[Incidence of catheter-related infection and associated risk factors in hospitalized patients with parenteral nutrition]. / Incidencia de infección asociada a catéter y factores de riesgo relacionados en pacientes hospitalizados con nutrición parenteral.

INTRODUCTION: The most severe complication of parenteral nutrition (PTN) is catheter-related infection (CRI). OBJECTIVES: To study the incidence rate and factors associated to CRI. MATERIAL AND METHODS: 271 patients followed at the Nutrition Unit for 6 months. The composition of the PTN was calculated according to the metabolic demands. 20.3% received a lipid solution enriched with omega-3 fatty acids (SMOF Fresenius Kabi®) and 79.7% with olive oil (Clinoleic Baxter®). RESULTS: The rate of CRI was 25 per 1,000 days of PTN (55 patients: 61.7±17.8 years, 60.3% males, 29.3±10.6 days of hospital stay and 10.4% mortality). Coagulase-negative Staphylococcus was the most frequently isolated microorganism. There were no differences by age, gender, mortality, or composition of the PTN between patients with or without infection. The patients treated with omega-3 received more calories with the PTN, at the expense of higher intake of glucose and lipids. However, the rate of infection was similar, although there was a not significant trend towards a lower infection rate when using the omega-3 composition (14.5% vs. 23.1%, respectively, p = 0.112). The duration of the nutritional support was higher in patients with CRI (13.0 ± 9.7 vs. 9.3 ± 8.1, p = 0.038). Total mortality (16.9%) was independent of the presence or absence of CRI (10.4% vs. 18.7%, p = 0.090) or of the use of omega-3 lipids or olive oil in the PTN (10.9% vs. 18.5%, p = 0.125). CONCLUSION: Patients submitted to PTN have a high rate of CRI. The presence of infection is related to the duration of the PTN, being independent of the age, gender, and composition of the solution. The use of omega-3 lipid solutions may be beneficial although further studies are needed to confirm this.

Sellado con alcohol al 70% en la infección asociada a catéter en nutrición parenteral domiciliaria / Sealing with 70% alcohol in catheter-related infection in home parenteral nutrition

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Incidencia de infección asociada a catéter y factores de riesgo relacionados en pacientes hospitalizados con nutrición parenteral / Incidence of catheter-related infection and associated risk factors in hospitalized patients with parenteral nutrition

Introducción: La complicación más grave de la nutrición parenteral (NPT) es la infección asociada a catéter (IAC). Objetivos: Estudiar la tasa de incidencia y los factores asociados a IAC. Material y métodos: 271 pacientes seguidos por la Unidad de Nutrición durante seis meses. La composición de la NPT se calculaba de acuerdo a las necesidades metabólicas. Un 20,3% recibió la solución lipídica enriquecida con ácidos grasos omega3 (SMOF Fresenius Kabi®) y un 79,7% con aceite de oliva (Clinoleic Baxter®). Resultados: La tasa de IAC fue de 25 por 1.000 días de NPT (55 pacientes: 61,7 ± 17,8 años, 60,3% hombres, 29,3 ± 10,6 días de estancia y 10,4% mortalidad). El Staphiloccocus coagulasa negativo fue el germen aislado más frecuente. No existían diferencias en la edad, sexo, mortalidad y composición de la NPT entre pacientes con y sin infección. Los pacientes tratados con omega-3 recibían más calorías en la NPT, a expensas de mayor aporte de glucosa y de lípidos. Sin embargo, la frecuencia de infección era similar, aunque existía una tendencia no significativa a ser menor con el uso de omega-3 (14,5% vs 23,1% respectivamente, p = 0,112). La duración del soporte nutricional fue mayor en los enfermos con IAC (13,0 ± 9,7 vs 9,3 ± 8,1, p = 0,038). La mortalidad total (16,9%) fue independiente de si el paciente presentaba o no IAC (10,4% vs 18,7%, p = 0,090) o del uso de lípidos omega3 o aceite de oliva en la NPT (10,9% vs 18,5%, p = 0,125). Conclusión: Los pacientes sometidos a NPT cursan con una tasa elevada de IAC. La presencia de infección se relaciona con la duración de la NPT, siendo independiente de la edad, sexo y composición de la solución. El uso de soluciones lipídicas con omega-3 podría ser beneficiosa, aunque se necesitan más estudios para su confirmación (AU)

