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Maselli KM, Carter IC, Matusko N, Warschausky S, Blackmer AB, Islam S, Rollins MD, Javid PJ, Arnold MA. Prevention of Parenteral Nutrition-associated Cholestasis Using Reduced Dose Soybean Lipid Emulsion: A Multicenter Randomized Trial. J Pediatr Surg 2024; 59:1369-1373. [PMID: 38614946 DOI: 10.1016/j.jpedsurg.2024.03.030] [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: 02/19/2024] [Accepted: 03/04/2024] [Indexed: 04/15/2024]
Abstract
INTRODUCTION Reducing soybean lipid emulsion (SLE) dose may prevent parenteral nutrition-associated cholestasis (PNAC) but effects on growth and neurodevelopment are unknown. The purpose of this study was to evaluate the effect of reduced dose SLE on growth and neurodevelopment. METHODS Surgical neonates at 4 centers were randomized to standard SLE (3 g/kg/day) or reduced SLE (1 g/kg/day) over a 12-week period. Bilirubin levels and growth parameters were measured baseline and weekly while on study. The effects of time and group on direct bilirubin and growth were evaluated with a linear mixed effects model. Neurodevelopmental outcomes were assessed at 12- and 24-months corrected gestational age. RESULTS Twenty-one individuals were randomized (standard dose = 9, reduced dose = 12). Subjects in the reduced dose group had slower rates of direct bilirubin increase and overall levels decreased earlier than those in the standard dose group. There was a trend toward a faster direct bilirubin decrease in the reduced dose group (p = 0.07 at day 84). There were no differences in the rates of change in weight (p = 0.352 at day 84) or height Z-scores (p = 0.11 at day 84) between groups. One subject in the reduced dose group had abnormal neurodevelopmental testing at 24 months. CONCLUSIONS Surgical neonates randomized to a reduced dose of SLE had improved trends in direct bilirubin levels without clinically significant differences in overall growth and neurodevelopment. TYPE OF STUDY Randomized Controlled Trial. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Kathryn M Maselli
- Section of Pediatric Surgery, University of Michigan, Ann Arbor, MI 48109, USA
| | - Irene C Carter
- Section of Pediatric Surgery, University of Michigan, Ann Arbor, MI 48109, USA
| | - Niki Matusko
- Section of Pediatric Surgery, University of Michigan, Ann Arbor, MI 48109, USA
| | - Seth Warschausky
- Department of Physical Medicine and Rehabilitation, Ann Arbor, MI 48109, USA
| | - Allison B Blackmer
- Department of Clinical Pharmacology, University of Colorado, Aurora, CO 80045, USA
| | - Saleem Islam
- Division of Pediatric Surgery, University of Florida, Gainesville, FL 32610, USA
| | - Michael D Rollins
- Divsion of Pediatric Surgery, University of Utah, Salt Lake City, UT 84113, USA
| | - Patrick J Javid
- Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, Seattle, WA 98105, USA
| | - Meghan A Arnold
- Section of Pediatric Surgery, University of Michigan, Ann Arbor, MI 48109, USA.
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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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Caffarelli C, Santamaria F, Piro E, Basilicata S, D'Antonio L, Tchana B, Bernasconi S, Corsello G. Advances for pediatricians in 2022: allergy, anesthesiology, cardiology, dermatology, endocrinology, gastroenterology, genetics, global health, infectious diseases, metabolism, neonatology, neurology, oncology, pulmonology. Ital J Pediatr 2023; 49:115. [PMID: 37679850 PMCID: PMC10485969 DOI: 10.1186/s13052-023-01522-8] [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: 08/18/2023] [Accepted: 08/30/2023] [Indexed: 09/09/2023] Open
Abstract
The last year saw intensive efforts to advance knowledge in pediatric medicine. This review highlights important publications that have been issued in the Italian Journal of Pediatrics in 2022. We have chosen papers in the fields of allergy, anesthesiology, cardiology, dermatology, endocrinology, gastroenterology, genetics, global health, infectious diseases, metabolism, neonatology, neurology, oncology, pulmonology. Novel valuable developments in epidemiology, pathophysiology, prevention, diagnosis and treatment that can rapidly change the approach to diseases in childhood have been included and discussed.
