• Title/Summary/Keyword: Total Parenteral Nutrition

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Parenteral Nutrition-Associated Cholestasis in Very Low Birth Weight Infants: A Single Center Experience

  • Kim, Ah-Young;Lim, Ryoung-Kyoung;Han, Young-Mi;Park, Kyung-Hee;Byun, Shin-Yun
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.19 no.1
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    • pp.61-70
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    • 2016
  • Purpose: Parenteral nutrition (PN)-associated cholestasis (PNAC) is one of the most common complications in very low birth weight infants (VLBWIs). The aim of this study is to evaluate the risk factors of PNAC in VBLWIs. Methods: We retrospectively reviewed the medical records of 322 VLBWIs admitted to the neonatal intensive care unit of our hospital from July 1, 2009 to December 31, 2013. We excluded 72 dead infants; 6 infants were transferred to another hospital, and 57 infants were transferred to our hospital at 2 weeks after birth. The infants were divided into the cholestasis and the non-cholestasis groups. PNAC was defined as a direct bilirubin level of ${\geq}2.0mg/dL$ in infants administered with PN for ${\geq}2weeks$. Results: A total of 187 VLBWI were enrolled in this study; of these, 46 infants developed PNAC. Multivariate logistic regression analysis showed that the risk factors of PNAC in VLBWI were longer duration of antimicrobial use (odds ratio [OR] 4.49, 95% confidence interval [95% CI] 4.42-4.58), longer duration of PN (OR 2.68, 95% CI 2.41-3.00), long-term lack of enteral nutrition (OR 2.89, 95% CI 2.43-3.37), occurrence of necrotizing enterocolitis (OR 2.40, 95% CI 2.16-2.83), and gastrointestinal operation (OR 2.19, 95% CI 2.03-2.58). Conclusion: The results of this study suggest that shorter PN, aggressive enteral nutrition, and appropriate antimicrobial use are important strategies in preventing PNAC.

Acute mediastinitis secondary to delayed vascular injury by a central venous catheter and total parenteral nutrition

  • Byeon, Gyeong-Jo;Kim, Eun-Jung;Yoon, Ji-Young;Yoon, Seok-Hyun;Woo, Mi-Na;Kim, Cheul-Hong
    • Journal of Dental Anesthesia and Pain Medicine
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    • v.15 no.1
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    • pp.31-34
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    • 2015
  • Vascular injury caused by a central venous catheter (CVC) has been reported to be a rare complication, especially delayed vascular injury due to CVC has a few cases and it can be fatal because of delayed recognition and more serious complications. A 59-year-old woman with no available medical history was admitted for treatment of ovarian cancer. For the surgery, a triple-lumen CVC was placed through the left subclavian vein. Parenteral nutrition through the CVC was used for postoperative nutritional management in the first postoperative day. On the sixth postoperative day (POD), the patient suddenly complained of dyspnea. The CT revealed bilateral pleural effusion and irregular soft tissue density and air bubble in anterior mediastinum suggesting migration of the distal portion of the CVC into the anterior mediastium. In the intensive care unit (ICU) bilateral thoracentesis and percutaneous drainage were performed. She was discharged from the ICU in 3 days later and transferred to the general ward. This case emphasizes the possibility of the delayed vascular injury related to CVC and some strategies for prevention of vascular injury.

A Study on the Status of Nutrition Support in Bone Marrow Transplantation Patients (골수이식 환자의 영양지원 실태에 관한 연구)

  • Kim, Jeong-Nam;Im, Hyeon-Suk;Song, Seung-Eun
    • Journal of the Korean Dietetic Association
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    • v.4 no.1
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    • pp.65-75
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    • 1998
  • Recently, the number of patients who received Bone Marrow Transplantation(BMT) has been increased dramatically and the diseases for which BMT if efficacious are increasing. Adequate nutritional card for BMT patients is crucial for the success of BMT because nutritional deficiency could provoke deteriorative effects. However, little is known about nutritional status among BMT patients in Korea. This study was conducted to assess oral and parenteral intake of BMT patients and compare the change of nutritional status before and after BMT. Twenty-two BMT patients who were admitted to the Severance hospital from December in 1995 to September in 1997 participated in the study. Total calorie requirements were calculated for each patients individually and nutritional support for each patients consisted of oral and parenteral feeding. To assess oral intake of BMT patients, each patients recorded the amount of food they have eaten from 6 days before BMT to 28 days after BMT. The medical records of each patients were used to assess parenteral intake. To compare the nutritional status before and after BMT, the results of anthropometric and biochemical test from 14 days before BMT to 28 days after BMT were used. At the time of admission, the patients were in allowable nutritional status and their total calorie intake was 93% of total calorie requirement. When the preparative regimen for BMT was started, the patients' oral intake was dramatically decreased below 400kcal/day. Even though their oral intake was increased after BMT, their oral intake at the 4th week after BMT was only 752kcal/d, which is only 35.8% of total calorie requirement. The patients' mean oral intake during BMT period (from 6 days before BMT to 28 days after BMT) was only 439kcal/d. Although Total Parenteral Nutrition(TPN) was added when the preparative regimen was started, the patients' mean total caloric intake during BMT period was 111% of basal energy expenditure and 83% of total calorie requirement. The mean total protein intake was only 58% of total protein requirement. In the comparison of nutritional status between pretransplant phase and posttransplant phase in BMT patients, their body weight and serum albumin level were significantly decreased(p<0.001). These results show inadequacies in nutritional intake among BMT patients, and indicate the need of TPN during BMT period.