Introduction: The most severe complication of parenteral nutrition (PTN) is catheter-related infection (CRI). Objectives: To study the incidence rate and factors associated to CRI. Material and methods: 271 patients followed at the Nutrition Unit for 6 months. The composition of the PTN was calculated according to the metabolic demands. 20.3% received a lipid solution enriched with omega-3 fatty acids (SMOF Fresenius Kabi®) and 79.7% with olive oil (Clinoleic Baxter®). Results: The rate of CRI was 25 per 1,000 days of PTN (55 patients: 61.7±17.8 years, 60.3% males, 29.3±10.6 days of hospital stay and 10.4% mortality). Coagulase-negative Staphylococcus was the most frequently isolated microorganism. There were no differences by age, gender, mortality, or composition of the PTN between patients with or without infection. The patients treated with omega-3 received more calories with the PTN, at the expense of higher intake of glucose and lipids. However, the rate of infection was similar, although there was a not significant trend towards a lower infection rate when using the omega-3 composition (14.5% vs. 23.1%, respectively, p = 0.112). The duration of the nutritional support was higher in patients with CRI (13.0 ± 9.7 vs. 9.3 ± 8.1, p = 0.038). Total mortality (16.9%) was independent of the presence or absence of CRI (10.4% vs. 18.7%, p = 0.090) or of the use of omega-3 lipids or olive oil in the PTN (10.9% vs. 18.5%, p = 0.125). Conclusion: Patients submitted to PTN have a high rate of CRI. The presence of infection is related to the duration of the PTN, being independent of the age, gender, and composition of the solution. The use of omega-3 lipid solutions may be beneficial although further studies are needed to confirm this (AU)

[Micronutrient supplementation in parenteral nutrition in Spanish hospitals]. / Utilización de micronutrientes en nutrición parenteral en los hospitales Españoles.

Several years ago, it was recommended not to add vitamins or oligoelements to parenteral nutrition (PN) solutions and to administer them immediately after the addition of the micronutrients to avoid their decay. Nowadays, it has been observed that with multilayer bags, ternary mixtures and sunlight protection vitamins degradation is minimal. Daily intake of micronutrients is necessary in the critically ill, malnourished or long-term PN patients. Aiming at knowing the schedules of use of micronutrients in PN in Spanish hospitals and the way PN bags are prepared regarding the factors conditioning their stability, we undertook a telephone survey to the pharmacists in charge of PN at the different hospitals. We compared the data obtained with those from other surveys performed in 2001 and 2003. Pharmacists from 97 hospitals answered the questionnaire (answer rate 88%). The hospital sizes ranged 104-1728 beds. As compared to the data form preceding years, we observed a better adequacy to the current recommendations, although there are still 30% of the hospitals that administer micronutrients on an every other day basis independent of the clinical situation of the patients. In most of the hospitals, multilayer bags are used and/or sunlight protection and ternary mixtures. According to these results showing the different criteria for administering vitamins and oligoelements in PN solutions, it seems necessary to elaborate consensus documents that adapt to the reality of the diverse practices besides promoting the performance of well-designed clinical studies establishing the requirements under special clinical situations.

Utilización de micronutrientes en nutrición parenteral en los hospitales españoles / Micronutrient supplementation in parenteral nutrition in spanish hospitals

Hace años se recomendó no añadir conjuntamente vitaminas y oligoelementos a las nutriciones parenterales (NP) y administrarlas inmediatamente después de la adición de los micronutrientes para evitar su degradación. Actualmente se ha visto que con bolsas multicapa, mezclas ternarias y fotoprotección la degradación de vitaminas es mínima. El aporte diario de micronutrientes es necesario al menos en pacientes críticos, malnutridos o con NP a largo plazo. Con el objetivo de conocer las pautas de utilización de los micronutrienes en NP en los hospitales españoles y la forma de preparación de las bolsas de NP, en relación a los factores condicionantes de su estabilidad, se realizó una encuesta telefónica a los farmacéuticos responsables del área de NP de los diferentes hospitales. Los datos obtenidos se compararon con otras encuestas realizadas en 2001 y 2003. Respondieron la encuesta 97 hospitales de los 110 hospitales a los que se llamó (tasa de respuesta 88%), cuyo número de camas estaba comprendido entre 104 y 1728. En comparación con los datos de años anteriores se observa una mayor adecuación a las recomendaciones vigentes, aunque todavía casi un 30% de los hospitales aportan los micronutrientes en días alternos con independencia de la situación clínica del paciente. La mayoría de los hospitales utilizan bolsas multicapa y/o fotoprotección y mezclas ternarias. A la vista de los resultados, en los que se pone en evidencia la disparidad de criterios en la administración de vitaminas y oligoelementos en las soluciones de NP parece necesario elaborar documentos de consenso que se adecuen a la realidad de las distintas prácticas además de favorecer la realización de estudios clínicos minuciosamente diseñados para establecer los requerimientos en situaciones clínicas especiales (AU)

