research in Epidemiology and Public Health (CIBERESP), Granada’s Node, Carlos III Health Institute, Avda. Monforte de Lemos 5, 28028 Madrid, Spain
| |
Collapse
|
13
|
Zhang XM, Zhou YQ, Wan YP, Li HJ, Chen ZQ, Song AQ, Tang ML, Xu R, Cai W. The association between parenteral nutrition and pancreatic injury in adult patients: a retrospective observational study. Nutr Metab (Lond) 2022; 19:73. [PMID: 36316774 PMCID: PMC9624056 DOI: 10.1186/s12986-022-00706-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 10/09/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Patients on parenteral nutrition (PN) are at high risk of both liver and pancreatic injury. More efforts were focused on liver, however, limited data is available to evaluate the effects of PN on pancreas. Thus, we performed a retrospective observational study to evaluate the association between PN and pancreatic injury in Chinese adult patients. METHODS Adult patients (18-80 years), who received PN for a week or longer, and with repeated measurements of pancreatic enzymes, were included in the analysis. Pancreatic injury was confirmed by serum level of pancreatic amylase (P-AMYwas 53 U/L or higher) or lipase (LP was 63 U/L or higher), which were evaluated at baseline and following every week during PN duration. Age, sex, body weight, height, diagnosis of diseases, history of diseases, surgery, white blood cell, c-reactive protein, liver and renal function, fasting blood glucose, lipid profile, and daily energy supplied by PN and enteral nutrition were abstracted from medical records. RESULTS A total number of 190 adult patients (125 men, 65 women) were included in the study. The average age and BMI were 61.8 ± 13.0 years and 21.7±3.3 kg/m2, while medium serum level of P-AMY and LP were 29.0 U/L (quartile range: 18.0, 47.0) and 33.0 U/L (quartile range: 19.0, 58.0), respectively at baseline. The median duration of PN was 15 days (quartile range: 11.0, 21.0). The prevalence of pancreatic injury was 42.1% (80/190) while it was 28.4% (54/190), 43.3% (77/178), 47.8% (44/92) after one-, two-, and three-week or longer PN adminstration. The proportion of daily energy supplement by PN (OR = 3.77, 95%CI: 1.87, 7.61) and history of infection were positively (OR = 3.00, 95%CI: 1.23, 7.36), while disease history for diabetes mellitus (OR = 0.38, 95%CI: 0.15, 0.98) and cancer (OR = 0.46, 95%CI: 0.23, 0.95), were negetively associated with pancreatic injury. Total bile acids were associated with the increment of P-AMY (beta = 0.98, 95%CI: 0.39, 1.56) and LP (beta = 2.55, 95%CI: 0.98, 4.12) by multi-variate linear regression. CONCLUSION PN was associated with pancreatic injury, as demonstrated by the increase of both serum P-AMY and LP.
Collapse
Affiliation(s)
- Xiao-Min Zhang
- Department of Pediatric Surgery, School of Medicine, Xin Hua Hospital, Shanghai Jiao Tong University, 200092, Shanghai, China
- Department of Clinical Nutrition, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 200127, Shanghai, China
| | - Yi-Quan Zhou
- Department of Clinical Nutrition, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 200127, Shanghai, China
| | - Yan-Ping Wan
- Department of Clinical Nutrition, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 200127, Shanghai, China
| | - Hao-Jie Li
- Department of Clinical Nutrition, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 200127, Shanghai, China
| | - Zhi-Qi Chen
- Department of Clinical Nutrition, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 200127, Shanghai, China
| | - An-Qi Song
- Department of Clinical Nutrition, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 200127, Shanghai, China
| | - Mo-Lian Tang
- Department of Clinical Nutrition, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 200127, Shanghai, China
| | - Renying Xu
- Department of Clinical Nutrition, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 200127, Shanghai, China.
| | - Wei Cai
- Department of Pediatric Surgery, School of Medicine, Xin Hua Hospital, Shanghai Jiao Tong University, 200092, Shanghai, China.
- Shanghai Key Laboratory of Pediatric Gastroenterology and Nutrition, Shanghai, China.
