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1.
Gulf J Oncolog ; 1(31): 21-25, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31591987

RESUMO

PURPOSE: The use of total parenteral nutrition (TPN) in terminally ill cancer patients is considered an aggressive approach with very limited benefits. We examined the practice of TPN in our end of life cancer patients and we investigated the patient and tumor characteristics that justify this practice. To our knowledge, this is the first study describing TPN administration of Middle Eastern patients with advanced cancer. METHODS: We conducted this retrospective observational study at Hotel-Dieu de France University Hospital, Lebanon. Eligible cases included all cancer patients that died at our institution between the 1st of January and the 31st of December 2014. The patients and tumors characteristics were analyzed for their potential role as determinant of TPN administration. The patients' hospitalization and causes of death were evaluated for the analysis of TPN benefits. RESULTS: Among the 129 patients enrolled, 39% had received TPN among which TPN administration correlated negatively to hyperlipidemia (OR= 0.33; 95% CI [0.12-0.87]) and to the presence of at least three cardiovascular risk factors (OR= 0.28; 95% CI [0.10 - 0.80]). However, it correlated positively to gastrointestinal tumors (OR= 3.9; 95% CI [1.3- 11.7]) and to imaging studies during the last month of life (OR= 3.4; 95% CI [1.3 - 9.0]). The TPN administration did not correlate to hospitalization during the last two weeks of life. CONCLUSION: The adoption of an optimal palliative care approach in Middle Eastern cancer patients at the end of life remains challenging. Oncologists seem to consider cardiovascular risk factors as a probable surrogate to predict complications of TPN.


Assuntos
Neoplasias/terapia , Cuidados Paliativos/métodos , Nutrição Parenteral Total/métodos , Idoso , Feminino , Humanos , Masculino , Oriente Médio , Neoplasias/mortalidade , Estudos Retrospectivos
2.
Pediatr Surg Int ; 35(12): 1345-1351, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31555865

RESUMO

PURPOSE: Short bowel syndrome (SBS) patients require long-term parenteral nutrition following massive bowel resection, which causes intestinal failure-associated liver disease (IFALD). Previous reports have shown that glucagon-like peptide-2 (GLP-2) resulted in the bowel adaptation for SBS. The aim of this study was to evaluate the effect of GLP-2 for IFALD in a parenterally fed rat model. METHODS: Using rat, a catheter was placed in the jugular vein, and 90% small bowel resection (SBR) was performed. Animals were divided into three groups: SBR and total parenteral nutrition (TPN) (SBS/TPN group), SBR and TPN plus GLP-2 at 1 µg/kg/h [SBS/TPN/GLP-2 (low) group], and SBR and TPN plus GLP-2 at 10 µg/kg/h [SBS/TPN/GLP-2 (high) group]. On day 13, the liver was harvested and analyzed by using nonalcoholic fatty liver disease (NAFLD) score. RESULTS: Histologically, hepatic steatosis in the SBS/TPN group and SBS/TPN/GLP-2 (high) group was observed. Both steatosis and lobular inflammation score in the SBS/TPN/GLP-2 (low) group were significantly lower compared with those in the other two groups (p < 0.05). Active NAFLD score in the SBS/TPN/GLP-2 (low) group was significantly lower compared with that in the SBS/TPN/GLP-2 (high) group (p < 0.01). CONCLUSION: Low-dose GLP-2 intravenous administration improves hepatic steatosis of IFALD following in an SBS parenterally fed rat model.


Assuntos
Peptídeo 2 Semelhante ao Glucagon/farmacologia , Intestino Delgado/cirurgia , Hepatopatia Gordurosa não Alcoólica/complicações , Nutrição Parenteral Total/métodos , Síndrome do Intestino Curto/complicações , Síndrome do Intestino Curto/terapia , Animais , Modelos Animais de Doenças , Masculino , Ratos , Ratos Sprague-Dawley
3.
Pediatr Surg Int ; 35(10): 1101-1107, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31396740

