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Randunu RS, Alawaini K, Huber LA, Randell EW, Brunton JA, Bertolo RF. Feeding Parenteral Nutrition in the Neonatal Period Programs Dyslipidemia in Adulthood in Yucatan Miniature Pigs. J Nutr 2024; 154:3353-3364. [PMID: 39270853 PMCID: PMC11600043 DOI: 10.1016/j.tjnut.2024.08.031] [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: 04/16/2024] [Revised: 07/29/2024] [Accepted: 08/26/2024] [Indexed: 09/15/2024] Open
Abstract
BACKGROUND Early nutritional challenges can lead to permanent metabolic changes, increasing risk of developing chronic diseases later in life. Total parenteral nutrition (TPN) is a life-saving nutrition regimen, used especially in intrauterine growth-restricted (IUGR) neonates. Early TPN feeding alters metabolism, but whether these alterations are permanent is unclear. Programmed metabolism is likely caused by epigenetic changes due to imbalances of methyl nutrients. OBJECTIVES We sought to determine whether feeding TPN in early life would increase risk of developing dyslipidemia in adulthood and whether supplementing the methyl nutrients betaine and creatine to TPN would prevent this development. We also sought to determine whether IUGR exacerbates the effects of neonatal TPN on lipid metabolism in adulthood. METHODS Female piglets (n = 32; 7 d old) were used in 4 treatments: 24 normal-weight piglets were randomly assigned to sow-fed (SowFed), standard TPN (TPN-control), and TPN with betaine and creatine (TPN-B+C); 8 IUGR piglets were fed control TPN (TPN-IUGR) as a fourth group. After 2 wk of treatment, all pigs were then fed a standard solid diet. At 8 mo old, central venous catheters were implanted to conduct postprandial fat tolerance tests. RESULTS Feeding TPN in the neonatal period led to dyslipidemia in adulthood, as indicated by higher postprandial triglyceride (TG) levels in TPN-control (P < 0.05), compared with SowFed. IUGR piglets were particularly sensitive to neonatal TPN feeding, as TPN-IUGR piglets developed obesity and dyslipidemia in adulthood, as indicated by greater backfat thickness (P < 0.05), higher liver TG (P < 0.05), slower postprandial TG clearance (P < 0.05), and elevated fasting plasma nonhigh-density lipoprotein-cholesterol (P < 0.01), and nonesterified fatty acids (P < 0.001), compared with TPN-control. CONCLUSIONS Feeding TPN in early life increases the risk of developing dyslipidemia in adulthood, especially in IUGR neonates; however, methyl nutrient supplementation to TPN did not prevent TPN-induced changes in lipid metabolism.
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Affiliation(s)
- Raniru S Randunu
- Department of Biochemistry, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Khaled Alawaini
- Department of Biochemistry, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Lee-Anne Huber
- Department of Animal Biosciences, University of Guelph, Guelph, ON, Canada
| | - Edward W Randell
- Discipline of Laboratory Medicine, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Janet A Brunton
- Department of Biochemistry, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Robert F Bertolo
- Department of Biochemistry, Memorial University of Newfoundland, St. John's, NL, Canada.
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张 鑫, 何 洋, 唐 军, 喻 佳, 应 俊, 母 得. [Interpretation of the 2023 "Guidelines for parenteral nutrition in preterm infants: the American Society for Parenteral and Enteral Nutrition"]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2024; 26:795-802. [PMID: 39148382 PMCID: PMC11334542 DOI: 10.7499/j.issn.1008-8830.2312083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 06/04/2024] [Indexed: 08/17/2024]
Abstract
The "Guidelines for parenteral nutrition in preterm infants: the American Society for parenteral and enteral nutrition" were developed by the American Society for Parenteral and Enteral Nutrition and published in the Journal of Parenteral and Enteral Nutrition in September 2023. The guidelines provide recommendations on 12 key clinical questions regarding parenteral nutrition (PN) for preterm infants. In comparison to similar guidelines, this set offers more detailed perspectives on PN for preterm infants. It presents evidence-based recommendations for the commencement time, nutrient dosage, and composition of PN, considering primary outcomes such as growth and development, as well as secondary outcomes like sepsis, retinopathy of prematurity, parenteral nutrition-related liver disease, and jaundice. This article aims to interpret the guidelines to provide a reference for colleagues in the field.
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Affiliation(s)
| | | | - 军 唐
- 出生缺陷与相关妇儿疾病教育部重点实验室,四川成都610041
| | - 佳洁 喻
- 四川大学华西医院临床流行病学与循证医学中心,四川成都610041
| | - 俊杰 应
- 出生缺陷与相关妇儿疾病教育部重点实验室,四川成都610041
| | - 得志 母
- 出生缺陷与相关妇儿疾病教育部重点实验室,四川成都610041
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3
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Fisher E, Staub E. Hypophosphataemia and late-onset sepsis in extremely preterm neonates: A case-control study. J Paediatr Child Health 2024; 60:323-329. [PMID: 38949099 DOI: 10.1111/jpc.16589] [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] [Received: 03/16/2023] [Revised: 12/06/2023] [Accepted: 05/24/2024] [Indexed: 07/02/2024]
Abstract
AIM Late-onset sepsis (LOS) is common in extreme prematurity. These infants are at risk of refeeding syndrome-associated hypophosphataemia. Our objective was to investigate whether hypophosphataemia predisposes to LOS in extremely premature neonates. METHODS A retrospective case-control study of neonates born before 29 weeks' gestation in an Australian NICU from 2016 to 2020. Cases developed LOS or localised infection. Two controls, matched within 2 gestational weeks and 90 calendar days, were selected per case. RESULTS Amongst 48 cases and 93 controls, cases were smaller at birth (767 g vs. 901 g, P = 0.01), but were otherwise comparable. Hypophosphataemia was more common in cases (26% vs. 15%, P = 0.18). Increased intravenous protein intake in the first week was protective against LOS (OR = 0.9, 95% CI 0.76-1.00, P = 0.04); median 2.1 g/kg/day in cases, 2.3 g/kg/day in controls. CONCLUSIONS Hypophosphataemia as part of refeeding syndrome is prevalent and under-recognised in extremely premature neonates. We did not find an association between hypophosphataemia and LOS. Low intravenous protein may be an independent risk factor for infection.