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Oral Insulin-like Growth Factor-I Combined Alters Intestinal Protein Synthesis in Parenterally-fed Piglets

  • Park, Yoo-Kyoung;Sharon M. Donovan
    • 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.

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Effects of the APACHEIII Score, Hypermetabolic Score on the Nutrition Status and Clinical Outcome of the Patients Administered with Total Parenteral Nutrition and Enteral Nutrition (경정영양과 중심정맥영양을 공급받는 환자에서 질병의 상태(APACHEIII Score), 과대사 정도가 영양상태 및 임상적 결과에 미치는 영향)

  • Rha Mi yong;Kim Eun mi;Cho Young Y.;Seo Jeong Meen;Choi Hay mie
    • Korean Journal of Community Nutrition
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    • v.11 no.1
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    • pp.124-132
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    • 2006
  • The aim of this study is to evaluate the clinical outcome. Between January 1,2002 to September 30, 2002, we prospectively and retrospectively recruited III hospitalized patients who received Enteral Nutrition (EN group n = 52) and Total Parenteral Nutrition (TPNgroup n = 59) for more than seven days. The factors of clinical outcomes are costs, incidences of infection, lengths of hospital stay, and changes in weight. The characteristics of patients were investigated, which included nutritional status, disease severity CAP ACHE III score) and hypermetabolic severity Chypermetabolic score). Hypermeta-bolic scores were determined by high fever (> $38^{\circ}C$), rapid breathing (> 30 breaths/min) , rapid pulse rate (> 100 beats/min), leukocytosis (WBC > 12000 $mm^{3}$), leukocytopenia (WBC > 3000 $mm^{3}$), status of infection, inflammatory bowel disease, surgery and trauma. There was a positive correlation between hypermetabolic score and length of hospital stay (ICU), medical cost, weight loss, antibiotics adjusted by age while APACHEIII score did not show correlation to clinical outcome. Medical cost was higher by $18.2\%$ in the TPN group than the EN group. In conclusion, there was a strong negative correlation between the clinical outcome (cost, incidence of infection, hospital stay) and hypermetabolic score. Higher metabolic stress caused more malnutrition and complications. For nutritional management of patients with malnutrition, multiple factors, including nutritional assessment, and evaluation of hypermetabolic severity are needed to provide nutritional support for critically ill patients.

Thiamine Deficiency in a Child with Short Bowel Syndrome and Review

  • Roilides, Ioannis;Vasilaki, Konstantina;Xinias, Ioannis;Iosifidis, Elias;Antachopoulos, Charalampos;Roilides, Emmanuel
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.22 no.5
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    • pp.493-499
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    • 2019
  • Thiamine (vitamin $B_1$) is a water-soluble vitamin that is not endogenously synthesized in humans. It is absorbed by the small intestine, where it is activated. Its active form acts as a coenzyme in many energy pathways. We report a rare case of thiamine deficiency in a 3.5-year old boy with short bowel syndrome secondary to extensive bowel resection due to necrotizing enterocolitis during his neonatal age. The patient was parenteral nutrition-dependent since birth and had suffered from recurrent central catheter-related bloodstream infections. He developed confusion with disorientation and unsteady gait as well as profound strabismus due to bilateral paresis of the abductor muscle. Based on these and a very low thiamine level he was diagnosed and treated for Wernicke encephalopathy due to incomplete thiamine acquisition despite adequate administration. He fully recovered after thiamine administration. After 1999 eight more cases have been reported in the PubMed mostly of iatrogenic origin.

Risk Factors of Malnutrition by Age in Hospitalized Older Adults (입원 노인의 연령별 영양불량 위험요인)

  • Kim, Eun Jung
    • Journal of Korean Clinical Nursing Research
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    • v.27 no.1
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    • pp.77-84
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    • 2021
  • Purpose: Malnutrition affects all age groups, but older adults are particularly more vulnerable to nutritional deficiencies. This study evaluated the age-specific factors affecting malnutrition in hospitalized older adults. Methods: A retrospective study was conducted on inpatient elderly people who received artificial nutrition from 2010 to 2017. Data of demographics, diagnosis, type of nutrition therapy, number of comorbidity, fall risk assessment, Acute Physiologic Assessment and Chronic Health Evaluation (APACHE) score, and intensive care unit admission were collected. Malnutrition was defined as a body mass index (BMI) of less than 18.5 kg/m2. Patients were classified as the young-old (65~74 years old), the old-old (75~84 years old), or the oldest-old (85 years old or older). Results: A total of 7,130 older adults were included, and 4,028 patients were classified as the young-old, 2,506 into the old-old, and 596 into the oldest-old. Proportion of malnutrition was higher in the oldest-old compared to the other groups. In multivariate analysis, parenteral nutrition, alcohol, and high risk of falls were factors affecting malnutrition in all groups. Parenteral nutrition and alcohol in the young-old, high risk of falls in the old-old, and male sex in the oldest-old were the factors affecting malnutrition by the age group. Conclusion: Older age was the most significant factor affecting malnutrition. Specific strategies by age are needed to improve nutritional status in hospitalized older adults as influencing factors for malnutrition vary among different age groups.

