• Nutritional Sciences
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• v.3 no.2
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• pp.57-65
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• 2000

Partial enteral nutrition (PEN) supplemented with insulin-like growth factor-I (IGF-I) to neonatal piglets receiving parenteral nutrition increases lactase-phlorizin hydrolase (LPH) activity, but not LPH mRNA. The goal of the current study was to investigate the mechanism by which IGF-I up-regulates LPH activity. We hypothesized that IGF-I regulates LPH synthesis post-transcriptionally. Methods: Newborn piglets (n=15) received 100% parenteral nutrition (TPN), 80% parenteral nutrition + 20% PEN (PEN), or PEN + IGF-I (1.0mg/kg/d). On day 7, two stable isotopes of leucine, [$^2 H_3$]-leucine and [$^{13}C_1$]-L-leucine were intravenously administered to measure mucosal protein and brush LPH (BB LPH) synthesis. Results: Weight gain, nutrient intake and jejunal weight and length were similar among the treatment groups. PEN increased mucosal weight, villus width and cross-sectional area, LPH activity, mRNA expression and the abundance of proLPHh compared to 100% TPN (p<0.05). IGF-I further increased mucosal weight, LPH activity and LPH activity per unit BB LPH ~2-fold over PEN alone (p<0.05), but did not affect LPH mRNA or the abundance of proLPHh or mature LPH. Isotopic enrichment of [$^2 H_3$]-leucine and [$^{13}C_1$]-L-leucine in plasma, mucosal protein and LPH precursors, and the fractional and absolute synthesis rates of mucosal protein and LPH were similar among the treatment groups. Total mucosal protein synthesis was increased 60% (p<0.05) and LPH synthesis tended (p=0.14) to be greater in the IGF-I treated animals compared to the other two groups. Conclusions: The primary mechanism by which IGF-I up-regulates LPH may be post-translational, either via reducing LPH turnover, or by specifically altering LPH activity.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.21 no.4
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• pp.321-328
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• 2018

Purpose: Feeding children is a problem in pediatric intensive care units (PICU) and it is difficult to know the correct amount. The purpose of this study is to evaluate if prealbumin or retinol binding proteins (RBP) are effective relative to daily enteral nutrition, without being affected by severity of diseases or infections and can be used to follow up nutritional amount. Methods: This is a prospective observational study that includes 81 patients admitted to PICU in Akdeniz University with estimated duration >72 hours, age between 1 month and 8 years. Daily calorie and protein intake were calculated and prealbumin, RBP and C-reactive protein (CRP) levels were measured on the first, third, fifth and seventh mornings. Results: We find moderate correlation between daily calorie intake and prealbumin levels (r=0.432, p<0.001), RBP levels and daily protein intake (r=0.330, p<0.001). When we investigated the relationship between changes of prealbumin, RBP, CRP, calorie and protein intake during intensive care stay, we found that increase of Prealbumin and RBP levels are explained by decrease of CRP levels (r=-0.546 and -0.645, p<0.001) and not with increase of nourishment. Conclusion: Even adjusted for PRISM3, age and CRP, prealbumin and RBP are correlated with last 24 hours' diet. However, it is not convenient to use as a follow up biomarker because increase of their levels is related with decrease of CRP levels.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.19 no.1
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• pp.44-53
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• 2016

Purpose: Parenteral nutrition (PN) not only provides nutritional support but also plays a crucial role in the treatment of children with intestinal failure. The aim of this study was to evaluate the clinical significance and clinical outcomes of long-term PN. Methods: Retrospective cohort study was conducted using the medical records of patients treated at Seoul National University Children's Hospital. This study included 19 patients who received PN for over six months. Most patients received home PN. Results: The indications for PN included short bowel syndrome, chronic intestinal pseudo-obstruction, and intractable diarrhea of infancy. The median age of PN initiation was 1.3 years, and the median treatment duration was 2.9 years. Two patients were weaned from PN; 14 continued to receive PN with enteral feedings; and 3 patients died. The overall survival rates at 2 and 5 years were 93.3% and 84.0%, respectively. The incidence of catheter-related bloodstream infections was 2.7/1,000 catheter-days and was associated with younger age at PN initiation and lower initial height Z-score. Six patients developed catheter-related central vein thrombosis, with an incidence of 0.25/1,000 catheter-days. Eleven patients experienced PN-associated liver disease (PNALD), and one patient underwent multi-visceral transplant. The patients with PNALD exhibited lower final heights and body weight Z-scores. All patients experienced micronutrient deficiencies transiently while receiving PN. Conclusion: PN is an important and safe treatment for pediatric intestinal failure. PNALD was linked to final anthropometric poor outcomes. Micronutrient deficiencies were common. Anthropometric measurements and micronutrient levels must be monitored for successful PN completion.

