An interactive microcomputer program for calculation of combined parenteral and enteral nutrition for neonates

A responsive, iterating program is described (available on diskette from first author), which enables the physician to formulate a balanced, total parenteral nutrition (TPN) for low-birth-weight and sick newborns. The program allows for the possibility of TPN or simultaneous intravenous, intraarterial, and oral feeding. It calculates the overall balance of fluids, nutrients, calories, electrolytes, minerals, trace elements, and vitamins. It features the integration of algorithms and limit tests of nutritional balance, to produce a feeding program that can be modified by clinical considerations of the physician, specific for each patient. The entire procedure can be accomplished, and a record of the entries and orders to the pharmacy and to the ward staff printed, within about 4-5 min. The program, which is written in BASIC, can be accommodated within and operated with a 16K byte microcomputer, equipped with a monitor, a printer, and a diskette or other program storage device.     

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??Parenteral nutrition (PN) is an essential and often life-saving treatment for infants and children who cannot be adequately fed orally or enterally, to prevent or correct malnutrition, and to sustain appropriate growth. PN is more costly and can induce severe complications than oral nutrition or EN. The complications is reduced by a meticulous mornitoring, establishment of a multidisciplinary nutrition support team, avoidance of unbalanced or excessive substrate supplies, strict hygiene measures to reduce catheter infections, and forceful enhancement of enteral feeding where possible to limit the amount and duration of PN.     

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??The incidence of malnutrition in critically ill children is always high??and parenteral nutrition??PN?? support is one of the important way to improve infants’nutrition status. The proper venous access and management is the fundamental assurance to infusion of PN. Properly venous access should be selected according to the concentration??osmotic pressure??pH and duration of parenteral nutrition. Venous accesses consist of peripheral venous access and central venous accesses??and central venous accesses consist of percutaneously inserted central catheter access?? peripherally inserted central catheter access and port. It will reduce complications effectively to choose suitable venous access??handle and manage inserted catheter well.     

Total parenteral nutrition in the management of traumatic chylous ascites in infancy

Chylous ascites is rare in the pediatric age group and usually of unknown etiology or due to congenital abnormalities of the lymphatic system. This report describes an infant with posttraumatic chylous ascites, unable to tolerate dietary therapy, in whom total parenteral nutrition allowed successful management. The experience gained in this case clarifies the management of chylous ascites from all causes. Specific recommendations for a treatment protocol are made.     

Intra-abdominal extravasation complicating parenteral nutrition in infants.

Two infants receiving total parenteral nutrition via a central venous catheter positioned in the inferior vena cava developed an acute abdomen secondary to extravasation of the infusate. The presence of an associated abdominal mass necessitated a laparotomy in one patient. Both infants recovered completely after the catheter had been removed.     

Home parenteral nutrition in chronic intestinal failure.

In children with severe failure of intestinal function, intravenous nutrition is at present the only treatment able to maintain adequate nutrition for prolonged periods of time. Over the last five years we have discharged 10 patients home on parenteral nutrition for a total of 25 patient years and here the outcome of these children is presented. Of the 10 patients, one has discontinued home parenteral nutrition (HPN), seven patients remain well, one patient has recently moved to the USA, and one patient has died after major abdominal surgery. All children had either normal or an accelerated rate of growth on HPN and developmentally all have progressed well. All the children over 5 years attend normal schools. The major complication of treatment was line sepsis with an overall rate of one episode in 476 days and a total of nine central lines (five patients) have required replacement giving an average line life of 680 days. For those children unfortunate enough to suffer from severe intestinal failure, HPN is preferable to prolonged hospital treatment and offers the chance of a good quality of life with prolonged survival.     

Manganese in long term paediatric parenteral nutrition.

The current practice of providing manganese supplementation to neonates on long term parenteral nutrition is leading to a high incidence of hypermanganesaemia. Magnetic resonance imaging (MRI) studies in adults on long term manganese parenteral nutrition have shown changes in TI weighted MRI images and similar findings in a neonate receiving trace element supplementation are reported here. Whole blood manganese concentration in the infant was 1740 nmol/l (or 8.3 times upper reference limit). In all neonates on long term parenteral nutrition with evidence of cholestatic liver disease so far investigated, the whole blood manganese concentrations were > 360 nmol/l (reference range 73-210). Manganese supplementation to patients on long term parenteral nutrition requires reappraisal, particularly in those who develop cholestatic liver disease associated with parenteral nutrition.     