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Affiliation(s)
- Carlo Caffarelli
- Clinica Pediatrica, Department of Medicine and Surgery, Azienda Ospedaliera- Universitaria, University of Parma, Parma, Italy.
| | - Francesca Santamaria
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Ettore Piro
- Department of Sciences for Health Promotion and Mother and Child Care "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Simona Basilicata
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Lorenzo D'Antonio
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Bertrand Tchana
- Cardiologia Pediatrica, Azienda-Ospedaliero Universitaria, Parma, Italy
| | | | - Giovanni Corsello
- Department of Sciences for Health Promotion and Mother and Child Care "G. D'Alessandro", University of Palermo, Palermo, Italy
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Garg PM, Pittman I, Yi J, Weis VG, Rodriguez RJ, Ladd MR, Rauh JL, McDonald AG, Welch C, Premkumar MH, Garg PP, Maheshwari A. Clinical Correlates of Cholestasis in Preterm Infants with Surgical Necrotizing Enterocolitis. NEWBORN (CLARKSVILLE, MD.) 2023; 2:191-197. [PMID: 37974929 PMCID: PMC10653206 DOI: 10.5005/jp-journals-11002-0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Background We sought to investigate the clinical determinants and outcomes of cholestasis in preterm infants with surgical necrotizing enterocolitis (sNEC). Methods Retrospective comparison of clinical information in preterm infants who developed cholestasis vs those who did not. Results Sixty-two (62/91, 68.1%) infants with NEC developed cholestasis at any time following the onset of illness. Cholestasis was seen more frequently in those who had received ionotropic support at 24 hours following sNEC diagnosis (87.1% vs 58.6%; p = 0.002), had higher mean C-reactive protein levels 2 weeks after NEC diagnosis (p = 0.009), had blood culture-positive sepsis [25 (40.3%) vs 4 (13.8%); p = 0.011], received parenteral nutrition (PN) for longer durations (108.4 ± 56.63 days vs 97.56 ± 56.05 days; p = 0.007), had higher weight-for-length z scores at 36 weeks' postmenstrual age [-1.0 (-1.73, -0.12) vs -1.32 (-1.76, -0.76); p = 0.025], had a longer length of hospital stay (153.7 ± 77.57 days vs 112.51 ± 85.22 days; p = 0.024), had intestinal failure more often (61% vs 25.0%, p = 0.003), had more surgical complications (50% vs 27.6%; p = 0.044), and had >1 complication (21% vs 3.4%; p = 0.031). Using linear regression, the number of days after surgery when feeds could be started [OR 15.4; confidence interval (CI) 3.71, 27.13; p = 0.009] and the postoperative ileus duration (OR 11.9, CI 1.1, 22.8; p = 0.03) were independently associated with direct bilirubin between 2 and 5 mg/dL (mild-moderate cholestasis) at 2 months of age. The duration of PN was independently associated with direct bilirubin >5 mg/dL (severe cholestasis) at 2 months of age in these patients. Conclusion Cholestasis was seen in 68% of infants following surgical NEC. The most likely contributive factors are intestinal failure and subsequent PN dependence for longer periods. Our data suggest that identification and prevention of risk factors such as sepsis and surgical complications and early feeds following NEC surgery may improve outcomes.