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Affiliation(s)
- Elizabeth Fisher
- Neonatal Intensive Care Unit, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Eveline Staub
- Neonatal Intensive Care Unit, Royal North Shore Hospital, St Leonards, New South Wales, Australia
- University of Sydney, Sydney, New South Wales, Australia
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4
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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.
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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.
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5
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Fayol L, Yaacoub J, Baillat M, des Robert C, Pauly V, Dagau G, Berbis J, Arnaud F, Baudesson A, Brévaut-Malaty V, Derain-Court J, Desse B, Fortier C, Mallet E, Ledoyen A, Parache C, Picaud JC, Quetin P, Richard B, Zoccarato AM, Maillotte AM, Boubred F. Association of Standardized Parenteral Nutrition with Early Neonatal Growth of Moderately Preterm Infants: A Population-Based Cohort Study. Nutrients 2024; 16:1292. [PMID: 38732538 PMCID: PMC11085250 DOI: 10.3390/nu16091292] [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: 04/02/2024] [Revised: 04/17/2024] [Accepted: 04/23/2024] [Indexed: 05/13/2024] Open
Abstract
In preterm infants, early nutrient intake during the first week of life often depends on parenteral nutrition. This study aimed to evaluate the influence of standardized parenteral nutrition using three-in-one double-chamber solutions (3-in-1 STD-PN) on early neonatal growth in a cohort of moderately preterm (MP) infants. This population-based, observational cohort study included preterm infants admitted to neonatal centers in the southeast regional perinatal network in France. During the study period, 315 MP infants with gestational ages between 320/7 and 346/7 weeks who required parenteral nutrition from birth until day-of-life 3 (DoL3) were included; 178 received 3-in-1 STD-PN solution (56.5%). Multivariate regression was used to assess the factors associated with the relative body-weight difference between days 1 and 7 (RBWD DoL1-7). Infants receiving 3-in-1 STD-PN lost 36% less body weight during the first week of life, with median RBWD DoL1-7 of -2.5% vs. -3.9% in infants receiving other PN solutions (p < 0.05). They also received higher parenteral energy and protein intakes during the overall first week, with 85% (p < 0.0001) and 27% (p < 0.0001) more energy and protein on DoL 3. After adjusting for confounding factors, RBWD DoL1-7 was significantly lower in the 3-in-1 STD-NP group than in their counterparts, with beta (standard deviation) = 2.08 (0.91), p = 0.02. The use of 3-in-1 STD-PN provided better energy and protein intake and limited early weight loss in MP infants.
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Affiliation(s)
- Laurence Fayol
- Department of Neonatology, Hôpital La Conception, Hôpitaux Universitaires de Marseille, 13005 Marseille, France (C.d.R.); (F.B.)
- Réseau Périnatal Méditerranée (PACA-Corse-Monaco), 13015 Marseille, France;
| | - Jilnar Yaacoub
- Department of Neonatology, Hôpital La Conception, Hôpitaux Universitaires de Marseille, 13005 Marseille, France (C.d.R.); (F.B.)
| | - Marine Baillat
- Department of Neonatology, Hôpital La Conception, Hôpitaux Universitaires de Marseille, 13005 Marseille, France (C.d.R.); (F.B.)
| | - Clotilde des Robert
- Department of Neonatology, Hôpital La Conception, Hôpitaux Universitaires de Marseille, 13005 Marseille, France (C.d.R.); (F.B.)
| | - Vanessa Pauly
- Research Unit EA 3279, Department of Public Health, Aix-Marseille University, 13005 Marseille, France; (V.P.); (J.B.)
| | - Gina Dagau
- Centre Hospitalier de Martigues, 13500 Martigues, France
| | - Julie Berbis
- Research Unit EA 3279, Department of Public Health, Aix-Marseille University, 13005 Marseille, France; (V.P.); (J.B.)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Anne-Marie Maillotte
- Réseau Périnatal Méditerranée (PACA-Corse-Monaco), 13015 Marseille, France;
- Centre Hospitalier Universitaire, 06000 Nice, France
| | - Farid Boubred
- Department of Neonatology, Hôpital La Conception, Hôpitaux Universitaires de Marseille, 13005 Marseille, France (C.d.R.); (F.B.)