早产儿早期静脉营养耐受性的探讨

目的 探讨早产儿生后1～2d对静脉营养的耐受性。方法 将不能完全耐受肠道营养的早产儿34例(胎龄29～36周，体重900～1800g)，随机分为两组，实验组于生后48h内添加氨基酸及脂肪乳；对照组采用传统的静脉营养方法，即生后第3天应用氨基酸，第5天应用脂肪乳，同时均根据病情尽早经口微量喂养。两组患儿均于生后第1天及第7天采血，监测血清游离脂肪酸、总胆红素、直接胆红素、白蛋白、甘油三脂、总胆固醇，每天监测体重、微量血糖及经皮胆红素值。比较两组患儿恢复出生体重的时间、血清游离脂肪酸、胆红素及血脂的变化。结果 1)实验组患儿恢复出生体重的时间较对照组短；2)两组患儿生后相同日龄测得血清游脂肪酸、总胆红素、直接胆红素、甘油三脂、总胆固醇及血清游离脂肪酸与白蛋白的摩尔比均无显著差异。结论 早产儿生后1～2d可耐受全或部分肠道外营养。     

早产儿早期静脉营养耐受性的探讨

目的探讨早产儿生后1～2 d对静脉营养的耐受性.方法将不能完全耐受肠道营养的早产儿34例(胎龄29～36周,体重900～1 800g),随机分为两组,实验组于生后48h内添加氨基酸及脂肪乳;对照组采用传统的静脉营养方法,即生后第3天应用氨基酸,第5天应用脂肪乳,同时均根据病情尽早经口微量喂养.两组患儿均于生后第1天及第7天采血,监测血清游离脂肪酸、总胆红素、直接胆红素、白蛋白、甘油三脂、总胆固醇,每天监测体重、微量血糖及经皮胆红素值.比较两组患儿恢复出生体重的时间、血清游离脂肪酸、胆红素及血脂的变化.结果1)实验组患儿恢复出生体重的时间较对照组短;2)两组患儿生后相同日龄测得血清游脂肪酸、总胆红素、直接胆红素、甘油三脂、总胆固醇及血清游离脂肪酸与白蛋白的摩尔比均无显著差异.结论早产儿生后1～2 d可耐受全或部分肠道外营养.     

The role of zinc in total parenteral nutrition.

Zinc deficiency was observed in an infant receiving total parenteral nutrition (TPN) for chronic untractable diarrhoea. Clinical findings included low zinc plasma levels, skin lesions and loss of all the advantages of TPN such as weight gain, serum proteins and albumin increase and normalization of intestinal mucosa. Oral administration of zinc sulphate was the decisive factor making possible both the improvement of clinical and laboratory findings and alimentation by natural route.     

Aluminum contamination of parenteral nutrition and aluminum loading in children on long-term parenteral nutrition

BACKGROUND: Children who are receiving parenteral nutrition are at risk of aluminum overload, which may contribute to such side effects as osteopenic bone disease. The aim of the present study is to determine the aluminum contamination of parenteral nutrition solutions and their components, and to assess the aluminum status of children on long-term parenteral nutrition. METHODS: Aluminum concentrations were determined by graphite furnace absorption spectroscopy in components and in final parenteral nutrition solutions. The urinary aluminum excretion and plasma aluminum concentration were determined in 10 children on long-term parenteral nutrition. RESULTS: The mean aluminum concentration in the administered parenteral nutrition solutions was 1.6 +/- 0.9 micromol x l(-1)(mean +/- standard deviation (SD)). The resulting mean aluminum daily intake of the 10 patients was 0.08 +/- 0.03 micromol x kg(-1) x day(-1). CONCLUSIONS: Compared to two previous studies performed in 1990 and in 1995 in our hospital, the aluminum contamination of parenteral nutrition solutions and the daily aluminum intake of the children seemed to decrease. However, the plasma aluminum concentration and daily urinary aluminum excretion of the children still remain above normal standards. The children had no clinical symptoms of bone disease but aluminum accumulation in tissue can not be excluded. To prevent this iatrogenic toxicity, the aluminum contamination of parenteral nutrition should be assessed regularly.     

