Effects of cyclic parenteral nutrition on parenteral nutrition-associated cholestasis in newborns.

BACKGROUND AND OBJECTIVES: Parenteral nutrition (PN) is one of the main nutritional methods used in newborns; however, long-term PN may induce PN-associated cholestasis (PNAC). This study aims to evaluate the effect of cyclic PN in the prevention and improvement of PNAC in newborns requiring long-term PN. METHODS AND STUDY DESIGN: A retrospective cohort study was conducted on patients admitted at the Seoul National University Children's Hospital neonatal intensive care unit between October 2010 and September 2015 and referred to the nutrition support team with total parenteral nutrition for more than 14 days. The primary outcome was the incidence of PNAC. The incidence of hypoglycemia, changes in direct bilirubin (DB) concentrations, and length of hospital stay were investigated. RESULTS: A total of 124 patients were observed in this study. Among these, 100 patients received continuous PN, whereas 24 patients received both continuous and cyclic PN. PNAC occurred in 31.5% (39/124) of study population. The incidence rates of PNAC were 27.4% during continuous PN period and 20.8% during cyclic PN period. Cyclic PN was an independent factor that significantly decreased PNAC incidence (OR=0.154; 95% CI, 0.045-0.529, p=0.003). DB concentrations significantly decreased (p=0.049) with therapeutic cyclic PN, but remained normal with prophylactic cyclic PN. No significant difference in hypoglycemia incidence and length of hospital stay was observed in both continuous PN and continuous to cyclic PN groups. CONCLUSIONS: Cyclic PN could be effective in the prevention and improvement of PNAC and also safe in terms of hypoglycemia in newborns.

The successful accomplishment of nutritional and clinical outcomes via the implementation of a multidisciplinary nutrition support team in the neonatal intensive care unit.

BACKGROUND: Nutritional support is critical for preterm infants in the neonatal intensive care unit (NICU). A multidisciplinary nutritional support team (NST) that focuses on providing optimal and individualized nutrition care could be helpful. We conducted a thorough evaluation of clinical and nutritional outcomes in a tertiary NICU following the implementation of an NST. METHODS: This study used a retrospective approach with historical comparisons. Preterm neonates < 30 weeks gestational age or weighing < 1250 g were enrolled. Clinical and nutritional outcomes were compared before and after the establishment of the NST. Medical records were reviewed, and clinical and nutritional outcomes were compared between the two groups. RESULTS: In total, 107 patients from the pre-NST period and 122 patients from the post-NST period were included. The cumulative energy delivery during the first week of life improved during the post-NST period (350.17 vs. 408.62 kcal/kg, p < 0.001). The cumulative protein and lipid deliveries also significantly increased. The time required to reach full enteric feedings decreased during the post-NST period (6.4 ± 5.8 vs. 4.7 ± 5.1 days, p = 0.016). Changes of Z-score in weight from admission to discharge exhibited more favorable results in the post-NST period (-1.13 ± 0.99 vs.-0.91 ± 0.74, p = 0.055), and the length of ICU stay significantly decreased in the post-NST period (81.7 ± 36.6 vs. 72.2 ± 32.9 days, p = 0.040). CONCLUSIONS: NST intervention in the NICU resulted in significant improvements in the provision of nutrition to preterm infants in the first week of life. There were also favorable clinical outcomes, such as increased weight gain and reduced length of ICU stay. Evaluable data remain sparse in the NICU setting with premature neonatal populations; therefore, the successful outcomes identified in this study may provide support for NST practices.

Effect of selenium-free parenteral nutrition on serum selenium of neonates and infants maintained on long-term parenteral nutrition.