- Aix-Marseille Université, C2VN, INRAE, INSERM, 13005 Marseille, France
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6
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Trivedi A, Jatana V, Sinn JK. Early versus late administration of amino acids in preterm infants receiving parenteral nutrition. Cochrane Database Syst Rev 2024; 1:CD008771. [PMID: 38275196 PMCID: PMC10811752 DOI: 10.1002/14651858.cd008771.pub3] [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: 01/27/2024]
Abstract
BACKGROUND Observational studies in preterm newborns suggest that delay in administering amino acids (AA) could result in a protein catabolic state and impact on growth and development. OBJECTIVES The objective of this review was to compare the efficacy and safety of early versus late administration of intravenous AA in neonates born at < 37 weeks of gestation. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, and trial registries in March 2023. We checked the reference lists of included studies and studies/systematic reviews where subject matter related to the intervention or population examined in this review. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing early administration of AA with late administration in premature newborn infants. We defined early administration of AA solution as the administration of AA in isolation or with total parenteral nutrition within the first 24 hours of birth, and late administration as the administration of AA in isolation or with total parenteral nutrition after the first 24 hours of birth. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodological procedures. We used the GRADE approach to assess the certainty of the evidence. MAIN RESULTS Nine studies (383 participants) were eligible for inclusion in the review. All study participants were born at < 37 weeks of gestation and were inpatients in neonatal intensive care units. No studies reported growth during the first months of life as assessed by difference in weight. Early administration of AA may have little or no effect on growth in the first month of life as measured by length (mean difference (MD) 0.00, 95% confidence interval (CI) -0.41 to 0.41; 1 study; 21 participants; low-certainty evidence) and head circumference (MD 0.05, 95% CI -0.03 to 0.14; 2 studies; 87 participants; low-certainty evidence). No studies reported the discharge weight outcome. Early administration of AA may result in little to no difference in neurodevelopmental outcome assessed by Mental Developmental Index (MDI) of < 70 at two years of age (odds ratio 0.83, 95% CI 0.21 to 3.28; 1 study; 111 participants; low-certainty evidence). No studies reported all-cause mortality at 28 days and before discharge. Early administration of AA may result in a large increase in positive nitrogen balance in the first three days of life (MD 250.42, 95% CI 224.91 to 275.93; 4 studies; 93 participants; low-certainty evidence). AUTHORS' CONCLUSIONS Low-certainty evidence suggests that there may be little to no difference between early and late administration of AA in growth (measured by length and head circumference during the first month after birth) and neurodevelopmental outcome (assessed by MDI of < 70). No RCTs reported on weight in the first month of life, mortality (all-cause mortality at 28 days and before discharge), or discharge weight. Low-certainty evidence suggests a large increase in positive nitrogen balance in preterm infants who received AA within 24 hours of birth. The clinical relevance of this observation is unknown. The number of infants in the RCTs included in the review was small, and there was clinical heterogeneity amongst trials. Adequately powered trials in infants < 37 weeks' gestation are required to determine optimal timing of initiation of AA. We identified two ongoing studies. Both studies will be recruiting infants ≥ 34 weeks of gestation and may or may not add to the outcome data for this review.
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Affiliation(s)
- Amit Trivedi
- Grace Centre for Newborn Intensive Care, The Children's Hospital at Westmead, Westmead, Australia
- The University of Sydney, Sydney, Australia
| | - Vishal Jatana
- Helen MacMillan Paediatric Intensive Care Unit, The Children's Hospital at Westmead, Westmead, Australia
| | - John Kh Sinn
- Department of Neonatology, Royal North Shore Hospital, The University of Sydney, Sydney, Australia
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If It Ain't Broke, Don't Fix It? J Perinat Neonatal Nurs 2024; 38:4-5. [PMID: 38278635 DOI: 10.1097/jpn.0000000000000794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
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8
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Meiliana M, Alexander T, Bloomfield FH, Cormack BE, Harding JE, Walsh O, Lin L. Nutrition guidelines for preterm infants: A systematic review. JPEN J Parenter Enteral Nutr 2024; 48:11-26. [PMID: 37855274 DOI: 10.1002/jpen.2568] [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: 06/23/2023] [Revised: 08/21/2023] [Accepted: 10/16/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND There is no consensus on optimal nutrition for preterm infants, leading to substantial practice variation. We aimed to assess the quality of nutrition guidelines for preterm infants, the consistency of recommendations, and the gaps in recommendations. METHODS We searched databases and websites for nutrition guidelines for preterm infants before first hospital discharge, which were endorsed, prepared, or authorized by a regional, national, or international body, written in English, and published between 2012 and 2023. Two reviewers independently screened articles and extracted the recommendations. Four reviewers appraised the included guidelines using Appraisal of Guidelines, Research, and Evaluation II. RESULTS A total of 7051 were identified, with 27 guidelines included, 26% of which were high in quality. Most guidelines lacked stakeholder involvement and rigor of development. We found considerable variation in recommendations, many of which lacked details on certainty of evidence and strength of recommendation. Recommendations for type of feed and breastmilk fortification were consistent among high-quality guidelines, but recommendations varied for intakes of almost all nutrients and monitoring of nutrition adequacy. Different guidelines gave different certainty of evidence for the same recommendations. Most gaps in recommendations were due to very low certainty of evidence. CONCLUSION Future development of nutrition guidelines for preterm infants should follow the standard guideline development method and ensure the rigorous process, including stakeholders' involvement, to improve the reporting of strength of recommendation, certainty of evidence, and gaps in recommendation. Evidence is needed to support recommendations about macro and micronutrient intakes, breastmilk fortification, and markers on adequacy of intake of different nutrients.
