A review of best evidenced-based enteral and parenteral nutrition support practices for preterm infants born <1,500 grams

2018 ◽  
Vol 1 ◽  
pp. 6-6
Author(s):  
Melissa K. Thoene ◽  
Ann L. Anderson-Berry
Keyword(s):  
Parenteral Nutrition ◽  
Preterm Infants ◽  
Nutrition Support ◽  
Support Practices ◽  
Evidenced Based ◽  
Enteral And Parenteral Nutrition

Enteral and parenteral nutrition considerations in pediatric patients

2019 ◽  
Vol 76 (19) ◽  
pp. 1492-1510
Author(s):  
Mary Petrea Cober ◽  
Kathleen M Gura
Keyword(s):  
Best Practices ◽  
Parenteral Nutrition ◽  
Pediatric Patients ◽  
Medication Administration ◽  
Nutrition Support ◽  
Disease States ◽  
Pediatric Populations ◽  
Enteral And Parenteral Nutrition ◽  
Indications For Use ◽  
Selection Of

Abstract Purpose Current clinical practice guidelines on management of enteral nutrition (EN) and parenteral nutrition (PN) in pediatric patients are reviewed. Summary The provision of EN and PN in pediatric patients poses many unique considerations and challenges. Although indications for use of EN and PN are similar in adult and pediatric populations, recommended EN and PN practices differ for pediatric versus adult patients in areas such as selection of EN and PN formulations, timing of EN and PN initiation, advancement of nutrition support, and EN and PN goals. Additionally, provision of EN and PN to pediatric patients poses unique compounding and medication administration challenges. This article provides a review of current EN and PN best practices and special nutrition considerations for neonates, infants, and other pediatric patients. Conclusion The provision of EN and PN to pediatric patients presents many unique challenges. It is important for pharmacists to keep current with pediatric- and neonatal-specific guidelines on nutritional management of various disease states, as well as strategies to address compounding and medication administration challenges, in order to optimize EN and PN outcomes.

scholarly journals Lipid enemas for meconium evacuation in preterm infants – a retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Maximilian Gross ◽  
Christian F. Poets
Keyword(s):  
Parenteral Nutrition ◽  
Preterm Infants ◽  
High Volume ◽  
Gastrointestinal Complications ◽  
Increased Risk ◽  
Before And After ◽  
Focal Intestinal Perforation ◽  
Clinically Significant ◽  
Enema Use ◽  
Enteral And Parenteral Nutrition

Abstract Background Enemas are used in preterm infants to promote meconium evacuation, but frequent high-volume enemas might contribute to focal intestinal perforation (FIP). To replace a regime consisting of frequent enemas of varying volume and composition, we implemented a once-daily, low-volume lipid enema (LE) regimen. We investigated its impact on meconium evacuation, enteral nutrition, and gastrointestinal complications in preterm infants. Methods We performed a single-center retrospective study comparing cohorts of preterm infants < 28 weeks gestation or < 32 weeks, but with birth weight < 10th percentile, before and after implementing LE. Outcomes were rates of FIP, necrotizing enterocolitis (NEC), and sepsis. We assessed stooling patterns, early enteral and parenteral nutrition. We used descriptive statistics for group comparisons and logistic regression to identify associations between LE and gastrointestinal complications and to adjust for group imbalances and potential confounders. Exclusion criteria were gastrointestinal malformations or pre-determined palliative care. Results Data from 399 infants were analyzed, 203 before vs. 190 after implementing LE; in the latter period, 55 protocol deviations occurred where infants received no enema, resulting in 3 groups with either variable enemas, LE or no enema use. Rates of FIP and sepsis were 11.9% vs. 6.4% vs. 0.0% and 18.4% vs. 13.5% vs. 14.0%, respectively. NEC rates were 3.0% vs. 7.8% vs. 3.5%. Adjusted for confounders, LE had no effect on FIP risk (aOR 1.1; 95%CI 0.5–2.8; p = 0.80), but was associated with an increased risk of NEC (aOR 2.9; 95%CI 1.0–8.6; p = 0.048). While fewer enemas were applied in the LE group resulting in a prolonged meconium passage, no changes in early enteral and parenteral nutrition were observed. We identified indomethacin administration and formula feeding as additional risk factors for FIP and NEC, respectively (aOR 3.5; 95%CI 1.5–8.3; p < 0.01 and aOR 3.4; 95%CI 1.2–9.3; p = 0.02). Conclusion Implementing LE had no clinically significant impact on meconium evacuation, early enteral or parenteral nutrition. FIP and sepsis rates remained unaffected. Other changes in clinical practice, like a reduced use of indomethacin, possibly affected FIP rates in our cohorts. The association between LE and NEC found here argues against further adoption of this practice. Trial registration Registered at the German Register of Clinical Trials (no. DRKS00024021; Feb 022021).