RESUMO

PURPOSE: To investigate the safety and efficacy of mucous fistula refeeding (MFR) in low-birth-weight infants. METHODS: Between December 2006 and December 2018, medical records of low-birth-weight infants who underwent small bowel enterostomy formation in the neonatal period and subsequent stoma closure at our institution were retrospectively reviewed. Patients were assigned to "refeeding" (RF) and "non-refeeding" (NRF) groups, which were compared for patient characteristics and clinical outcomes. We also cultured the proximal stoma output over time in the RF group and reviewed changes in the flora to evaluate the safety of refeeding. RESULTS: In the RF group, compared with that before refeeding, there was significantly more rapid weight gain after refeeding (17.7 vs 10.6 g/day; P = 0.002). Median total time of parenteral nutrition (PN) was 25 and 87 days in the RF and NRF groups, respectively (P = 0.001). The number of patients who developed PN-associated liver disease (PNALD) was smaller in the RF group (P = 0.12). No complications of MFR were noted and no pathogenic bacteria were cultured. CONCLUSION: MFR was able to diminish the need for PN, which potentially decreased the incidence of PNALD, and was safe as there were no complications of the refeeding process.


Assuntos
Enterostomia/métodos , Recém-Nascido de Baixo Peso , Mucosa Intestinal/cirurgia , Intestino Delgado/cirurgia , Nutrição Parenteral Total/métodos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Resultado do Tratamento
4.
BMJ Case Rep ; 12(8)2019 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-31451461

RESUMO

This is a case report of a neonate who was antenatally diagnosed with jejunal atresia which turned out to be duodenal atresia with apple peel syndrome. A previous sibling, who also had apple peel but with jejunal atresia, succumbed to sepsis after surgery. The first sibling had jejunal stenosis and had died of sepsis following surgery. Combination of duodenal atresia with apple peel is extremely rare. This coupled with a familial condition is rarer still. This case was challenging due to the short length of the gut and prolonged need for total parenteral nutrition and sepsis in postoperative period.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/métodos , Obstrução Duodenal , Atresia Intestinal , Jejunostomia/métodos , Sepse Neonatal , Adulto , Diagnóstico Diferencial , Obstrução Duodenal/diagnóstico , Obstrução Duodenal/etiologia , Obstrução Duodenal/fisiopatologia , Obstrução Duodenal/cirurgia , Duodeno/anormalidades , Duodeno/diagnóstico por imagem , Duodeno/cirurgia , Feminino , Humanos , Recém-Nascido , Atresia Intestinal/diagnóstico , Atresia Intestinal/genética , Atresia Intestinal/fisiopatologia , Atresia Intestinal/cirurgia , Jejuno/anormalidades , Jejuno/diagnóstico por imagem , Jejuno/cirurgia , Anamnese , Sepse Neonatal/diagnóstico , Sepse Neonatal/etiologia , Sepse Neonatal/terapia , Nutrição Parenteral Total/métodos , Gravidez , Diagnóstico Pré-Natal/métodos , Doenças Raras/diagnóstico , Irmãos , Resultado do Tratamento
5.
Pediatr Dermatol ; 36(4): 520-523, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31124168

RESUMO

Well-known causes of zinc deficiency, also referred to as acrodermatitis enteropathica (AE), include defects in intestinal zinc transporters and inadequate intake, but a rare cause of acquired zinc deficiency discussed here is an iatrogenic nutritional deficiency caused by parenteral nutrition administered without trace elements. While zinc-depleted parenteral nutrition causing dermatosis of acquired zinc deficiency was first reported in the 1990s, it is now again relevant due to a national vitamin and trace element shortage. A high index of suspicion may be necessary to diagnose zinc deficiency, particularly because early clinical findings are nonspecific. We present this case of acquired zinc deficiency in a patient admitted to a pediatric intensive care unit for respiratory distress and atypical pneumonia, who subsequently developed a severe bullous eruption due to iatrogenic zinc deficiency but was treated effectively with enteral and parenteral zinc supplementation, allowing for rapid re-epithelialization of previously denuded skin.


Assuntos
Acrodermatite/diagnóstico , Desnutrição/diagnóstico , Nutrição Parenteral Total/efeitos adversos , Zinco/deficiência , Acrodermatite/tratamento farmacológico , Acrodermatite/etiologia , Acrodermatite/patologia , Biópsia por Agulha , Criança , Serviço Hospitalar de Emergência , Humanos , Doença Iatrogênica , Imuno-Histoquímica , Unidades de Terapia Intensiva , Masculino , Desnutrição/etiologia , Multimorbidade , Nutrição Parenteral Total/métodos , Pneumonia Bacteriana/diagnóstico , Pneumonia Bacteriana/terapia , Prognóstico , Doenças Raras , Insuficiência Respiratória/diagnóstico , Insuficiência Respiratória/terapia , Medição de Risco , Resultado do Tratamento , Zinco/administração & dosagem
6.
FASEB J ; 33(3): 3378-3391, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30514107