Several years ago, it was recommended not to add vitamins or oligoelements to parenteral nutrition (PN) solutions and to administer them immediately after the addition of the micronutrients to avoid their decay. Nowadays, it has been observed that with multilayer bags, ternary mixtures and sunlight protection vitamins degradation is minimal. Daily in take of micronutrients is necessary in the critically ill, malnourished or long-term PN patients. Aiming at knowing the schedules of use of micronutrients in PN in Spanish hospitals and the way PN bags are prepared regarding the factors conditioning their stability, we undertook a telephone survey to the pharmacists in charge of PN at the different hospitals. We compared the data obtained with those from other surveys performed in 2001 and 2003. Pharmacists from 97 hospitals answered the questionnaire(answer rate 88%). The hospital sizes ranged 104-1728 beds. As compared to the data form preceding years, we observed a better adequacy to the current recommendations, although there are still 30% of the hospitals that administer micronutrients on an every other day basis independent of the clinical situation of the patients. In most of the hospitals, multilayer bags are used and/or sunlight protection and ternary mixtures. According to these results showing the different criteria for administering vitamins and oligoelements in PN solutions, it seems necessary to elaborate consensus documents that adapt to the reality of the diverse practices besides promoting the performance of well-designed clinical studies establishing the requirements under special clinical situations (AU)

Parenteral nutrition supplemented with glutamine in patients undergoing bone marrow transplantation.

UNLABELLED: The objective of the study is to evaluate if the administration of glutamine in parenteral nutrition (PN) solution reduces the need for antibiotics, the risk of liver disease and the duration of hospital stay in bone marrow transplantation. MATERIAL AND METHODS: Retrospective observational study in 68 adult patients undergoing a bone marrow transplantation who required PN for mucositis. Of these patients, 40 were given PN with 2,063 +/- 294 kcal/day and 98.6 +/- 13.9 g of amino acids/day, supplemented with Lglutamine (13.5-27 g/day), and 28 were given isocaloric (1,966 +/- 307 kcal/day) and isonitrogenated (92 +/- 16.3 g of amino acids/day) PN with standard glutamine-free amino acid solution. Antibiotic consumption and duration of hospital stay were analysed. Of the total cohort, hepatic profile was studied at the beginning and on day 7 of PN in 50 patients without liver disease at the start of PN. RESULTS: There were no differences between both groups with regard to total number and duration of antibiotics prescribed or hospital stay. Of the 50 patients without hepatic alterations at the beginning of PN, 2 patients in the control group and 5 in the glutamine group developed a hepatic profile compatible with liver disease secondary to PN. Comparing both groups, there were no differences in hepatic enzyme values. CONCLUSIONS: Supplementation with PN glutamine does not improve the variables studied, but the actual clinical use of glutamine in this haematological treatment should be studied further and its potential advantages identified.

Parenteral nutrition supplemented with glutamine in patients undergoing bone marrow transplantation / Nutrición parenteral suplementada con glutamina en pacientes sometido a trasplante de médula ósea

The objective of the study is to evaluate if the administration of glutamine in parenteral nutrition (PN) solution reduces the need for antibiotics, the risk of liver disease and the duration of hospital stay in bone marrow transplantation. Material and methods: Retrospective observational study in 68 adult patients undergoing a bone marrow transplantation who required PN for mucositis. Of these patients, 40 were given PN with 2,063 ± 294 kcal/day and 98.6 ± 13.9 g of amino acids/day, supplemented with Lglutamine (13.5-27 g/day), and 28 were given isocaloric (1,966 ± 307 kcal/day) and isonitrogenated (92 ± 16.3 g of amino acids/day) PN with standard glutamine-free amino acid solution. Antibiotic consumption and duration of hospital stay were analysed. Of the total cohort, hepatic profile was studied at the beginning and on day 7 of PN in 50 patients without liver disease at the start of PN. Results: There were no differences between both groups with regard to total number and duration of antibiotics prescribed or hospital stay. Of the 50 patients without hepatic alterations at the beginning of PN, 2 patients in the control group and 5 in the glutamine group developed a hepatic profile compatible with liver disease secondary to PN. Comparing both groups, there were no differences in hepatic enzyme values. Conclusions: Supplementation with PN glutamine does not improve the variables studied, but the actual clinical use of glutamine in this haematological treatment should be studied further and its potential advantages identified (AU)