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Affiliation(s)
| | - Tanith Alexander
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Neonatal Unit, Kidz First, Middlemore Hospital, Auckland, New Zealand
| | | | | | - Jane E Harding
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Orla Walsh
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Luling Lin
- Liggins Institute, University of Auckland, Auckland, New Zealand
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9
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Fanjeaux C, Vazquez R, Guerrault-Moro MN, Lagrave AC. Capillary electrophoresis in parenteral nutrition control - validation of two analytical methods: Amino acids/glucose/glucose-1-phosphate and K/Na/Ca/Mg. Eur J Hosp Pharm 2023:ejhpharm-2023-003848. [PMID: 37798088 DOI: 10.1136/ejhpharm-2023-003848] [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: 05/25/2023] [Accepted: 09/12/2023] [Indexed: 10/07/2023] Open
Abstract
OBJECTIVES Production of parenteral nutrition bags (PNBs) involves many nutrients: complete control of the production process decreases the risk of error. This study aimed to develop and validate two analytical methods by capillary electrophoresis (CE) for simultaneous detection of: glucose, amino acids (Primene®) and glucose-1-phosphate (Phocytan®) (anionic method, AM) on one hand; and on the other hand potassium, sodium, calcium and magnesium (cationic method, CM). METHODS Methods were developed using capillary electrophoresis with diode array detection (CE-DAD) (CE 7100, Agilent), indirect photometric detection, 56 cm long capillary and two different buffers (pH=12.1 for AM and pH=3.2 for CM). These methods were validated according to guidelines from the Société Française des Sciences et Techniques Pharmaceutiques (SFSTP).Analytical parameters were optimised: temperature was regulated at 15°C and the current settled to - 15kV, for a 21 minute analysis time for AM. Conditions were settled to 25°C and 30kV for CM so the analysis time dropped to 7 minutes.Accuracy profiles were established and recovery rates (RR), Repeatability and Reproducibility Coefficient of Variation (respectively RaCV and RoCV) were calculated.Capability was also calculated for each nutrient and concentration range according to guidelines from the Evaluation and Research Group on Protection in a Controlled Atmosphere (GERPAC). RESULTS Methods were successfully validated with: RR between 99.2 and 101.9%, RaCV between 1.5 and 3.1%, and RoCV between 2.4 and 4.1% for AM, and RR between 97.5 and 102.7%, RaCV between 0.5 and 2.3%, and RoCV between 0.6 and 2.8% for CM.Accuracy profiles were established with 95% β probability, except for glucose-1-phosphate (90%). Acceptance limits were settled to ±1 0% of target value. Capabilities are defined as "good" or "very good". CONCLUSIONS The methods developed by this research will ensure the composition of PNB is compliant to PNB formulas. These results show CE is an appropriate method for PNB quantitative control.CE utilisation for controlling other hospital preparations seems to be a relevant alternative to conventional methods such as liquid chromatography.
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10
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Kindt A, Kraus Y, Rasp D, Foerster KM, Ahmidi N, Flemmer AW, Herber-Jonat S, Heinen F, Weigand H, Hankemeier T, Koletzko B, Krumsiek J, Babl J, Hilgendorff A. Improved Macro- and Micronutrient Supply for Favorable Growth and Metabolomic Profile with Standardized Parenteral Nutrition Solutions for Very Preterm Infants. Nutrients 2022; 14:3912. [PMID: 36235563 PMCID: PMC9572167 DOI: 10.3390/nu14193912] [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] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/09/2022] [Accepted: 09/10/2022] [Indexed: 11/16/2022] Open
Abstract
Very preterm infants are at high risk for suboptimal nutrition in the first weeks of life leading to insufficient weight gain and complications arising from metabolic imbalances such as insufficient bone mineral accretion. We investigated the use of a novel set of standardized parenteral nutrition (PN; MUC PREPARE) solutions regarding improving nutritional intake, accelerating termination of parenteral feeding, and positively affecting growth in comparison to individually prescribed and compounded PN solutions. We studied the effect of MUC PREPARE on macro- and micronutrient intake, metabolism, and growth in 58 very preterm infants and compared results to a historic reference group of 58 very preterm infants matched for clinical characteristics. Infants receiving MUC PREPARE demonstrated improved macro- and micronutrient intake resulting in balanced electrolyte levels and stable metabolomic profiles. Subsequently, improved energy supply was associated with up to 1.5 weeks earlier termination of parenteral feeding, while simultaneously reaching up to 1.9 times higher weight gain at day 28 in extremely immature infants (<27 GA weeks) as well as overall improved growth at 2 years of age for all infants. The use of the new standardized PN solution MUC PREPARE improved nutritional supply and short- and long-term growth and reduced PN duration in very preterm infants and is considered a superior therapeutic strategy.