The Outcome of Nutrition Support of Surgery Patients with Hypermetabolic Severity by Total Parenteral Nutrition and Enteral Nutrition and Biochemical Data (경장영양과 중시정맥영양을 공급받는 외과계 수술 환자의 과대사 정도에 따른 영양 섭취량 및 생화학적 검사 결과)

  • Rha Mi-Yong;Kim Eun-Mi;Cho Young-Y.;Seo Jeong-Meen;Choi Hay-Mie
    • Korean Journal of Community Nutrition
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    • v.11 no.2
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    • pp.289-297
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    • 2006
  • This study evaluated the nutrition intake and changes in laboratory data of surgery patients with hypermetabolic severity on nutrition support. From January 2002 to September 2002, 66 hospitalized surgery patients who had received enteral nutrition (EN, n=19) and total parenteral nutrition (TPN, n=47) for more than 7 days were prospectively and retrospectively recruited. The laboratory data was examined pre-operatively, and on the post-operative 1, 3, 7 day and at the time of discharge. The characteristics of the patients were examined for the hypermetabolic severity, The hypermetabolic scores were determined by high fever ($>38^{\circ}C$), rapid breathing (>30 breaths/min), rapid pulse rate (>100 beats/min) , leukocytosis ($WBC>12,000/{\mu}l$), leukocytopenia ($WBC>3,000/{\mu}l$), status of infection, inflammatory bowel disease, surgery and trauma. The scores for the hypermetabolic status were divided into three groups (mild 0-10, moderate 11-40, severe>41). According to the results of the study, 38.3% (n=23), 45.4% (n=30) and 19.6% (n=13) were in the mild, moderate, and severe groups, respectively. There was a decrease in the serum albumin level and weight loss according to the hypermetabolic severity. However, the white blood cells (WBC), fasting blood sugar (FBS), c-reactive protein (CRP), total bilirubin, GOT, and GPT increased. The nutritional intake was TPN (32.5 kcal/kg, protein 1.2 g/kg, fat 0.25 g/kg), EN (28.1 kcal/kg, protein 1.0 g/kg, fat 1.01 g/kg). The serum albumin, hemoglobin and cholesterol were higher in the EN group than in the TPN group. But the FBS, total bilirubin, GOT and GPT were higher in the TPN group than the EN group. In conclusion, there was a negative correlation between the changes in the laboratory data and the hypermetabolic severity. There was an increase in the number of metabolic complications in the TPN group.

Effects of Early Parenteral Nutrition for Extremely Low Birth Weight Infants (초극소 저출생 체중아(${\leq}$1,000 g)에서 조기에 시작하는 정맥 영양공급의 효과)

  • Ahn, So-Yoon;Shin, Ji-Hun;Shin, Jung-Hee;Sung, Se-In;Jung, Ji-Mi;Kim, Jin-Kyu;Chang, Yun-Sil;Jang, Yun-Sil;Park, Won-Soon
    • Neonatal Medicine
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    • v.18 no.1
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    • pp.76-81
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    • 2011
  • Purpose: The object of this study was to evaluate the efficacy of early total parenteral nutrition with early amino acid in extremely low birth weight infant (ELBWI). Methods: We retrospectively analyzed the medical records of all ELBWIs who were born and admitted to Samsung Medical Center from January 2003 to December 2003 and January 2009 to December 2009 and alive at the time of discharge. Data for nutritional status and morbidities were compared between period 1 (2003, n=22), in which parenteral nutritional support was started gradually over several days and period 2 (2009, n=38), in which parenteral nutrition with amino acid was started as soon as possible after birth. Results: Compared to period 1, birth weight and Apgar score were lower in period 2. The intake amount of glucose, amino acid and total calorie was higher and the level of blood urea nitrogen was increased more from 7th day to 14th day after birth in period 2 when compared than period 1. The weight gain velocity was faster at 7th and 14th postnatal day in period 2. There were no differences in the incidence of necrotizing enterocolitis, moderate to severe bronchopulmonary dysplasia, and severe intraventricular hemorrhage (${\geq}$ Gr III) between two periods but, the incidence of periventricular leukomalacia(PVL) was significantly lower in period 2. Conclusion: Early initiation of total parenteral nutrition with early amino acid in ELBWIs was beneficial at weight gain with lowering catabolism and increasing anabolism. And it could be related with reducing the incidence of PVL.