Effect of parenteral nutrition on oral intake.

Oral intake following a high density oral supplement (preload) is lower than that after a low density preload. We studied a similar effect of parenteral nutrition on oral intake. Twelve neurologically intact children (8-16 yr) with orthopedic problems and no concurrent illness were included in the study. As part of the inclusion criteria, all patients had documented energy intake for breakfast of +/- 10% on 3 consecutive days. On the fourth day parenteral nutrition equal to 50% of the mean energy intake for breakfast was provided for 4 hours before breakfast and energy intake measured. The composition of the parenteral energy was matched with that of the oral intake. The mean oral energy intake without (470 +/- 90 kcal) and with (458 +/- 64 kcal) parenteral nutrition preload was comparable (p > 0.05). Our conclusion is that parenteral nutrition does not affect oral intake in patients without underlying gastrointestinal disease.     

小儿肠外营养指南：维生素

正2016年,由欧洲儿科胃肠肝病和营养学会(ESPGHAN)、欧洲儿科研究学会(ESPR)、欧洲肠外肠内营养学会(ESPEN)三个欧洲学术组织,联合蔡威教授为代表的中国肠外肠内营养学会(CSPEN)儿科学组,共同修订、发布了最新的《儿科肠外营养指南》,2018年6月发表于《Clinical Nutrition》(临床营养)杂志,12月在《中华儿科杂志》发布了"推荐意见节译"。     

Iodine supplementation in children receiving long-term parenteral nutrition.

In 18 children receiving long-term total parenteral nutrition (TPN) without iodide supplements, thyroid function test results were normal but serum iodide levels were greater than in control subjects (p less than 0.01). Iodine contamination of TPN solutions and fat emulsions accounted for only half of the recommended parenteral intake. Skin absorption of topical iodinated disinfectant may explain the adequate, if not excessive, iodine intake. We conclude that iodine is an unnecessary supplement in TPN solutions.     

Liver disease in infants receiving total parenteral nutrition.

Progressive cholestasis and abnormal elevations of liver enzymes occurred in one third of 92, mostly preterm, newborn infants who received total parenteral nutrition (TPN) with protein hydrolysates, synthetic L-amino acids, and intravenous fat emulsion. The synthetic amino acid plus intravenous fat emulsion was not superior to the protein hydrolysate in preventing liver disease. The liver function returned to normal after discontinuation of TPN, which suggests a causal relationship. Hepatic microscopy was abnormal in 12 of 14 infants examined. The main features were progressive cholestasis and portal tract fibrosis and infiltration, which led to liver failure and death in two infants. In our experience, liver disease is the major metabolic complication of TPN in infants.     

Amino acids in parenteral nutrition of preterm infants. Comparison of oral and parenteral supply

Parenteral feeding of preterm infants has been accepted as an alternative form of nutrition in those infants unable to accept oral feeding. The amount of amino acid nitrogen and the composition of the amino acid solution to be used, however, have not yet been defined. The amino acid intake and the plasma amino acid concentration of three groups of preterm infants were compared. Twenty-three infants were fed parenterally. Of these, 16 were studied during the first week of life (group I) and 7 during the second week (group II). A control group of 9 infants fed with oral formula was also studied in the second week (group III). In general, plasma amino acid concentrations in the parenterally fed groups were higher than in the orally fed group, in spite of a lower intake. Comparison of the amino acid intake of groups I and II relative to group III, with the plasma amino acid concentrations of groups I and II relative to group III, revealed a rather constant ratio with the exception of tyrosine and aspartic acid, where higher values were found. It is concluded that further increase in the amino acid nitrogen in parenteral feeding of preterm infants requires a more adapted preparation.