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Affiliation(s)
- Alida Kindt
- Institute of Computational Biology, Helmholtz Zentrum München, 85764 Oberschleißheim, Germany
- Metabolomics and Analytics Center, Leiden Academic Centre for Drug Research, Leiden University, 2333 AL Leiden, The Netherlands
| | - Yvonne Kraus
- Center for Comprehensive Developmental Care (CDeCLMU), Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Department of Pediatrics, Dr von Hauner Children's Hospital, Munich University Hospital, Ludwig Maximilians University, 80336 Munich, Germany
- Comprehensive Pneumology Center, Helmholtz Zentrum München, Member of the German Lung Research Center (DZL), 81377 Munich, Germany
| | - David Rasp
- Metabolomics and Analytics Center, Leiden Academic Centre for Drug Research, Leiden University, 2333 AL Leiden, The Netherlands
| | - Kai M. Foerster
- Comprehensive Pneumology Center, Helmholtz Zentrum München, Member of the German Lung Research Center (DZL), 81377 Munich, Germany
- Department of Neonatology, Perinatal Center, Dr. von Hauner Children’s Hospital, Ludwig-Maximilians University, 80337 Munich, Germany
| | - Narges Ahmidi
- Institute of Computational Biology, Helmholtz Zentrum München, 85764 Oberschleißheim, Germany
| | - Andreas W. Flemmer
- Department of Neonatology, Perinatal Center, Dr. von Hauner Children’s Hospital, Ludwig-Maximilians University, 80337 Munich, Germany
| | - Susanne Herber-Jonat
- Department of Neonatology, Perinatal Center, Dr. von Hauner Children’s Hospital, Ludwig-Maximilians University, 80337 Munich, Germany
| | - Florian Heinen
- Center for Comprehensive Developmental Care (CDeCLMU), Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Department of Pediatrics, Dr von Hauner Children's Hospital, Munich University Hospital, Ludwig Maximilians University, 80336 Munich, Germany
| | - Heike Weigand
- Center for Comprehensive Developmental Care (CDeCLMU), Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Department of Pediatrics, Dr von Hauner Children's Hospital, Munich University Hospital, Ludwig Maximilians University, 80336 Munich, Germany
| | - Thomas Hankemeier
- Metabolomics and Analytics Center, Leiden Academic Centre for Drug Research, Leiden University, 2333 AL Leiden, The Netherlands
| | - Berthold Koletzko
- Division of Metabolic and Nutritional Medicine, Department of Paediatrics, Dr. von Hauner Children’s Hospital University Hospital, Ludwig-Maximilians University, 81377 Munich, Germany
| | - Jan Krumsiek
- Institute of Computational Biology, Helmholtz Zentrum München, 85764 Oberschleißheim, Germany
- Institute for Computational Biomedicine, Englander Institute for Precision Medicine, Department of Physiology and Biophysics, Weill Cornell Medicine, New York, NY 10065, USA
| | - Juergen Babl
- Pharmacy of the University Hospital, Ludwig-Maximilians University, 81377 Munich, Germany
| | - Anne Hilgendorff
- Center for Comprehensive Developmental Care (CDeCLMU), Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Department of Pediatrics, Dr von Hauner Children's Hospital, Munich University Hospital, Ludwig Maximilians University, 80336 Munich, Germany
- Comprehensive Pneumology Center, Helmholtz Zentrum München, Member of the German Lung Research Center (DZL), 81377 Munich, Germany
- Department of Neonatology, Perinatal Center, Dr. von Hauner Children’s Hospital, Ludwig-Maximilians University, 80337 Munich, Germany
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11
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Thyroid Dysfunction and the Effect of Iodine-Deficient Parenteral Nutrition in Very Low Birth Weight Infants: A Nationwide Analysis of a Korean Neonatal Network Database. Nutrients 2022; 14:nu14153043. [PMID: 35893897 PMCID: PMC9331788 DOI: 10.3390/nu14153043] [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: 06/21/2022] [Revised: 07/20/2022] [Accepted: 07/23/2022] [Indexed: 11/30/2022] Open
Abstract
Background: To investigate the impact of nutritional iodine deficiency on thyroid dysfunction (TD) in very low birth weight (VLBW) infants, we analyzed the association between iodine-deficient parenteral nutrition (PN) and TD requiring L-thyroxine (TD-LT4). Methods: Data of VLBW infants were obtained from the Korean Neonatal Network registry. Factors including duration of PN were analyzed according to TD-LT4. Results: TD-LT4 occurred in 490 (8.7%) of 5635 infants, and more frequently occurred in infants requiring PN for ≥4 weeks (10.2%). PN ≥ 4 weeks was one of the risk factors for TD-LT4, with an odds ratio (OR) of 1.346, p = 0.002. However, multivariate analysis showed that TD-LT4 was more of a risk for infants that were small for gestational age (OR 2.987, p < 0.001) and for other neonatal morbidities such as seizures (OR 1.787, p = 0.002) and persistent pulmonary hypertension (OR 1.501, p = 0.039) than PN ≥ 4 weeks (OR 0.791, p = 0.080). Conclusions: Prolonged iodine-deficient PN might affect TD-LT4 in VLBW infants. However, the effect of nutritional iodine deficiency on TD-LT4 risk was less than that of SGA or severe neonatal morbidities in Korean VLBW infants.
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12
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Use of parenteral nutrition in term and late preterm infants: an Australian and New Zealand survey. Br J Nutr 2022; 128:131-138. [PMID: 34378499 DOI: 10.1017/s0007114521003020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
There is limited information regarding the use of parenteral nutrition (PN) in term and late preterm infants. We conducted a survey to study the current clinical practices within Australia and New Zealand (ANZ). A fifteen-question online survey was distributed to 232 neonatologists and fifty-five paediatric intensivists across ANZ between September and November 2019. At least one neonatologist from twenty-seven out of thirty tertiary neonatal intensive care units responded (90 %). Responses were received from sixty-nine neonatologists (30 %) and seven paediatric intensivists (13 %). The overall response rate was 26 % (76/287). Thirty-three percent (25/76) commenced PN within 24 h of admission, 27 % (20/75) between 24 and 48 h, 24 % (18/75) between 48 and 72 h, 9 % (7/75) between 72 and 96 h and 4 % (3/75) between 96 h and 7 days. None of the respondents commenced PN after 7 d of admission. Sixty-one percent (46/75) aimed for 1·5-3 g/kg per d of parenteral amino acids, whereas 27 % (20/75) aimed for 2-3 g/kg per d. Renal failure (59 %; 38/64) and high plasma urea (44 %; 28/64) were the major indications for withholding/decreasing the amino acid intake. Eighty-three percent (63/76) aimed for a dose of 2·5g-3·5 g/kg per d of parenteral lipids; about 9 % (7/76) targeted a dose of 1-2·5 g/kg per d and 4 % (3/76) for > 3·5 g/kg per d. Thirty-two percent (24/74) reported that they would withhold/decrease the dose of parenteral lipids in infants with sepsis. The variations in clinicians' practices with respect to the use of PN in term and late preterm infants highlight the need for high-quality research in this population.