El objetivo del estudio es determinar si la administración de glutamina en la solución de nutrición parenteral (NP) disminuye la necesidad de antibióticos, el riesgo de hepatopatía y la duración de la estancia hospitalaria en trasplante de células hematológicas. Material y método: Estudio observacional retrospectivo, con 68 pacientes adultos sometidos a trasplante de células hematológicas, que precisaron NP por mucositis. De ellos, 40 pacientes recibieron NP con 2.063 ± 294 kcal/día y 98,6 ± 13,9 g de aminoácidos/día, suplementada con L-glutamina (13,5-27 g/día) y 28 recibieron una NP isocalórica (1.966 ± 307 kcal/día) e isonitrogenada (92 ± 16,3 g de aminoácidos/día) con solución de aminoácidos estándar libre de glutamina. Se analizó el consumo de antibióticos y la duración de la estancia hospitalaria. De la cohorte total, en 50 pacientes sin hepatopatía al inicio de la NP se estudió el perfil hepático al inicio y en el día 7 de la NP. Resultados: No hubo diferencias entre ambos grupos respecto al número total y duración de antibióticos prescritos, ni en estancia hospitalaria. De los 50 pacientes sin alteraciones hepáticas al inicio de la NP, 2 pacientes en el grupo control y 5 en el grupo glutamina desarrollaron un perfil hepático compatible con hepatopatía secundaria a NP. Comparando ambos grupos no hubo diferencias en los valores de enzimas hepáticas. Conclusiones: La suplementación con glutamina de NP no mejora las variables estudiadas, pero se debe continuar investigando el uso clínico real de glutamina en este tratamiento hematológico, identificando sus potenciales ventajas (AU)

Nutrición parenteral domiciliaria en pacientes con cáncer avanzado: experiencia en un solo centro a lo largo de diez años / Home parenteral nutrition in patients with advanced cancer: experience of a single centre over ten years

El uso de la nutrición parenteral domiciliaria (NPD) en pacientes con cáncer avanzado sin tratamiento curativo continúa siendo objeto de controversia y conlleva una considerable carga emocional. Sin embargo, este grupo de pacientes constituye la primera indicación de NPD en muchos programas. Objetivo: Presentar las características de una serie de pacientes incluidos en un programa de NPD en los últimos diez años. Método: Estudio retrospectivo de las historias clínicas de los once pacientes que recibieron NPD en este período. Se recogieron los datos demográficos, clínicos, complicaciones y evolución y se compararon con la del grupo de pacientes con enfermedad benigna que recibieron NPD en el mismo período. Para las comparaciones se utilizó la t de Student y el test de la Chi-cuadrado cuando estuvieron indicados. Se consideró significación estadística si p < 0,05. Resultados: Once pacientes recibieron NPD, nueve a causa de una obstrucción intestinal irresoluble y dos por una fístula de alto débito. La edad media del inicio de la NPD fue de 50,8 ± 12,7 años frente a los 37,3 ± 17,2 en el grupo con enfermedad benigna (p < 0,05). La duración media del NPD fue de 71,05 ± 217 días en el primer grupo, sensiblemente inferior al segundo (387,12 ± 995,85; p < 0,05), con un rango entre 5 y 760 días. Los pacientes recibieron la infusión a través de un reservorio subcutáneo ya previamente implantado (n: 9) y en dos ocasiones, de forma electiva, a través de un catéter tunelizado. La tasa de infección fue superior en el grupo con cáncer (0,34 episodios/paciente y 1.000 días de NPD) que en el grupo con enfermedad benigna (0,08 episodios; p < 0,05). Sólo en uno de los pacientes se suspendió la NPD antes de los 5 días previos al fallecimiento, por deterioro clínico. Dos pacientes precisaron ingreso por una complicación asociada a la técnica. En los dos casos se trató de una fungemia que obligó a la retirada del catéter. La calidad de vida medida mediante una escala de actividad fue similar al inicio de la NPD en ambos grupos. Ninguno de los pacientes que fueron incluidos en el programa continúa vivo. Conclusiones: la NPD ofrece al paciente con cáncer avanzado y grave disfunción intestinal la posibilidad de tratamiento en su domicilio, con un bajo índice de complicaciones. Si consideramos la corta duración media de la NPD, la inclusión en el programa ha de valorarse de forma individual y revisarse periódicamente (AU)

