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Parenteral nutrition in prematures

Eugene Ct Lau, Adrian Ch Fung, Kenneth Ky Wong, Paul Kh Tam
BACKGROUND: Necrotizing enterocolitis in premature neonates often results in bowel resection and stoma formation. One way to promote bowel adaptation before stoma closure is to introduce proximal loop effluents into the mucous fistula. In this study, we reviewed our experience with distal loop refeeding with respect to control group. METHODS: All patients with necrotizing enterocolitis between 2000 and 2014 necessitating initial diverting enterostomies and subsequent stoma closure in a tertiary referral center were included...
September 15, 2016: Journal of Pediatric Surgery
Ekene A Onwuka, Payam Saadai, Laura A Boomer, Benedict C Nwomeh
BACKGROUND: Esophageal perforation in neonates occurs most often in cases of extreme prematurity and is commonly due to iatrogenic causes. Treatment over recent decades has become more conservative. The purpose of this study was to review cases of esophageal perforation in neonates and to describe the presentation, management, and outcomes. MATERIALS AND METHODS: A retrospective chart review was performed for patients with International Classification of Diseases, Ninth Revision code for esophageal perforation treated at our institution between the years 2009 and 2015...
September 2016: Journal of Surgical Research
Colin D Gause, Madoka Hayashi, Courtney Haney, Daniel Rhee, Omar Karim, Brian W Weir, Dylan Stewart, Jeffrey Lukish, Henry Lau, Fizan Abdullah, Estelle Gauda, Howard I Pryor
BACKGROUND/PURPOSE: Premature neonates can develop intraabdominal conditions requiring emergent bowel resection and enterostomy. Parenteral nutrition (PN) is often required, but results in cholestasis. Mucous fistula refeeding allows for functional restoration of continuity. We sought to determine the effect of refeeding on nutrition intake, PN dependence, and PN associated hepatotoxicity while evaluating the safety of this practice. METHODS: A retrospective review of neonates who underwent bowel resection and small bowel enterostomy with or without mucous fistula over 2years was undertaken...
November 2016: Journal of Pediatric Surgery
Daniel T Robinson, Camilia R Martin
Fatty acids are critical nutrient regulators of intracellular signaling and influence key pathways including inflammatory responses, hemostasis as well as central nervous system development and function. Preterm birth interrupts the maternal-fetal transfer of essential fatty acids including docosahexaenoic and arachidonic acids, which occurs during the third trimester. Postnatal deficits of these nutrients accrue in preterm infants during the first week and they remain throughout the first months. Due to the regulatory roles of these fatty acids, such deficits contribute an increased risk of developing prematurity-related morbidities including impaired growth and neurodevelopment...
September 2, 2016: Seminars in Fetal & Neonatal Medicine
Murat Konak, Nuriye Tarakci, Hüseyin Altunhan, Ali Annagür, Aysun Toker, Rahmi Örs
OBJECTIVE: The aim of our study was to determine whether lipid solutions delivered separately or in mixture with total parenteral nutrition (TPN) solutions effect the balance between oxidant and antioxidant levels in premature infants. METHODS: A total of 60 preterm newborns who were delivered at their 30-34 gestational weeks and received TPN were included in the study. Premature newborns were randomized into two groups based on the delivery method of the lipid solution, separately (Group 1) or in mixture with TPN solutions (Group 2)...
September 1, 2016: Journal of Maternal-fetal & Neonatal Medicine
T Hang Nghiem-Rao, Allison F Dahlgren, Deepti Kalluri, Yumei Cao, Pippa M Simpson, Shailendra B Patel
BACKGROUND: Premature and critically ill infants receiving total parenteral nutrition (TPN) are at risk for dyslipidemia, and altered cholesterol levels in early life may contribute to later cardiovascular risk. Data regarding plasma cholesterol response to TPN in young infants are lacking. OBJECTIVE: To determine the changes in plasma cholesterol levels during the first week of life in infants receiving TPN and a comparison group of infants who did not receive TPN during routine care...