• Journal of the Korean Dietetic Association
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• v.1 no.1
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• pp.21-30
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• 1995

Critically ill patients admitted in ICU and NCU were studied with respect to their nutritional status and support to them at initial period, and the effect of nutritional support after 3 weeks. The nutritional support was supplied to these patients with the enteral and parenteral nutrition. The results of biochemical test and status of nutritional support on 52(29 males, 23 females) critically ill patients were based on medical records and the anthropometry was measured on 28 patients. The subjects were in mild malnutrition. Their initial calorie intakes were 85% of BEE, 57% of total energy requirements and 49% of protein requirement were provided. Two groups, one group of serum albumin level more than 3.5g/dl and the other group of serum albumin level less than 3.5g/dl, were significant different in total calorie and protein intakes. After 3 weeks, inappropriate nutritional support in the group of normal nutrition results in significant decreasing of serum albumin level but, there were no changes in the group of malnutrition. Nutritional support is one of the mainstays in the management of these critically ill patients and is aimed at preventing malnutrition. Therefore, timely nutritional support is heavily required in cases of critically ill patients whether their initial nutritional status is normal or not.

• Korean Journal of Adult Nursing
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• v.20 no.1
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• pp.44-54
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• 2008

Purpose: The purpose of the study were to examine the nutritional status of severe brain injury adult patients in critical period, and to compare the nutritional states before and after tube feeding. Methods: Data from 19 patients admitted to the SICU in a university hospital due to severe brain injury were analyzed. Nutritional states were measured by anthropometric and blood biochemical indicators. Results: MAC and MAMC were significantly decreased only at 7 days after admission compared with those on the day of admission. TSF was significantly decreased from 7 days to 14 days after admission. Fat rate was significantly decreased from 3 days to 14 days after admission. Hb was significantly decreased only at 3 days after admission. Albumin was significantly decreased from 3 days to 14 days after admission. However, lymphocyte was significantly increased at 14 days after admission. TSF and Albumin became significantly worse even after initiating tube feeding. Conclusions: Nutritional status of severe brain injury patients in SICU became worse after admission whichever indicators were adopted to evaluate nutritional status, anthropometric or blood biochemical indicators, and became worse even after initiating tube feeding.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.19 no.1
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• pp.31-37
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• 2008

Patients with impaired ability to eat require nutritional support enterally or parenterally. Gastrostomy is a preferred method because total parenteral nutrition has many complications and high cost. Surgical gastrostomy has been a traditional and well-established method prior to the development of percutaneous gastrostomy. Since then, percutaneous gastrostomy has been established as an effective, safe, easy technique with a low morbidity and mortality rate. Consequently, percutaneous gastrostomy has been the first method for long-term enteral nutrition. The purpose of this review is to describe the techniques, indications, complications of percutaneous radiologic gastrostomy/gastrojejunostomy and to compare with endoscopic method.

• Korean Journal of Community Nutrition
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• v.27 no.2
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• pp.121-131
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• 2022

Objectives: This study aimed to examine the effectiveness of the intervention of the nutrition support team (NST) on the nutritional status of critically ill patients. Methods: The medical records of 176 adult patients who were admitted to the intensive care unit and received enteral or parenteral nutrition for more than 7 days were retrospectively analyzed. The patients were classified into the NST and non-NST groups according to whether they were referred to the NST or not. The NST group was further classified into the compliance and non-compliance groups depending on their compliance with the NST recommendations. Results: The NST referral rate was 56.8%, and the rate of compliance with the NST recommendations was 47.0%. Significantly higher energy and protein were provided to the NST and the compliance groups than to the non-NST and the non-compliance groups. The proportion of patients who reached the target calories after the initiation of enteral nutrition was significantly higher in the NST and the compliance groups than in the non-NST and the non-compliance groups. The serum albumin and hemoglobin levels significantly decreased in every group, but the changes were significantly lower in the compliance group. The nutritional status at discharge from the intensive care unit compared to the status at admission was significantly worse in the NST, non-NST, and non-compliance groups. However, the status was maintained in the compliance group. The length of stay in the intensive care unit was significantly shorter in the compliance group. Conclusions: Compliance with the NST recommendations was found to provide more calories and protein and prevent the deterioration of the nutritional status of critically ill patients. Therefore, effective communication between medical staff and the NST from the early stages of admission to the intensive care unit is needed to improve referrals to the NST and compliance with the recommendations.