The use of Home Parenteral Nutrition (HPN) in patients with advanced cancer without the possibility of curative treatment continues to be a controversial subject entailing a considerable emotional burden. Sonetheless, this group of patients constitutes the main indication for HPN in many programmes. Goal: to present the characteristics of a series of patients included on an HPN programme over the last ten years. Method: Retrospective study of the case histories of the 11 patients who received HPN over this period. The demographic and clinical details were noted along with their complications and evolution for comparison with those of a control group of patients with benign disease receiving HPN over the same period. For the comparisons, Student´s t test and the chi-squared test were used as and when indicated. Results were considered statistically significant if p < 0.05. Results: Eleven patients received HPN, nine of them because of an irresoluble intestinal obstruction and two because of a high flow fistula. The mean age at the start of HPN was 50.8 ± 12.7 years versus 37.3 ± 17.2 years for the group with benign disease (p < 0.05). the mean duration of HPN was 71.05 ± 217 days in the first group, notably less than the second (387.15 ± 995.85; p < 0.05), with a range between 5 and 760 days. The patients received the infusion through a previously implanted subcutaneous reservoir (n = 9) and on two occasions, electively, through a tunnelled catheter. The infection rate was higher in the group with cancer (0.34 episodes per patient and 1,000 days on HPN) than in the group with benign disease (0.08 episodes; p < 0.05). HPN was suspended in only one of the patients more than 5 days prior to death due to clinical deterioration. Two patients required admission due to a complication associated with the technique. In both cases, a fungal infection of the blood made it necessary to withdraw the catheter. The quality of life, measured by means of an activity scale, was similar at the start of HPN in both groups. None of the patients included on the programme is still alive. Conclusions: HPN offers patients with advanced cancer and severe intestinal dysfunction the possibility of an at-home treatment with a low complication rate. If we take into account the short mean duration of HPN, inclusion on the programme must be assessed individually and regularly revised (AU)

[Therapeutic alternatives in intestinal failure]. / Alternativas terapéuticas en el fracaso intestinal.

BACKGROUND: Long-term parenteral nutrition is effective in the treatment of intestinal failure. Equally, the results of intestinal transplantation (IT) are promising. The choice of one or other form of treatment depends on the balance between the advantages and disadvantages of each. Based on these premises, we analyzed the outcome of home parenteral nutrition (HPN) for intestinal failure in our patients. METHODS: Intestinal failure was considered when parenteral nutrition was required for more than 5 months. In the 14 patients included in the HPN program since 1993, we reviewed the indication of HPN as well as their suitability for IT. RESULTS: Five of the 14 patients received HPN for causes other than intestinal failure. Of the remaining nine patients, four had severe motility disorder, three had short bowel syndrome, and two had protracted diarrhea of infancy. All these patients would be potential candidates for IT. Five patients were weaned off HPN because of intestinal adaptation between 2.5 and 13 months after starting HPN. One patient died because of lack of venous access. Three patients currently continue on HPN. CONCLUSION: Intestinal rehabilitation constitutes the best option for patients with intestinal failure. HPN offers the best interim treatment while waiting for adaptation. IT should be reserved for those patients with severe complications due to HPN. Nevertheless, it may become a real option for those with indefinite HPN. HPN and IT should be considered as complementary treatments.

Alternativas terapéuticas en el fracaso intestinal / Therapeutic alternatives in intestinal failure