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13
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Abbassi A, Hasni N, Ben Hamida EB. Impact of computerized physician order entry system on parenteral nutrition medication errors in a teaching neonatal intensive care unit. ANNALES PHARMACEUTIQUES FRANÇAISES 2022; 80:819-826. [PMID: 35568248 DOI: 10.1016/j.pharma.2022.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 05/10/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Parenteral nutrition (PN) offers a quality therapeutic option when enteral feeding is non-tolerated or impossible. However, it can be associated with an increased risk of medical errors, especially in sensitive populations such as newborns. This study aimed at determining the impact of the implementation of a computerized physician order entry (CPOE) system on PN medication errors in the neonatology department in the largest teaching hospital in Tunisia. Materiel & Methods: The frequency of medication errors in PN, in a teaching neonatal intensive care unit, was prospectively reviewed by a pharmacist between December 2018 and March 2019 in a two-phase interventional study (pre and post locally developed CPOE System implementation). RESULTS Implementation of CPOE system decreased PN order errors from 379 to 147 representing a 61.1% reduction. The decreases on PN order errors per stage, i.e. prescribing and preparation, were form 207 to 22 (89.4%), and from 117 to 66 (43.6%) respectively. Mean nutrients intakes were in conformity to the recommended daily intakes during the CPOE phase of the study. CPOE is a protective tool against prescription and preparation errors. It significantly impacted all items of the ordering process. CONCLUSIONS In addition to the rigorous application of the recommendations, the CPOE system allows to reduce the risk of PN medication errors. This improves the safety and quality of medicines in newborns.
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Affiliation(s)
- A Abbassi
- Department of Pharmacy, Charle-Nicolle Hospital, 1006 Tunis, Tunisia.
| | - N Hasni
- College of Pharmacy, 5000 Monastir, Tunisia.
| | - E B Ben Hamida
- Neonatal intensive care unit, Charles-Nicolle Hospital, 1006 Tunis, Tunisia.
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14
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Optimal Nutrition Parameters for Neonates and Infants with Congenital Heart Disease. Nutrients 2022; 14:nu14081671. [PMID: 35458233 PMCID: PMC9029500 DOI: 10.3390/nu14081671] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/04/2022] [Accepted: 04/11/2022] [Indexed: 02/04/2023] Open
Abstract
Congenital heart defects are known causes of malnutrition. Optimal nutritional management is paramount in improving short and long-term prognosis for neonates and infants with congenital heart malformations, as current strategies target preoperative and postoperative feeding requirements. Standardized enteral and/or parenteral feeding protocols, depending on the systemic implications of the cardiac defect, include the following common practices: diagnosing and managing feeding intolerance, choosing the right formula, and implementing a monitoring protocol. The latest guidelines from the American Society for Parenteral and Enteral Nutrition and the European Society of Paediatric and Neonatal Intensive Care, as well as a significant number of recent scientific studies, offer precious indications for establishing the best feeding parameters for neonates and infants with heart defects.
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15
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Ambreen G, Kumar V, Ali SR, Jiwani U, Khowaja W, Hussain AS, Hussain K, Raza SS, Rizvi A, Ansari U, Ahmad K, Demas S, Ariff S. Impact of a standardised parenteral nutrition protocol: a quality improvement experience from a NICU of a developing country. Arch Dis Child 2022; 107:381-386. [PMID: 34257078 DOI: 10.1136/archdischild-2021-321552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 06/21/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Nutrition societies recommend using standardised parenteral nutrition (SPN) solutions. We designed evidence-based SPN formulations for neonates admitted to our neonatal intensive care unit (NICU) and evaluated their outcomes. DESIGN This was a quality improvement initiative. Data were collected retrospectively before and after the intervention. SETTING A tertiary-care level 3 NICU at the Aga Khan University in Karachi, Pakistan. PATIENTS All NICU patients who received individualised PN (IPN) from December 2016 to August 2017 and SPN from October 2017 to June 2018. INTERVENTIONS A team of neonatologists and nutrition pharmacists collaborated to design two evidence-based SPN solutions for preterm neonates admitted to the NICU. MAIN OUTCOME MEASURES We recorded mean weight gain velocity from days 7 to 14 of life. The other outcomes were change in weight expressed as z-scores, metabolic abnormalities, PN-associated liver disease (PNALD), length of NICU stay and episodes of sepsis during hospital stay. RESULTS Neonates on SPN had greater rate of change in weight compared with IPN (β=13.40, 95% CI: 12.02 to 14.79) and a smaller decrease in z-scores (p<0.001). Neonates in the SPN group had fewer hyperglycemic episodes (IPN: 37.5%, SPN: 6.2%) (p<0.001), electrolyte abnormalities (IPN: 56.3%, SPN: 21%) (p<0.001), PNALD (IPN: 52.5%, SPN: 18.5%) (p<0.001) and sepsis (IPN: 26%, SPN: 20%) (p<0.05). The median length of stay in NICU was 14.0 (IQR 12.0-21.0) for the IPN and 8.0 (IQR 5.0-13.0) days for the SPN group. CONCLUSIONS We found that SPN was associated with shorter NICU stay and greater weight gain. In-house preparation of SPN can be used to address the nutritional needs in resource-limited settings where commercially prepared SPN is not available.