RESUMO

Intestinal villus atrophy is a major complication of total parenteral nutrition (TPN). Our previous study revealed that TPN-induced villus atrophy is accompanied by elevated expression of CUGBP, Elav-like family member 1 (CELF1); however, its mechanism of action has not been fully understood. Herein, we report a pivotal role of CELF1/p53 axis, which induces a sustained antiproliferative signal, leading to suppressed proliferation of intestinal epithelial cells (IECs). By using a rat model of TPN, we found synchronous upregulation of CELF1 and p53 in jejunum mucosa, accompanied by a 51% decrease in crypt cell proliferation rate. By using HCT-116 cells as an IEC model in vitro, we found that the expression of CELF1 altered dynamically in parallel to proliferation rate, suggesting a self-adaptive expression pattern in IECs in vitro. Furthermore, ectopic overexpression of CELF1 elicited a significant antiproliferative effect in HCT-116, Caco-2, and IEC-6 cells, whereas knockdown of CELF1 elicited a significant proproliferative effect. Moreover, cell-cycle assay revealed that ectopic overexpression of CELF1 induced sustained G2 arrest and G1 arrest in HCT-116 and IEC-6 cells, respectively, which could be abolished by p53 silencing. Mechanistically, polysomal profiling and nascent protein analysis revealed that regulation of p53 by CELF1 was mediated through accelerating its protein translation in polysomes. Taken together, our findings revealed a sustained suppression of IEC proliferation evoked by CELF1/p53 axis, which may be a potential therapeutic target for the treatment of TPN-induced villus atrophy.-Yan, J.-K., Zhang, T., Dai, L.-N., Gu, B.-L., Zhu, J., Yan, W.-H., Cai, W., Wang, Y. CELF1/p53 axis: a sustained antiproliferative signal leading to villus atrophy under total parenteral nutrition.


Assuntos
Atrofia/tratamento farmacológico , Atrofia/genética , Proteínas CELF1/genética , Proliferação de Células/efeitos dos fármacos , Preparações de Ação Retardada/farmacologia , Proteína Supressora de Tumor p53/genética , Animais , Células CACO-2 , Pontos de Checagem do Ciclo Celular/efeitos dos fármacos , Pontos de Checagem do Ciclo Celular/genética , Linhagem Celular Tumoral , Proliferação de Células/genética , Células Epiteliais/efeitos dos fármacos , Fase G1/efeitos dos fármacos , Fase G1/genética , Fase G2/efeitos dos fármacos , Fase G2/genética , Células HCT116 , Humanos , Mucosa Intestinal/efeitos dos fármacos , Jejuno/efeitos dos fármacos , Masculino , Nutrição Parenteral Total/métodos , Ratos , Ratos Sprague-Dawley , Transdução de Sinais/efeitos dos fármacos , Transdução de Sinais/genética , Regulação para Cima/efeitos dos fármacos , Regulação para Cima/genética
8.
Int Urol Nephrol ; 51(1): 1-7, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30465143

RESUMO

BACKGROUND: This study aimed to systematically summarize and analyze the current evidence regarding the effect of total parenteral nutrition (TPN) versus early enteral nutrition (EEN) on postoperative outcomes of cystectomy. METHODS: A comprehensive search of online databases was conducted to identify comparative studies on the postoperative outcomes of patients receiving TPN and EEN after cystectomy. Our subsequent meta-analysis followed the PRISMA Protocol and the Cochrane Handbook. RESULTS: Five studies with 556 participants were included for meta-analysis. EEN was shown to have a significant effect on reducing the overall complications (odds ratio (OR) 0.52, 95% confidence interval (CI) 0.37-0.75, P < 0.01) and infectious complications (OR 0.32, 95% CI 0.21-0.49, P < 0.01) compared with TPN. Additionally, EEN saved €614-€3120 in costs compared to TPN. There were no significant differences between TPN and EEN groups regarding mortality rate (OR 0.47, 95% CI 0.06-3.51, P = 0.46), the incidence of postoperative ileus (OR 0.90, 95% CI 0.55-1.47, P = 0.68), length of hospital stay (mean difference (MD) 2.12, 95% CI - 0.15 to 4.40, P = 0.07), or time to resume a full diet (MD 1.31, 95% CI - 1.15 to 3.77, P = 0.30). CONCLUSION: EEN was found to have a significant effect on reducing infectious complications and costs compared with TPN treatment after cystectomy. Remarkably, EEN had no significant impact on mortality incidence, postoperative ileus, length of hospital stay, or the time to resumption of full diet.