Enteral and Parenteral Nutrition

2017 ◽  
Author(s):  
Kris M. Mogensen ◽  
Malcolm K. Robinson
Keyword(s):  
Small Bowel ◽  
Parenteral Nutrition ◽  
Ethical Issues ◽  
Nutritional Assessment ◽  
Enterocutaneous Fistula ◽  
Pelvic Abscess ◽  
Nutrition Support ◽  
Tube Placement ◽  
Fistula Formation ◽  
Enteral And Parenteral Nutrition

Alternative routes of nutrient administration are available for patients who are unable to eat or digest sufficient food to prevent malnutrition. These routes include enteral (administered through the gastrointestinal tract) and parenteral (administered intravenously). This review details the clinical consequences of malnutrition, nutritional assessment, the benefits of nutrition support therapy,  determining the nutrient prescription, special considerations in nutrition support therapy, aspects of obtaining enteral or parenteral access, monitoring of patients receiving nutrition support therapy, and complications and ethical issues associated with enteral and parenteral nutrition. Figures include algorithms showing the identification of malnutrition, the nutrition support decision process, and the approach to gastric residual monitoring; nasogastric tube displacement leading to pneumothorax; proper placement of a long or “midline” catheter versus a peripherally inserted central catheter; and photographs of a 43-year-old man with Crohn disease complicated by enterocutaneous fistula formation, distal small bowel obstruction, and evisceration of the small bowel after developing a pelvic abscess. Tables list acute illness- or injury-related malnutrition; chronic disease−related malnutrition; social or environmental circumstances−related malnutrition; indications and contraindications to enteral and parenteral nutrition; selected examples of predictive equations; electrolyte provision in parenteral nutrition; parenteral vitamin and trace element requirements; complications associated with enteral and parenteral nutrition; and indications, contraindications, and complications of gastrostomy tube placement. This review contains 6 highly rendered figures, 11 tables, and 167 references.

Our experience of enteral and parenteral nutrition support assessment in Turkey

2016 ◽  
pp. 1040-1044
Author(s):  
Deniz Erdem ◽  
Piril Tuncay ◽  
Dilek Atabey ◽  
Mutlu Doganay ◽  
Arzu sahna ◽  
...  
Keyword(s):  
Parenteral Nutrition ◽  
Nutrition Support ◽  
Enteral And Parenteral Nutrition

scholarly journals Low Iodine Content in the Diets of Hospitalized Preterm Infants

2012 ◽  
Vol 97 (4) ◽  
pp. E632-E636 ◽  
Author(s):  
Mandy B. Belfort ◽  
Elizabeth N. Pearce ◽  
Lewis E. Braverman ◽  
Xuemei He ◽  
Rosalind S. Brown
Keyword(s):  
Parenteral Nutrition ◽  
Human Milk ◽  
Preterm Infants ◽  
Iodine Content ◽  
Iodine Concentration ◽  
Iodine Intake ◽  
Hormone Synthesis ◽  
Donor Human Milk ◽  
Preterm Formula ◽  
Enteral And Parenteral Nutrition

Context: Iodine is critical for normal thyroid hormone synthesis and brain development during infancy, and preterm infants are particularly vulnerable to the effects of both iodine deficiency and excess. Use of iodine-containing skin antiseptics in intensive care nurseries has declined substantially in recent years, but whether the current dietary iodine intake meets the requirement for hospitalized preterm infants is unknown. Objective: The aim of the study was to measure the iodine content of enteral and parenteral nutrition products commonly used for hospitalized preterm infants and estimate the daily iodine intake for a hypothetical 1-kg infant. Methods: We used mass spectrometry to measure the iodine concentration of seven preterm infant formulas, 10 samples of pooled donor human milk, two human milk fortifiers (HMF) and other enteral supplements, and a parenteral amino acid solution and soy-based lipid emulsion. We calculated the iodine provided by typical diets based on 150 ml/kg · d of formula, donor human milk with or without HMF, and parenteral nutrition. Results: Preterm formula provided 16.4–28.5 μg/d of iodine, whereas unfortified donor human milk provided only 5.0–17.6 μg/d. Adding two servings (six packets) of Similac HMF to human milk increased iodine intake by 11.7 μg/d, whereas adding two servings of Enfamil HMF increased iodine intake by only 0.9 μg/d. The other enteral supplements contained almost no iodine, nor did a parenteral nutrition-based diet. Conclusions: Typical enteral diets for hospitalized preterm infants, particularly those based on donor human milk, provide less than the recommended 30 μg/d of iodine, and parenteral nutrition provides almost no iodine. Additional iodine fortification should be considered.

Sign in / Sign up

Export Citation Format

Share Document