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Affiliation(s)
- Gul Ambreen
- Department of Pharmacy, Aga Khan University Hospital, Karachi, Pakistan
| | - Vikram Kumar
- Neonatology, Indus Hospital and Health Network, Karachi, Sindh, Pakistan
| | - Syed Rehan Ali
- Neonatology, Indus Hospital and Health Network, Karachi, Sindh, Pakistan
| | - Uswa Jiwani
- Center of Excellence in Women and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Waqar Khowaja
- Department of Paediatrics and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Ali Shabbir Hussain
- Department of Paediatrics and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Kashif Hussain
- Department of Pharmacy, Aga Khan University Hospital, Karachi, Pakistan
| | - Syed Shamim Raza
- Department of Pharmacy, Aga Khan University Hospital, Karachi, Pakistan
| | - Arjumand Rizvi
- Department of Paediatrics and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Uzair Ansari
- Department of Paediatrics and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Khalil Ahmad
- Department of Paediatrics and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Simon Demas
- Department of Paediatrics and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Shabina Ariff
- Department of Paediatrics and Child Health, Aga Khan University Hospital, Karachi, Pakistan
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16
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Ozer Bekmez B, Oguz SS. Early vs late initiation of sodium glycerophosphate: Impact on hypophosphatemia in preterm infants <32 weeks. Clin Nutr 2021; 41:415-423. [PMID: 35007810 DOI: 10.1016/j.clnu.2021.12.011] [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: 09/21/2021] [Revised: 11/27/2021] [Accepted: 12/07/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND & AIMS Early electrolyte and mineral imbalances have emerged as a conspicuous problem in very preterm babies since the revision of nutrition guidelines and the eventual implementation of early aggressive parenteral nutrition (PN). We opted to carry out a study with the introduction of phosphorus as sodium glycerophosphate in PN from the first day onward to reveal the impact on serum phosphorus and calcium levels following the surge in the incidence of hypercalcemia and hypophosphatemia. METHODS In this single-center, prospective, observational cohort study, inborn babies <32 gestational weeks and <1500 g between August 2017 and July 2018 were enrolled consecutively. Infants born in the first 6-month of this period were initiated PN (Early phosphorus group) containing phosphorus (1 mmol P as sodium glycerophosphate/100 ml PN) immediately after birth, and in the latter six-months, mineral-free standard PN (Control group) was commenced up until 48 h of life. Parenteral nutritional prescriptions of both groups were similar in terms of macro and micronutrient intakes except for early phosphorus, calcium, and sodium. Serum mineral and electrolyte levels were measured on Days 1-3-7 and compared between the groups. The primary outcome was the presence of hypophosphatemia in the first week of life. The secondary outcome was hypercalcemia, preterm morbidity, and mortality. RESULTS A total of 261 infants were included in this study. There were 130 babies in Early phosphorus group and 131 in control group. Gestational ages (28.79 ± 2.1 vs 28.46 ± 2.2 weeks, respectively) and birth weights (1138 ± 273 vs 1090 ± 274 g, respectively) were similar in the groups. Mean serum phosphorus levels were higher on all days in Early phosphorus group (p < 0.001). Early phosphorus group had a lower incidence of hypophosphatemia on days 1-3 and 7 (p < 0.001). The percentage of hypercalcemic infants was significantly lower in Early phosphorus group on day 3 (p < 0.001). No difference was noted in terms of hypernatremia in the groups. CONCLUSIONS Adding phosphorus to PN in the first hours of life reduced the frequency of hypophosphatemia and hypercalcemia without any surge in hypernatremia or morbidity. Nutrition guidelines need to be revised accordingly in terms of early mineral/electrolyte supplementation.
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Affiliation(s)
- Buse Ozer Bekmez
- Sariyer Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey.
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17
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Ray S. NICE guideline review: Neonatal parenteral nutrition (NG154). Arch Dis Child Educ Pract Ed 2021; 106:292-295. [PMID: 33199498 DOI: 10.1136/archdischild-2020-320581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 10/21/2020] [Accepted: 10/25/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Sagarika Ray
- Department of Neonatal Medicine, Shrewsbury and Telford Hospital NHS Trust, Telford TF1 6TF, UK
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18
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Neonatal intensive care unit (NICU) exposures exert a sustained influence on the progression of gut microbiota and metabolome in the first year of life. Sci Rep 2021; 11:1353. [PMID: 33446779 PMCID: PMC7809424 DOI: 10.1038/s41598-020-80278-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 12/18/2020] [Indexed: 12/19/2022] Open
Abstract
Emerging evidence has shown a link between the perturbations and development of the gut microbiota in infants with their immediate and long-term health. To better understand the assembly of the gut microbiota in preterm infants, faecal samples were longitudinally collected from the preterm (n = 19) and term (n = 20) infants from birth until month 12. 16S rRNA gene sequencing (n = 141) and metabolomics profiling (n = 141) using nuclear magnetic resonance spectroscopy identified significant differences between groups in various time points. A panel of amino acid metabolites and central metabolism intermediates significantly correlated with the relative abundances of 8 species of bacteria were identified in the preterm group. In contrast, faecal metabolites of term infants had significantly higher levels of metabolites which are commonly found in milk such as fucose and β-hydroxybutyrate. We demonstrated that the early-life factors such as gestational age, birth weight and NICU exposures, exerted a sustained effect to the dynamics of gut microbial composition and metabolism of the neonates up to one year of age. Thus, our findings suggest that intervention at this early time could provide ‘metabolic rescue’ to preterm infants from aberrant initial gut microbial colonisation and succession.