Assuntos
Cistectomia , Nutrição Enteral/métodos , Nutrição Parenteral Total/métodos , Complicações Pós-Operatórias/prevenção & controle , Cistectomia/efeitos adversos , Cistectomia/métodos , Humanos , Cuidados Pós-Operatórios/métodos
9.
Obesity (Silver Spring) ; 27(1): 22-29, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30421863

RESUMO

OBJECTIVE: The aim of this study was to test the effectiveness of the OPTIFAST program (OP), a total meal replacement dietary intervention, compared with a food-based (FB) dietary plan for weight loss. METHODS: Participants with BMI 30 to 55 kg/m2 , age 18 to 70 years old, were randomized to OP or FB dietary and lifestyle interventions for 26 weeks, followed by a weight-maintenance phase. Outcomes were percent change in body weight (%WL) from baseline to weeks 26 and 52, associated changes in body composition (using dual energy x-ray absorptiometry), and adverse events. Primary analysis used repeated-measures multivariable linear mixed models to compare outcomes between groups in a modified intention-to-treat fashion (mITT). RESULTS: A total of 273 participants (83% of randomized; 135 OP, 138 FB) made up the mITT population. Mean age was 47.1 ± 11.2 years; 82% were female and 71% non-Hispanic white. Baseline BMI was 38.8 ± 5.9 kg/m2 . At 26 weeks, OP %WL was 12.4% ± 0.6% versus 6.0% ± 0.6% in FB (P < 0.001). At 52 weeks, OP %WL was 10.5% ± 0.6% versus 5.5% ± 0.6% in FB (P < 0.001). Fat mass loss was greater for OP; lean mass loss was proportional to total weight loss. There was no difference in serious adverse event rates between groups. CONCLUSIONS: Compared with an FB approach, OP was more effective with greater sustained weight loss.


Assuntos
Obesidade/terapia , Nutrição Parenteral Total/métodos , Perda de Peso/fisiologia , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
10.
Arch Dis Child Fetal Neonatal Ed ; 104(5): F480-F485, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30425112

RESUMO

OBJECTIVE: To investigate the epidemiology and healthcare factors associated with late-onset neonatal enterococcal infections. DESIGN: Multicentre, multinational retrospective cohort study using prospectively collected infection data from a neonatal infection surveillance network between 2004 and 2016; this was supplemented with healthcare data from a questionnaire distributed to participating neonatal units. SETTING: Sixty neonatal units across Europe (UK, Greece, Estonia) and Australia. PATIENTS: Infants admitted to participating neonatal units who had a positive culture of blood, cerebrospinal fluid or urine after 48 hours of life. RESULTS: In total, 414 episodes of invasive Enterococcus spp infection were reported in 388 infants (10.1% of a total 4083 episodes in 3602 infants). Enterococcus spp were the second most common cause of late-onset infection after coagulase-negative Staphylococcus spp and were strongly associated with necrotising enterocolitis (NEC) (adjusted OR 1.44, 95% CI 1.02 to 2.03, p=0.038), total parenteral nutrition (TPN) (adjusted OR 1.34, 95% CI 1.06 to 1.70, p=0.016), increasing postnatal age (per 1-week increase: adjusted OR 1.04, 95% CI 1.02 to 1.06, p<0.001) and decreasing birth weight (per 1 kg increase: adjusted OR 0.85, 95% CI 0.74 to 0.97, p=0.017). There was no evidence that inadequate nurse to patient staffing ratios in high-dependency units were associated with a higher risk of enterococcal infections. CONCLUSIONS: Enterococcus spp were the second most frequent cause of late-onset infections. The association between enterococcal infections, NEC and TPN may inform empiric antimicrobial regimens in these contexts and provide insights into reducing these infections.