BACKGROUND: The risk of selenium deficiency increases for infants receiving long-term parenteral nutrition (PN). This study analyzed selenium deficiency in neonates and infants requiring long-term PN and evaluated the effect of intravenous (IV) selenium provision. METHODS: This study was a retrospective study of neonates and infants who were admitted to a neonatal intensive care unit from January 2010 to December 2019, received PN for ≥2 weeks, and had their serum selenium concentration measured. Patients were divided into two groups, depending on their serum selenium concentration, a deficient group (n = 55) and a nondeficient group (n = 47). RESULTS: Of the study participants, 53.9% (55 of 102) were deficient in selenium. No difference in demographic and clinical characteristics existed except bronchopulmonary dysplasia. A subgroup analysis was performed for patients (n = 29). The average dose of IV selenium administered to patients was 2.7 ± 1.0 mcg/kg/day. The average initial serum selenium concentration was 36.5 ± 18.0 mcg/L, and the serum concentration significantly increased to 52.5 ± 19.1 mcg/L after IV selenium administration (P < .001). The correlation between the average IV selenium dose and the change in serum selenium concentrations was statistically significant (r = .423; P = .022). CONCLUSION: Selenium deficiency is common in neonates and infants receiving long-term PN. Serum selenium concentration increased proportionally as the IV selenium dose increased. Therefore, it is recommended to supply a proper dose of IV selenium depending on the degree of selenium deficiency.

Nutrition Support Team Reconsultation During Nutrition Therapy in Korea.

BACKGROUND: The aim of this study was to investigate the nutrition support team (NST) reconsultation practice and to evaluate reasons and describe risk factors for NST reconsultation during nutrition therapy (NT) in hospitalized patients. METHODS: This study included 2505 patients aged >18 years who received NT through NST consultation between January 2016 and December 2016 at Seoul National University Hospital. NST reconsultation refers to consulting the NST more than twice during a single hospitalization period. Risk factors affecting NST reconsultation were included only when NST reconsultation occurred for specific reasons other than routine evaluations. RESULTS: The NST reconsultation rate was 36.4% (913/2505) with 926 reasons, including 'changes in the nutrition provision method' (n = 474, 51.2%), 'NT-related complications' (n = 284, 30.7%), 'routine evaluations' (n = 137, 14.8%), and 'discharge planing including home NT' (n = 31, 3.3%). The reconsultation rate of enteral nutrition (EN) was 40.8% (n = 378) and that of parenteral nutrition (PN) was 59.2% (n = 548). Among the NT-related complications, diarrhea (n = 65, 49.2%) was the most common with EN, whereas electrolyte abnormality (n = 52, 34.2%) was the most common with PN. Performance of surgery (odds ratio [OR], 2.061; P < .001), low serum albumin levels (<3 mg/dL; OR, 1.672; P < .001), presence of comorbidities (OR, 1.556; P < .001), and low body mass index (kg/m2 ) (<18.5; OR, 1.508; P < .001) were predictive risk factors for NST reconsultation. CONCLUSIONS: Frequent evaluation of nutrition status through a multidisciplinary NST is important in patients with these risk factors.

Clinical significance of potential drug-drug interactions in a pediatric intensive care unit: A single-center retrospective study.

Despite the high prevalence of potential drug-drug interactions in pediatric intensive care units, their clinical relevance and significance are unclear. We assessed the characteristics and risk factors of clinically relevant potential drug-drug interactions to facilitate their efficient monitoring in pediatric intensive care units. This retrospective cohort study reviewed the medical records of 159 patients aged <19 years who were hospitalized in the pediatric intensive care unit at Seoul National University Hospital (Seoul, Korea) for ≥3 days between August 2019 and February 2020. Potential drug-drug interactions were screened using the Micromedex Drug-Reax® system. Clinical relevance of each potential drug-drug interaction was reported with official terminology, magnitude of severity, and causality, and the association with the patient's clinical characteristics was assessed. In total, 115 patients (72.3%) were exposed to 592 potential interactions of 258 drug pairs. In 16 patients (10.1%), 22 clinically relevant potential drug-drug interactions were identified for 19 drug pairs. Approximately 70% of the clinically relevant potential drug-drug interactions had a severity grade of ≥3. Exposure to potential drug-drug interactions was significantly associated with an increase in the number of administrated medications (6-7 medications, p = 0.006; ≥8, p<0.001) and prolonged hospital stays (1-2 weeks, p = 0.035; ≥2, p = 0.049). Moreover, clinically relevant potential drug-drug interactions were significantly associated with ≥8 prescribed drugs (p = 0.019), hospitalization for ≥2 weeks (p = 0.048), and ≥4 complex chronic conditions (p = 0.015). Most potential drug-drug interactions do not cause clinically relevant adverse outcomes in pediatric intensive care units. However, because the reactions that patients experience from clinically relevant potential drug-drug interactions are often very severe, there is a medical need to implement an appropriate monitoring system for potential drug-drug interactions according to the pediatric intensive care unit characteristics.