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19
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Neonatal intensive care unit (NICU) exposures exert a sustained influence on the progression of gut microbiota and metabolome in the first year of life. Sci Rep 2021; 11:1353. [PMID: 33446779 PMCID: PMC7809424 DOI: 10.1038/s41598-020-80278-1 10.1038/s41598-021-88758-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Emerging evidence has shown a link between the perturbations and development of the gut microbiota in infants with their immediate and long-term health. To better understand the assembly of the gut microbiota in preterm infants, faecal samples were longitudinally collected from the preterm (n = 19) and term (n = 20) infants from birth until month 12. 16S rRNA gene sequencing (n = 141) and metabolomics profiling (n = 141) using nuclear magnetic resonance spectroscopy identified significant differences between groups in various time points. A panel of amino acid metabolites and central metabolism intermediates significantly correlated with the relative abundances of 8 species of bacteria were identified in the preterm group. In contrast, faecal metabolites of term infants had significantly higher levels of metabolites which are commonly found in milk such as fucose and β-hydroxybutyrate. We demonstrated that the early-life factors such as gestational age, birth weight and NICU exposures, exerted a sustained effect to the dynamics of gut microbial composition and metabolism of the neonates up to one year of age. Thus, our findings suggest that intervention at this early time could provide 'metabolic rescue' to preterm infants from aberrant initial gut microbial colonisation and succession.
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20
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Suganuma H, Bonney D, Andersen CC, McPhee AJ, Sullivan TR, Gibson RA, Collins CT. The efficacy and safety of peripheral intravenous parenteral nutrition vs 10% glucose in preterm infants born 30 to 33 weeks' gestation: a randomised controlled trial. BMC Pediatr 2020; 20:384. [PMID: 32799841 PMCID: PMC7429781 DOI: 10.1186/s12887-020-02280-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 08/07/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Preterm infants born 30 to 33 weeks' gestation often require early support with intravenous fluids because of respiratory distress, hypoglycemia or feed intolerance. When full feeds are anticipated to be reached within the first week, risks associated with intravenous delivery mode and type must be carefully considered. Recommendations are for parenteral nutrition to be infused via central venous lines (because of the high osmolarity), however, given the risks associated with central lines, clinicians may opt for 10% glucose via peripheral venous catheter when the need is short-term. We therefore compare a low osmolarity peripheral intravenous parenteral nutrition (P-PN) solution with peripheral intravenous 10% glucose on growth rate in preterm infants born 30 to 33 weeks' gestation. METHODS In this parallel group, single centre, superiority, non-blinded, randomised controlled trial, 92 (P-PN 42, control 50) infants born 30+ 0 to 33+ 6 weeks' gestation, were randomised within 24 h of age, to receive either P-PN (8% glucose, 30 g/L amino acids, 500 IU/L heparin and SMOFlipid®) or a control of peripheral intravenous 10% glucose. Both groups received enteral feeds according to hospital protocol. The primary outcome was rate of weight gain from birth to 21 days of age. RESULTS The rate of weight gain was significantly increased in P-PN infants compared with control (P-PN, n = 42, 18.7, SD 6.6 g/d vs control, n = 50, 14.8, SD 6.0 g/d; adjusted mean difference 3.9 g/d, 95% CI 1.3 to 6.6; P = 0.004), with the effect maintained to discharge home. Days to regain birthweight were significantly reduced and length gain significantly increased in P-PN infants. One infant in the P-PN group had a stage 3 extravasation which rapidly resolved. Blood urea nitrogen and triglyceride levels were significantly higher in the P-PN group in the first week of life, but there were no instances of abnormally high levels. There were no significant differences in any other clinical or biochemical outcomes. CONCLUSION P-PN improves the rate of weight gain to discharge home in preterm infants born 30 to 33 weeks gestation compared with peripheral intravenous 10% glucose. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12616000925448 . Registered 12 July 2016.
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Affiliation(s)
- Hiroki Suganuma
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute Adelaide, South Australia, Australia
- Discipline of Paediatrics, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - Dennis Bonney
- Neonatal Medicine, Women's and Children's Hospital, Adelaide, SA, Australia
| | - Chad C Andersen
- Neonatal Medicine, Women's and Children's Hospital, Adelaide, SA, Australia
| | - Andrew J McPhee
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute Adelaide, South Australia, Australia
- Neonatal Medicine, Women's and Children's Hospital, Adelaide, SA, Australia
| | - Thomas R Sullivan
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute Adelaide, South Australia, Australia
- School of Public Health, The University of Adelaide, Adelaide, SA, Australia
| | - Robert A Gibson
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute Adelaide, South Australia, Australia
- School of Agriculture Food and Wine, The University of Adelaide, Adelaide, SA, Australia
| | - Carmel T Collins
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute Adelaide, South Australia, Australia.
- Discipline of Paediatrics, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia.
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