Assuntos
Antibacterianos , Infecções Bacterianas , Enterococcus , Enterocolite Necrosante , Doenças do Recém-Nascido , Nutrição Parenteral Total/métodos , Antibacterianos/classificação , Antibacterianos/uso terapêutico , Austrália/epidemiologia , Infecções Bacterianas/epidemiologia , Infecções Bacterianas/etiologia , Infecções Bacterianas/terapia , Estudos de Coortes , Enterococcus/efeitos dos fármacos , Enterococcus/isolamento & purificação , Enterococcus/patogenicidade , Enterocolite Necrosante/epidemiologia , Enterocolite Necrosante/microbiologia , Enterocolite Necrosante/terapia , Europa (Continente)/epidemiologia , Feminino , Humanos , Recém-Nascido , Doenças do Recém-Nascido/epidemiologia , Doenças do Recém-Nascido/microbiologia , Doenças do Recém-Nascido/terapia , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Masculino , Estudos Retrospectivos , Sepse/epidemiologia , Sepse/microbiologia , Sepse/prevenção & controle
11.
Pediatr Surg Int ; 35(4): 457-461, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30417229

RESUMO

PURPOSE: To determine the impact of intra-operative Trans-anastomotic Tube (TAT) placement on the cost of post-operative nutrition in infants with congenital duodenal obstruction (CDO). METHODS: A retrospective analysis of patients undergoing corrective surgery for CDO, with birth-weight over 1.5 kg over a 10-year period. Data are presented as median (inter-quartile range) and analysed with Mann-Whitney U test and Fisher's exact test as appropriate. RESULTS: 59 patients were included. There was no difference between TAT and non-TAT groups for baseline characteristics, age at operation and abnormality. In the TAT group there was a significant reduction in the duration of post-operative parenteral nutrition (PN) [6 (0-11) vs 12 (8-19) days, p = 0.006], the cost of PN [£750 (0-1375) vs £1500 (1000-2375), p = 0.006] and the total cost of nutrition [£765.26 (38.36-1404) vs £1387.52 (1008.23-2363.08), p = 0.015], thereby demonstrating a median cost saving of £622.26 per patient. 14% experienced TAT displacement but no other TAT complications were encountered. CONCLUSION: The use of a TAT is a safe and effective way to reduce the duration of PN required in patients with CDO. This infers a significant cost saving per patient, a factor that cannot be overlooked in this period of austerity.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/métodos , Obstrução Duodenal/terapia , Estado Nutricional , Nutrição Parenteral Total/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Anastomose Cirúrgica , Custos e Análise de Custo , Obstrução Duodenal/congênito , Obstrução Duodenal/diagnóstico , Feminino , Humanos , Recém-Nascido , Masculino , Nutrição Parenteral Total/economia , Estudos Retrospectivos
12.
Neonatal Netw ; 37(4): 218-223, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30567919

RESUMO

PURPOSE: The purpose of this article was to develop standardized nutritional guidelines that would promote increased growth velocity (GV) in premature infants. DESIGN: Evidence-based standardized nutritional guidelines were developed. Guidelines included total parenteral nutrition advancement; enteral feeding advancement; and a bedside nurse gastric residual management algorithm. Staff education was given. Guideline compliance was measured. Nutritional intake and daily weights were recorded. SAMPLE: Infants of birth weight <1,500 grams who were admitted to the NICU before day of life four. MAIN OUTCOME VARIABLE: Increase in GV from 12 to 15 g/kg/d. RESULTS: Growth velocity was unchanged. Compliance to the nutritional guidelines was 70 percent. No difference was seen in length of stay. Rate of necrotizing enterocolitis was decreased.


Assuntos
Nutrição Enteral/métodos , Recém-Nascido de Peso Extremamente Baixo ao Nascer/crescimento & desenvolvimento , Recém-Nascido Prematuro/crescimento & desenvolvimento , Recém-Nascido de muito Baixo Peso/crescimento & desenvolvimento , Enfermagem Neonatal/normas , Nutrição Parenteral Total/métodos , Guias de Prática Clínica como Assunto , Feminino , Humanos , Recém-Nascido , Masculino
13.
J Wound Ostomy Continence Nurs ; 45(6): 503-509, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30395125