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Affiliation(s)
- Parvesh Mohan Garg
- Department of Pediatrics/Neonatology, Atrium Health Wake Forest Baptist, Wake Forest School of Medicine, Winston Salem, North Carolina, United States of America
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi, United States of America
- Global Newborn Society, Clarksville, Maryland, United States of America
| | - Isabella Pittman
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi, United States of America
| | - Joe Yi
- Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, NC, United States of America
| | - Victoria G Weis
- Department of Regenerative Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina, United States of America
| | - Ricardo Jorge Rodriguez
- Department of Pediatrics/Neonatology, Atrium Health Wake Forest Baptist, Wake Forest School of Medicine, Winston Salem, North Carolina, United States of America
| | - Mitchell R Ladd
- Department of Pediatric Surgery, Atrium Health Wake Forest Baptist, Wake Forest School of Medicine, Winston Salem, North Carolina, United States of America
| | - Jessica L Rauh
- Department of Pediatric Surgery, Atrium Health Wake Forest Baptist, Wake Forest School of Medicine, Winston Salem, North Carolina, United States of America
| | - Anna Greene McDonald
- Department of Pathology, Atrium Health Wake Forest Baptist, Wake Forest School of Medicine, Winston Salem, North Carolina, United States of America
| | - Cherrie Welch
- Department of Pediatrics/Neonatology, Atrium Health Wake Forest Baptist, Wake Forest School of Medicine, Winston Salem, North Carolina, United States of America
| | | | - Padma P Garg
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi, United States of America
| | - Akhil Maheshwari
- Global Newborn Society, Clarksville, Maryland, United States of America
- Louisiana State University Health Sciences Center – Shreveport, LA, United States of America
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Wang YS, Shen W, Yang Q, Lin R, Tang LX, Bai RM, Yang D, Zhang J, Zhang YJ, Yu WT, Song SR, Kong J, Song SY, Mao J, Tong XM, Li ZK, Wu F, Lin XZ. Correction: Analysis of risk factors for parenteral nutrition-associated cholestasis in preterm infants: a multicenter observational study. BMC Pediatr 2023; 23:305. [PMID: 37330470 DOI: 10.1186/s12887-023-04116-9] [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: 06/19/2023] Open
Affiliation(s)
- Ya-Sen Wang
- Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen university, Xiamen, 361003, China
- Xiamen key laboratory of perinatal-neonatal infection, Xiamen, China
- Xiamen Clinical Research Center for Perinatal Medicine, Xiamen, China
| | - Wei Shen
- Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen university, Xiamen, 361003, China
- Xiamen key laboratory of perinatal-neonatal infection, Xiamen, China
- Xiamen Clinical Research Center for Perinatal Medicine, Xiamen, China
| | - Qing Yang
- Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen university, Xiamen, 361003, China
- Xiamen key laboratory of perinatal-neonatal infection, Xiamen, China
- Xiamen Clinical Research Center for Perinatal Medicine, Xiamen, China
| | - Rong Lin
- Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen university, Xiamen, 361003, China
- Xiamen key laboratory of perinatal-neonatal infection, Xiamen, China
- Xiamen Clinical Research Center for Perinatal Medicine, Xiamen, China
| | - Li-Xia Tang
- Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen university, Xiamen, 361003, China
- Xiamen key laboratory of perinatal-neonatal infection, Xiamen, China
- Xiamen Clinical Research Center for Perinatal Medicine, Xiamen, China
| | - Rui-Miao Bai
- Department of Neonatology, Northwest Women and Children's Hospital, Xian, 710061, China
| | - Dong Yang
- Department of Neonatology, Northwest Women and Children's Hospital, Xian, 710061, China
| | - Juan Zhang
- Department of Pediatrics, Peking University Third Hospital, Beijing, 100191, China
| | - Yi-Jia Zhang
- Department of Pediatrics, Peking University Third Hospital, Beijing, 100191, China
| | - Wen-Ting Yu
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, 110000, China
| | - Shi-Rong Song
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, 110000, China
| | - Juan Kong
- Department of Neonatology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, Guangdong, China
| | - Si-Yu Song
- Department of Neonatology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, Guangdong, China
| | - Jian Mao
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, 110000, China
| | - Xiao-Mei Tong
- Department of Pediatrics, Peking University Third Hospital, Beijing, 100191, China
| | - Zhan-Kui Li
- Department of Neonatology, Northwest Women and Children's Hospital, Xian, 710061, China
| | - Fan Wu
- Department of Neonatology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, Guangdong, China
| | - Xin-Zhu Lin
- Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen university, Xiamen, 361003, China.
- Xiamen key laboratory of perinatal-neonatal infection, Xiamen, China.
- Xiamen Clinical Research Center for Perinatal Medicine, Xiamen, China.
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