Antecedentes: La nutrición parenteral prolongada es eficaz en el tratamiento del fracaso intestinal. Paralelamente asistimos al desarrollo de programas de trasplante intestinal con resultados esperanzadores. El reto de elegir una u otra forma de tratamiento dependerá del balance entre ventajas e inconvenientes de ambas posibilidades. Bajo estas premisas se analiza la evolución de nuestros pacientes con nutrición parenteral domiciliaria (NPD) por fracaso intestinal. Métodos: Consideramos fracaso intestinal cuando se precisó nutrición parenteral más de 5 meses. Se revisó la indicación, la evolución y la idoneidad como candidato a trasplante en los 14 niños incluidos en el programa de NPD desde 1993.Resultados: Cinco de los 14 pacientes recibieron NPD por causas distintas del fracaso intestinal. De los otros nueve, cuatro padecían una grave alteración de la motilidad; tres un síndrome de intestino corto y dos una diarrea intratable del lactante. Todos serían potenciales candidatos para trasplante intestinal. En cinco niños fue posible suspender la nutrición parenteral por conseguir adaptación intestinal entre 2 meses y medio y 13 meses desde el inicio de la NPD. Una paciente falleció por falta de accesos venosos. Tres pacientes continúan actualmente con NPD. Conclusión: La rehabilitación intestinal constituye la mejor opción para pacientes con fracaso intestinal. La NPD constituye el mejor tratamiento provisional en espera de la adaptación intestinal. El trasplante intestinal debería reservarse para aquellos pacientes que presenten complicaciones graves asociadas a la NPD. Sin embargo, podría considerarse como alternativa para quienes dependen indefinidamente de NPD. Ambas técnicas, NPD y trasplante deben considerarse tratamientos complementarios (AU)

[Survey on parenteral nutrition preparation variability in pediatrics]. / Encuesta sobre la variabilidad en la elaboración de la nutrición parenteral en pediatría.

UNLABELLED: The prescription and preparation of paediatric parenteral nutrition in Spain are subject to great variability. AIM: To identify how paediatric parenteral nutrition is prescribed and prepared in Spain. MATERIAL AND METHODS: During the first quarter of 2001, a telephone survey was carried out among most of the hospitals in which parenteral nutrition is habitually prepared. The survey included questions on who was in charge of the prescription, the use of different solutions, addition of supplements (carnitine, heparin and glutamine), as well as information on the shelf-life of the mixtures. Subsequently, the results of the survey were compared with the following guidance documents: "Enteral and parenteral nutrition in paediatrics", drafted under the auspices of the Spanish Association for Paediatric Gastroenterology, Hepatology and Nutrition (2000) and the "Guidelines for the use of parenteral and enteral nutrition in adult and paediatric patients"/"Nutrition support practice manual" from the American Society for Parenteral and Enteral Nutrition (1998). RESULTS: Of the 48 hospitals surveyed, paediatric parenteral nutrition was not prepared in 12 of them. the number of food bags prepared daily correlated directly with the size of the hospital. In all cases, the paediatricians were responsible for prescription. In 87% of the centres, this prescription was customized (i.e. solutions adapted to each individual patient). All of the hospitals used dextrose as the source of carbohydrates and specific amino acid solutions for paediatric medicine. Basically, lipid emulsions with long chain triglycerides were used in 65% of cases and another 19% used physical mixtures of MCT and LCT. Only half of the hospitals routinely used all-in-one mixtures. Inorganic phosphate continued to be used in most cases (78%) versus sodium glycerol phosphate. Vitamins and trace elements were added daily in 65% of the hospitals, with alternate administration in the remainder. In half of the centres, heparin was added to the mixture and carnitine in 27%. For 40% of the centres responding to the survey, the solution had to be used within 24 hours of its preparation; 11% did not indicate the shelf-life. CONCLUSIONS: Although parenteral nutrition is prescribed by the paediatricians on all occasions, the preparation protocols differ significantly between hospitals. Standardization is exceptional. It is noteworthy that all-in-one mixtures are only used in half of the hospitals surveyed. We suggest the creation of a multidisciplinary working party (pharmacists, paediatricians, neonatologists) in order to draw up protocols for the preparation of paediatric parenteral nutrition.

Encuesta sobre la variabilidad en la elaboración de la nutrición parenteral en pediatría / Survey of the variability in the preparation of parenteral nutrition in paediatric care