• Journal of the Korean Dietetic Association
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• v.20 no.4
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• pp.235-246
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• 2014

The purpose of this study was to evaluate nurses' perception of clinical nutrition services. A cross-sectional survey design was performed. The research was accomplished by using questionnaires developed for this study and administered from September 12 to December 31, 2013 to 343 nurses at 43 tertiary hospitals and 20 general hospitals. The percentage of nurses who recognized clinical nutrition certificate as issued from nation was 27.8%. The mean scores of perceived usefulness on clinical nutrition services was 4.23/5.00, whereas that of perceived implementation was 3.76/5.00. The mean scores of necessity of disease-specialized clinical dietitian at capital hospitals were significantly higher for obesity (P<0.01), cancer (P<0.05), and infant & childhood disease (P<0.01) than at local hospitals. The rates of nurses' experience in group education on cancer at capital hospitals (21.7%) was significantly higher than that at local hospitals (10.3%) (P<0.05). The mean scores of perceived importance of clinical nutrition services were 4.46/5.00 for 'group nutrition education', 4.46/5.00 for 'individual consultation', and 4.40/5.00 for 'nutrition management for enteral nutrition (EN) patients'. The most common reason why clinical nutrition services are important was 'improving malnutritional status'. To activate clinical nutrition services especially at local hospitals, clinical dietitians should give systematic assistance to patients and also institutional supports are needed.

• Advances in pediatric surgery
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• v.4 no.1
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• pp.16-26
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• 1998

Parenteral nutrition has been an essential part of postoperative care of neonates requiring major surgery who are unable to tolerate enteral feeding for long periods during the postoperative period. However, TPN via central venous catheters(central TPN), used in increasing trend, still presents significant morbidity. To find out whether TPN via peripheral veins(peripheral TPN) could be used as a viable alternative for postoperative parenteral nutrition in neonates, a clinical study was carried out by a retrospective analysis of 53 neonates subjected to peripheral TPN for more than 7 days after surgery. Operations consisted of procedures for esophageal atresia with tracheoesophageal fistula, gastroschisis and omphalocele. Surgery was performed at the Division of Pediatric Surgery, Department of Surgery, Hanyang University Hospitall, from 1983 to 1994. The mean total duration of TPN was 13.3 days (range; 7-58 days), the average daily total fluid intake was 117.6 ml/kg during TPN and 158.6 ml/kg during subsequent oral feeding. The average daily total calorie intake was 57.7 kcal/kg during full strength TPN and 101.3 kcal/kg during subsequent oral feeding. The mean urine output was maintained at 3.5 ml/kg/ hour during TPN and at 3.6 ml/kg/hour during subsequent oral feeding. The increment of body weight observed during TPN was 132 g in TEF, 53 g in gastroschisis and 3 g in omphalocele patients, while loss of body weight was not observed. The mortality rate was 5.7 %(3/53) and was related to the underlying congenital anomalies, not the TPN. The most common complication of peripheral TPN observed was laboratory findings suggestive of liver dysfunction in 23 cases(43.4 %) with no significant clinical symptom or signs in any case, transient pulmonary edema in one case, and generalized edema in one case. None of the major complications usually expected associated with central TPN were observed. The result of this study suggest that peripheral TPN can be used for adeguate postoperative nutritional support in neonates requiring 2 to 3 weeks of TPN.

• Journal of Clinical Nutrition
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• v.10 no.2
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• pp.31-37
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• 2018

Recently, in Korea, the importance of preparation and use of injectable drugs has been emphasized due to successive fatal accidents caused by injection infections. Parenteral nutrition (PN) has also been identified as a cause of infection. Cases of infection due to PN have been reported not only in Korea, but also abroad, and contamination occurs mainly during the preparation of PN. Because sterile preparation and compounding of injections are very important for infection control and patient safety, this article reviews the major guidelines outlined thus far. The Korea Ministry of Food and Drug Safety in 2006 published guidelines and the KSHP (Korean Society of Health-System Pharmacists) recently issued guidelines for the aseptic preparation of injections. In addition, as US guidelines, the ASHP (American Society of Health-System Pharmacists) guidelines and United States Pharmacopeia (USP) <797> are also reviewed. The recent guidelines published by the KSHP have significance in that they were adopted in accordance with the domestic reality, even though they conform to foreign guidelines, and are expected to be guidelines for hospital pharmacists performing aseptic preparation work. In addition, the Korea Ministry of Health and Welfare is considering appropriate guidelines for the safe management of medications, training staff for infection prevention and strengthening staff capacity. Furthermore, the gradual expansion of aseptic compounding facilities and human resources, as well as the provision of adequate medical costs are also considered. Based on the establishment and standardization of injectable drugs compounding guidelines for Korean hospitals, it is believed that if human resources and facilities are supported and medical charges are improved, it will be possible to expect the safer preparation and use of injections.