July 2016: Journal of Clinical Lipidology
Michael Sorrell, Alvaro Moreira, Kay Green, Rachel Jacobs, Robin Tragus, Laura Keller, Amy Quinn, Donald McCurnin, Alice Gong, Abeer El Sakka, Naveen Mittal, Cynthia Blanco
OBJECTIVES: To study the acute and long-term outcomes of preterm infants treated with an intravenous (IV) fish oil-based lipid emulsion (FishLE) for parenteral nutrition-associated liver disease (PNALD). METHODS: Preterm infants 14 days to 24 months of age with anatomic short gut or severe intestinal dysmotility, serum direct bilirubin ≥4 mg/dL, and requiring >60% calories from PN were eligible. Enrolled infants received 1 g/kg/day of FishLE until resolution of direct hyperbilirubinemia or return of enteral nutrition...
August 27, 2016: Journal of Pediatric Gastroenterology and Nutrition
Karen Whitfield, Claudia Barkeij, Angela North
AIM: To present a case of an extremely premature infant and the role that the specialist neonatal pharmacist has on the quality of care of these patients. METHOD: Interventions and recommendations made by the pharmacists over the admission of a triplet born at 23 weeks and 5 days gestation were recorded. The type of interventions were categorised and classified for risk using a consequence/probability matrix.1 RESULTS: The patient required admission to the intensive care unit and subsequently the special care unit for a period of 163 days before discharge home...
September 2016: Archives of Disease in Childhood
Jemma S Cleminson, Stefan P Zalewski, Nicholas D Embleton
PURPOSE OF REVIEW: The increasing recognition of the role of nutritional care for preterm infants continues to result in a proliferation of review articles, systematic reviews, observational studies and trials. In this article, we review a selection of important studies published in the last 12–18 months. RECENT FINDINGS: The selected studies demonstrate the potential importance of light protecting parenteral nutrition solutions, the benefits of standardized concentrated parenteral nutrition solutions and the importance of insulin-like growth factor I in early life...
May 2016: Current Opinion in Clinical Nutrition and Metabolic Care
Geeta Gathwala, Rahul Aggarwal
Deficient antioxidant defenses in preterm infants have been implicated in diseases such as bronchopulmonary dysplasia, retinopathy of prematurity, necrotizing enterocolitis, periventricular leukomalacia, and intraventricular hemorrhage. The antioxidant properties of selenium make it important in the nutrition of very low-birth weight (VLBW) infants. Selenium is a component of glutathione peroxidase (GPX), an enzyme that prevents the production of free radicals. Preterm infants have low selenium stores and require supplementation by parenteral and enteral routes...
April 2016: Indian Journal of Public Health
Mohamed H Ragab, Mohammed Y Al-Hindi, Meshari M Alrayees
INTRODUCTION: In the context of the continuous quest to improve the care of the neonates especially the critically ill premature infants, the extended role of pharmacists in the process of parenteral nutrition order writing and effective participation in decision-making especially in the neonatal population is increasingly important. This review aims to present results from the literature review of available evidence on the pharmacist role in neonatal parenteral nutrition therapy. MATERIAL AND METHODS: Key medical, clinical, and review databases were searched; relevant articles were retrieved and evaluated...
July 2016: Saudi Pharmaceutical Journal: SPJ: the Official Publication of the Saudi Pharmaceutical Society
Katie Satrom, Glenn Gourley
Cholestasis in preterm infants has a multifactorial etiology. Risk factors include degree of prematurity, lack of enteral feeding, intestinal injury, prolonged use of parenteral nutrition (PN), and sepsis. Soy-based parenteral lipid emulsions have been implicated in the pathophysiology of PN-associated liver injury. Inflammation plays an important role. Medical therapies are used; however, their effects have not consistently proven effective. Evaluation of cholestasis involves laboratory work; direct bilirubin levels are used for diagnosis and trending...
June 2016: Clinics in Perinatology
Amy B Hair, Katherine E Chetta, Ann M Bruno, Keli M Hawthorne, Steven A Abrams
BACKGROUND: Early parenteral nutrition (PN) provides essential macro- and micronutrients for extremely low birth weight (ELBW) infants <1000 g. Frequent cases of hypercalcemia [whole blood ionized calcium (iCa) > 1.45 mmol/L] in the first week of life while receiving PN solutions at our large quaternary center prompted investigation and 2 plan-do-study-act (PDSA) cycles to reduce rates of hypercalcemia. OBJECTIVE: We compared 2 cohorts of ELBW infants separated by PDSA cycles to evaluate and reduce the incidence of abnormal iCa concentration...