Practice of parenteral nutrition in hospitalized adult patients in Korea: A retrospective multicenter cross-sectional study.

There have been no studies on the characteristics of parenteral nutrition (PN) supply for adult inpatients in South Korea. The aim of this retrospective multicenter cross sectional study was to investigate the current practice and characteristics of PN support in hospitalized adult patients in South Korea for the first time. This study was conducted retrospectively for the adult patients who were hospitalized and received PN in nine hospitals on August 1st, 2017 to October 30th, 2017. We evaluated the type of PN formulation, PN administration period, administration route, calories supplied, amount of protein supplied, and laboratory results. Among the 11,580 inpatient admissions on that day, 1,439 patients received PN (12.4%). The majority of enrolled patients (96.5%) used the commercial PN, of which 86.2% were multi-chamber. 71.2% of them received PN peripherally. The average in hospital PN duration was 17.8 ± 52.6 days. Patients received only 65.4 ± 25.4% calories of their target calories. The in-hospital mortality of enrolled patients was 22%. In South Korea, commercial PN was usually administered to hospitalized adult patients and in-hospital mortality in adult patients using PN was higher in South Korea compared to other countries. This study provides the characteristics and the PN support status of hospitalized adult patients receiving PN in South Korea.

Factors affecting postoperative dietary adaptation in short bowel syndrome.

BACKGROUND/AIMS: To investigate factors that affect post-operative dietary adaptation in patients with short bowel syndrome. METHODOLOGY: It was reviewed post-operative nutritional courses in nine patients with less than 200cm of residual small bowel after bowel resection. Surgical factors affecting post-operative dietary adaptation were analysed in view of the post-operative weaning from parenteral nutrition (PN). RESULTS: One of two patients with less than 50 cm of residual small bowel achieved oral feeding. This patient with 40 cm of residual small intestine, who had undergone small bowel resection 12 months previously, achieved oral feeding within one month. As a whole, only 2 patients failed to wean PN. One patient with 40 cm of residual small intestine, who had undergone total gastrectomy three months ago, failed to wean PN. The other patient with 160 cm of ileum without the stomach, duodenum, jejunum, ileocecal valve, or most of the colon after three consecutive bowel resections, failed to wean PN. CONCLUSIONS: Tapering of PN was possible even in patients with less than 50 cm of residual small bowel, if they had undergone previous bowel resections and were provided with adequate PN for a sufficient time.

Outcomes with perioperative fat emulsions containing omega-3 fatty acid: A meta-analysis of randomized controlled trials.