- Shanghai Institute of Pediatric Research, No. 1665, Kong Jiang Road, 200092, Shanghai, China.
| |
Collapse
|
14
|
Evans K, Battersby C, Boardman JP, Boyle EM, Carroll WD, Dinwiddy K, Dorling J, Gallagher K, Hardy P, Johnston E, Mactier H, Marcroft C, Webbe J, Gale C. National priority setting partnership using a Delphi consensus process to develop neonatal research questions suitable for practice-changing randomised trials in the United Kingdom. BMJ Open 2022; 12:e061330. [PMID: 36171048 PMCID: PMC9528679 DOI: 10.1136/bmjopen-2022-061330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Methodologically robust clinical trials are required to improve neonatal care and reduce unwanted variations in practice. Previous neonatal research prioritisation processes have identified important research themes rather than specific research questions amenable to clinical trials. Practice-changing trials require well-defined research questions, commonly organised using the Population, Intervention, Comparison, Outcome (PICO) structure. By narrowing the scope of research priorities to those which can be answered in clinical trials and by involving a wide range of different stakeholders, we aim to provide a robust and transparent process to identify and prioritise research questions answerable within the National Healthcare System to inform future practice-changing clinical trials. METHODS AND ANALYSIS A steering group comprising parents, doctors, nurses, allied health professionals, researchers and representatives from key organisations (Neonatal Society, British Association of Perinatal Medicine, Neonatal Nurses Association and Royal College of Paediatrics and Child Health) was identified to oversee this project. We will invite submissions of research questions formatted using the PICO structure from the following stakeholder groups using an online questionnaire: parents, patients, healthcare professionals and academic researchers. Unanswered, non-duplicate research questions will be entered into a three-round eDelphi survey of all stakeholder groups. Research questions will be ranked by mean aggregate scores. ETHICS AND DISSEMINATION The final list of prioritised research questions will be disseminated through traditional academic channels, directly to key stakeholder groups through representative organisations and on social media. The outcome of the project will be shared with key research organisations such as the National Institute for Health Research. Research ethics committee approval is not required.
Collapse
Affiliation(s)
- Katie Evans
- Neonatal Medicine, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Cheryl Battersby
- Neonatal Medicine, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - James P Boardman
- MRC Centre for Reproductive Health, The University of Edinburgh, Edinburgh, UK
| | - Elaine M Boyle
- Neonatal Medicine, Department of Health Sciences, University of Leicester, Leicester, UK
| | - William D Carroll
- Department of Paediatric Respiratory Medicine, University Hospitals of North Midlands, Stoke-on-Trent, UK
| | - Kate Dinwiddy
- Chief Executive of British Association of Perinatal Medicine, London, UK
| | - Jon Dorling
- Neonatal Medicine, University Hospital Southampton, Southampton, UK
| | - Katie Gallagher
- Child and Adolescent Health, University College London, EGA Institute for Women's Health, London, UK
| | - Pollyanna Hardy
- National Perinatal Epidemiology Unit, Clinical Trials Unit, University of Oxford, Oxford, UK
| | - Emma Johnston
- Parents and Families Engagement Lead, Thames Valley and Wessex Operational Deliveries Network, Thames Valley and Wessex, UK
| | - Helen Mactier
- Neonatal Medicine, University of Glasgow, Glasgow, UK
| | - Claire Marcroft
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - James Webbe
- Neonatal Medicine, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Chris Gale
- Neonatal Medicine, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| |
Collapse
|
15
|
Iping R, Hulst J, Joosten K. Research developments in pediatric intensive care nutrition: A research intelligence review. Clin Nutr ESPEN 2022; 50:1-7. [DOI: 10.1016/j.clnesp.2022.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/30/2022] [Accepted: 06/16/2022] [Indexed: 10/17/2022]
|
16
|
Joosten K, Verbruggen S. PN Administration in Critically Ill Children in Different Phases of the Stress Response. Nutrients 2022; 14:nu14091819. [PMID: 35565787 PMCID: PMC9104104 DOI: 10.3390/nu14091819] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/13/2022] [Accepted: 04/18/2022] [Indexed: 01/22/2023] Open
Abstract
Nutritional support is an important part of the treatment of critical ill children and the phase of disease has to be taken into account. The metabolic stress response during acute critical illness is characterized by severe catabolism. So far, there is no evidence that the acute catabolic state can be prevented with nutritional support. The Pediatric ’Early versus Late Parenteral Nutrition’ (PEPaNIC) trial showed that withholding supplemental parenteral nutrition (PN) during the first week in critically ill children, when enteral nutrition was not sufficient, prevented infections and shortened the stay in the pediatric intensive care unit (PICU) and the hospital. A follow-up performed 2 and 4 years later showed that withholding parenteral nutrition (PN) also improved several domains of the neurocognitive outcome of the children. Current international guidelines recommend considering withholding parenteral macronutrients during the first week of pediatric critical illness, while providing micronutrients. These guidelines also recommend upper and lower levels of intake of macronutrients and micronutrients if PN is administered.
Collapse
|