June 2016: Journal of Nutrition
Leilei Wang, Jing Zhang, Jiejin Gao, Yan Qian, Ya Ling
Purpose. To retrospectively study the effect of fish oil-based lipid emulsion and soybean oil-based lipid emulsion on cholestasis associated with long-term parenteral nutrition in premature infants. Methods. Soybean oil-based lipid emulsion and fish oil-based lipid emulsion had been applied in our neonatology department clinically between 2010 and 2014. There were 61 qualified premature infants included in this study and divided into two groups. Soybean oil group was made up of 32 premature infants, while fish oil group was made up of 29 premature infants...
2016: Gastroenterology Research and Practice
Nor Aini Kamarudin, Mohamed Mansor Manan, Hanis Hanum Zulkifly, Chin Fen Neoh, Salmiah Mohd Ali, Long Chiau Ming
This study aimed to investigate the effects of parenteral nutrition (PN) administration of amino acids (AA) on physical changes among very low birth weight infants in a local hospital setting in Malaysia. A retrospective study was carried out at a hospital in Malaysia. Records of neonates prescribed PN in the neonatal unit in 2012 were screened for eligibility. A total of 199 premature neonates received PN support in the year 2012 and, of these, 100 fulfilled the inclusion criteria. The median value of AA intake on the first day of PN was 2...
2016: Asia Pacific Journal of Clinical Nutrition
Jennifer L Fang, Atsushi Sorita, William A Carey, Christopher E Colby, M Hassan Murad, Fares Alahdab
CONTEXT: The effectiveness of many interventions aimed at reducing the risk of retinopathy has not been well established. OBJECTIVE: To estimate the effectiveness of nutritional interventions, oxygen saturation targeting, blood transfusion management, and infection prevention on the incidence of retinopathy of prematurity (ROP). DATA SOURCES: A comprehensive search of several databases was conducted, including Medline, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus through March 2014...
April 2016: Pediatrics
C Pieltain, Th Senterre, V De Halleux, J Rigo
During the last trimester of gestation, transplacental mineral transfer and fetal mineral accretion is particularly high: 2.3-3.2 mmol/kg/day (90-130 mg/kg/d) of calcium, 2.4-2.7 mmol/kg/d (65-75 mg/kg/day) of phosphorus and 0.12-0.20 mmol/kg/d (2.9-4.8 mg/kg/day) of magnesium. After birth, there is a dramatic change in bone mineral metabolism from a maximal bone deposition during fetal life to a postnatal bone turnover stimulation improving bone structure and resistance. This physiological change could partly reduce the mineral requirements, as minerals available from the remodeling activities could be recycled for bone mineralization...
December 2015: Revue Médicale de Liège
Michelle L Baack, Susan E Puumala, Stephen E Messier, Deborah K Pritchett, William S Harris
Docosahexaenoic acid (DHA) is an essential fatty acid (FA) important for health and neurodevelopment. Premature infants are at risk of DHA deficiency and circulating levels directly correlate with health outcomes. Most supplementation strategies have focused on increasing DHA content in mother's milk or infant formula. However, extremely premature infants may not reach full feedings for weeks and commercially available parenteral lipid emulsions do not contain preformed DHA, so blood levels decline rapidly after birth...
April 2016: Lipids
Adriana Martins de Lima, Ana Lucia Goulart, Adriana Bruscato Bortoluzzo, Benjamin Israel Kopelman
OBJECTIVE: to assess the nutritional practices in neonatal intensive care units (NICU) associated with growth retardation in premature (preterm) infants. METHODS: retrospective study of preterm infants weighing between 500 and 1,499 g admitted to NICU. Evolution of growth and parenteral (PN) and enteral (EN) nutrition practices were analyzed. RESULTS: among 184 preterm infants divided into G1 (500 to 990 g; n=63) and G2 (1000 to 1499 g; n=121), 169 received PN (G1=63, G2=106)...
November 2015: Revista da Associação Médica Brasileira
Zakir Hossain, Dylan MacKay, James K Friel
OBJECTIVES: The objective of the present exploratory study was to investigate how the fatty acid (FA) composition of different food sources for preterm infants including breast milk (BM), formula (F), human milk fortifiers (HMFs), and total parenteral nutrition (TPN) impacted preterm infant's plasma FA. The associations between FA content of plasma with antioxidant enzyme activity and cognition were also evaluated. METHODS: Thirty-two premature infants were included in the present study...
July 2016: Journal of Pediatric Gastroenterology and Nutrition
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