La prescripción y la elaboración de la nutrición parenteral pediátrica en España están sujetas a una gran variabilidad. Objetivo: conocer cómo se prescribe y se elabora la nutrición parenteral pediátrica en España. Material y métodos: se realizó una encuesta telefónica durante el primer trimestre del año 2001 entre la mayoría de hospitales donde se elaboran rutinariamente nutriciones parenterales. La encuesta incluyó preguntas sobre quién era el encargado de la prescripción, el uso de diferentes soluciones, adición de componentes - carnitina, heparina y glutamina - así como información sobre la caducidad de las mezclas. Se compararon posteriomente los resultados de la encuesta con dos documentos-guía: "Nutrición enteral y parenteral en pediatría" elaborado bajo los auspicios de la Sociedad Española de Gastroenterología, Hepatología y Nutrición Pediátrica (año 2000) y con las "Guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients" / "Nutrition support practice manual" de la American Society for Parenteral and Enteral Nutrition (1998). Resultados: de los 48 hospitales encuestados, en doce de ellos no se elaboraban nutriciones parentereales pediátricas. El número de bolsas elaboradas diariamente se correlacionó directamente con el tamaño del hospital. En todos los casos, los pediatras se encargaban de la prescripción. En el 87 por ciento de centros esta prescripción era individualizada (es decir, soluciones ajustadas a cada paciente particular). Todos los hospitales usaban dextrosa como fuente hidrocarbonada y soluciones de aminoácidos específicas para pediatría. Un 65 por ciento usaban fundamentalmente emulsiones lipídicas de triglicéridos de cadena larga y un 19 por ciento mezclas físicas de MCT/LCT. Sólo en la mitad de hospitales se utilizaban rutinariamente mezclas ternarias. El fosfato inorgánico continuaba siendo mayoritariamente usado (78 por ciento) frente al glicerofosfato sódico. Se añadían vitaminas y oligoelementos a diario en el 65 por ciento de los hospitales, alternándolos en el resto. En la mitad de centros se añadía heparina a la mezcla, y en un 27 por ciento carnitina. Para el 40 por ciento de los centros que respondieron a la encuesta la solución debe utilizarse dentro de las 24 horas de su elaboración; un 11 por ciento no indicaban la fecha de caducidad. Conclusiones: aunque la nutrición parenteral es prescrita por los pediatras en todas las ocasiones, los protocolos de elaboración difieren significativamente entre hospitales. La estandarización es excepcional. Destaca que las mezclas ternarias sólo se usan en la mitad de hospitales encuestados. Sugerimos la creación de un grupo de trabajo multidisciplinar - farmacéuticos, pediatras, neonatólogos - para establecer protocolos de elaboración de la nutrición parenteral pediátrica (AU)

The prescription and preparation of paediatric parenteral nutrition in Spain are subject to great variability. Aim: To identify how paediatric parenteral nutrition is prescribed and prepared in Spain. Material and methods: During the first quarter of 2001, a telephone survey was carried out among most of the hospitals in which parenteral nutrition is habitually prepared. The survey included questions on who was in charge of the prescription, the use of different solutions, addition of supplements (carnitine, heparin and glutamine), as well as information on the shelf-life of the mixtures. Subsequently, the results of the survey were compared with the following guidance documents: “Enteral and parenteral nutrition in paediatrics”, drafted under the auspices of the Spanish Association for Paediatric Gastroenterology, Hepatology and Nutrition (2000) and the “Guidelines for the use of parenteral and enteral nutrition in adult and paediatric patients”/ “Nutrition support practice manual” from the American Society for Parenteral and Enteral Nutrition (1998). Results: Of the 48 hospitals surveyed, paediatric parenteral nutrition was not prepared in 12 of them. the number of food bags prepared daily correlated directly with the size of the hospital. In all cases, the paediatricians were responsible for prescription. In 87% of the centres, this prescription was customized (i.e. solutions adapted to each individual patient). All of the hospitals used dextrose as the source of carbohydrates and specific amino acid solutions for paediatric medicine. Basically, lipid emulsions with long chain triglycerides were used in 65% of cases and another 19% used physical mixtures of MCT and LCT. Only half of the hospitals routinely used all-in-one mixtures. Inorganic phosphate continued to be used in most cases (78%) versus sodium glycerol phosphate. Vitamins and trace elements were added daily in 65% of the hospitals, with alternate administration in the remainder. In half of the centres, heparin was added to the mixture and carnitine in 27%. For 40% of the centres responding to the survey, the solution had to be used within 24 hours of its preparation; 11% did not indicate the shelf-life. Conclusions: Although parenteral nutrition is prescribed by the paediatricians on all occasions, the preparation protocols differ significantly between hospitals. Standardization is exceptional. It is noteworthy that all in one mixtures are only used in half of the hospitals surveyed. We suggest the creation of a multidisciplinary working party (pharmacists, paediatricians, neonatologists) in order to draw up protocols for the preparation of paediatric parenteral nutrition (AU)