PURPOSE: Results of a meta-analysis of data from clinical studies comparing patient outcomes and hospital length of stay (LOS) in surgical patients receiving fish oil (FO)-containing i.v. fat emulsions (IVFEs) versus non-FO-containing IVFEs are presented. METHODS: Computerized searches of the MEDLINE, Embase, and Coch rane CENTRAL databases were performed in August 2014 to identify English-language articles on randomized controlled trials (RCTs) comparing FO-containing and non-FO-containing IVFEs in adult surgical patients receiving parenteral nutrition. Selected articles were analyzed for methodological and publication bias and study heterogeneity (I2 statistic). RESULTS: Data from 19 RCTs (total n = 1,167) were included in the meta-analysis. Compared with use of non-FO-containing IVFEs (products based in soybean oil [SO], medium-chain triglycerides, or olive oil), use of FO-containing IVFEs was associated with reduced infectious morbidity (odds ratio [OR], 0.44; 95% confidence interval [CI], 0.30-0.65; p < 0.0001; I2 = 0%); the effect size was greatest for FO-containing versus SO-based IVFEs. Relative to use of SO-based IVFEs, use of FO-containing IVFEs was associated with a significant reduction in hospital LOS (weighted mean difference, -2.70 days; 95% CI, -3.60 to -1.79 days; p < 0.00001; I2 = 0%). CONCLUSION: The results of the meta-analysis indicated that FO-containing IVFEs could improve infectious morbidity and LOS. The overall effect of reducing infectious morbidity and LOS was found to be the greatest in comparison with the SO-based IVFEs.

Analysis of risk factors for lipid intolerance of intravenous fat emulsion in very low birth weight infants.

In order to prevent fatty acid deficiency and to supply enough energy, intravenous fat emulsion is necessary for parenteral nutrition in preterm neonates. However, parenteral administration of intravenous fat emulsion can induce lipid intolerance. The purpose of this study was to analyze risk factors for lipid intolerance in very low birth weight infants. This retrospective study included 80 preterm neonates whose birth weight was less than 1,500 g. Subjects were divided into 2 categories: those with a serum triglyceride level of ≥ 200 mg/dl (n = 33, 41%) and those with a serum triglyceride level of < 200 mg/dl (n = 47, 59%). We conducted logistic regression analysis using variables which were significant in univariate analysis. All statistical analyses were processed in SPSS version 19.0. Four risk factors for lipid intolerance were obtained through analysis of the electronic medical record. Lipid intolerance occurred more frequently in neonates with sepsis; those with a birth weight less than 1,000 g; those who was administered intravenous fat emulsion more than 2.6 g/kg/day; and those whose gestational age was less than 28 weeks. It is suggested that serum triglyceride levels should be closely monitored to prevent lipid intolerance in preterm neonates with the aforementioned characteristics.

Prealbumin levels as a useful marker for predicting infectious complications after gastric surgery.

BACKGROUND/OBJECTIVES: Preoperative nutritional status is associated with postoperative complications. Prealbumin, a visceral protein, is sensitive to protein malnutrition. The objective of this study is to evaluate the role of preoperative prealbumin levels as a marker for predicting complications after gastric surgery. METHODS: An observational study was performed on 183 patients who underwent gastric surgery due to benign or malignant gastric disease at Seoul National University Hospital (SNUH) between August 2009 and October 2010. Preoperative prealbumin levels were also measured. Nutritional variables such as prealbumin (cutoff value, 18 mg/dL), albumin, body mass index (BMI), and clinicopathologic data were collected. Postoperative hospital stay, 30-day complications and mortality rate were obtained to investigate outcomes. RESULTS: The complication rate was 52% in the abnormal prealbumin group (n = 23) and 24% in the normal prealbumin group (n = 160; p = 0.005). The complication rate was higher in patients with low preoperative albumin levels (<3.5 g/dL) and abnormal BMI (<18.5 kg/m(2)), but the differences were not statistically significant. Comorbidity of diabetes mellitus (DM), resection extent, combined resection, TNM stage and prealbumin levels were associated with complications. In multivariate analysis, DM and combined resection were significantly correlated with complications (p = 0.001 for each). In subgroup analysis, resection extent, approach, combined resection, TNM stage, and prealbumin levels were significantly associated with infectious complications. Multivariate analysis identified combined resection (p = 0.001) and prealbumin levels (p = 0.032) as independent variables. CONCLUSIONS: Preoperative prealbumin levels could be a useful marker for predicting complications, especially infectious complications, after gastric surgery.