RESUMO

PURPOSE: The primary aim of this study was to examine and describe peripheral intravenous extravasation (PIVE) injuries using point-of-care ultrasound (POC-US). A secondary aim was to define skin tissue changes before and after hyaluronidase application using POC-US. DESIGN: Case series design. SUBJECTS AND SETTING: We report on 10 neonates with stage 3 or 4 PIVE who were studied clinically and with POC-US. All infants were studied during the December 2015 to September 2016 period in a large academic neonatal intensive care unit. METHODS: Initially, neonates with PIVE were staged using 3 criteria: physical findings, nature of the infusate, and the size of the injury. Next, we described different ultrasound appearances of the tissue injury in PIVE based on the type of the infusate (clear fluid, blood, or both). We then located the largest PIVE pocket and measured the skin elevation over it. Skin elevation ratio was measured at 3 time points: before hyaluronidase injection followed by 3 to 6 hours and 24 hours after hyaluronidase therapy. Each ultrasound examination of the skin injury was staged (severe, moderate, mild, or minimal) based on the skin elevation ratio obtained. In addition, we described changes in the skin using ultrasound before and after hyaluronidase treatment. RESULTS: Three types of ultrasound images based on the type of the extravasated fluid were described in detail. Based on the initial ultrasound measurements of the skin elevation ratio, 6 infants were staged with severe PIVE and 4 were staged as moderate PIVE. Finally, POC-US was used to describe the tissue changes before and after hyaluronidase injection. CONCLUSIONS: Point-of-care ultrasound may offer more structured and objective staging of PIVE injuries due to direct visualization of the skin tissue. This method needs to be further studied and introduced as a practical tool to complement physical examination of PIVE injuries.


Assuntos
Administração Intravenosa/efeitos adversos , Extravasamento de Materiais Terapêuticos e Diagnósticos/diagnóstico , Ultrassonografia/métodos , Administração Intravenosa/métodos , Transfusão de Sangue/métodos , Estudos de Casos e Controles , Extravasamento de Materiais Terapêuticos e Diagnósticos/complicações , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Neonatal/organização & administração , New York , Nutrição Parenteral Total/efeitos adversos , Nutrição Parenteral Total/métodos , Sistemas Automatizados de Assistência Junto ao Leito/normas , Sistemas Automatizados de Assistência Junto ao Leito/estatística & dados numéricos , Projetos de Pesquisa , Índice de Gravidade de Doença
14.
J Pediatr Surg ; 53(12): 2444-2448, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30309733

RESUMO

AIMS AND OBJECTIVES: Fish oil (FO) lipid emulsion and a new lipid emulsion (SMOF) are important treatments for intestinal failure-associated liver disease. We evaluated the efficacy of FO and SMOF lipid emulsion on intestinal mucosal adaptation using a total parenteral nutrition (TPN)-supported rat model of short bowel syndrome. MATERIAL & METHODS: Sprague-Dawley rats underwent jugular vein catheterization and 90% small bowel resection and were divided into three groups: TPN with soy bean oil lipid emulsion (SO group), FO lipid emulsion (FO group), or SMOF (SMOF group). On day 13, the rats were euthanized, and the small intestine was harvested. The microscopic morphology and crypt cell proliferation rate (CCPR) were then evaluated. RESULTS: The villus height of the ileum in the SMOF group was significantly higher than in the SO group. The crypt depth of the intestine in the SMOF group was significantly lower than in the SO group. The CCPRs of the intestine in the FO and SMOF groups were both higher than in the SO group. CONCLUSIONS: Lipid emulsion affected the bowel morphology, such as the mucosa as well as the intestinal smooth muscle. Further studies are needed to clarify the mechanisms.


Assuntos
Adaptação Fisiológica/efeitos dos fármacos , Emulsões Gordurosas Intravenosas/farmacologia , Óleos de Peixe/farmacologia , Intestino Delgado/efeitos dos fármacos , Síndrome do Intestino Curto/tratamento farmacológico , Animais , Proliferação de Células/efeitos dos fármacos , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Masculino , Nutrição Parenteral Total/métodos , Ratos , Ratos Sprague-Dawley
15.
Rev Esc Enferm USP ; 52: e03360, 2018 Oct 04.
Artigo em Inglês | MEDLINE | ID: mdl-30304200

RESUMO

OBJECTIVE: The objective of this study was to identify the incidence of infiltration and extravasation in newborns using peripheral venous catheter, and affecting factors. METHOD: This observational study examined catheters inserted into newborns who received inpatient care in the neonatal intensive care unit of a state hospital located in the west of Turkey. A total of 452 peripheral venous catheters inserted into 152 newborns were observed. The forms were completed by the researchers based on their observations at each shift. RESULTS: The infiltration/extravasation occurred in 45.6% of peripheral venous catheters inserted into newborns; 19.7% were stage I and 11.7% were stage IV. A statistically significant relationship was found between the gestation week as well as the birth weight of newborns and the occurrence of infiltration/extravasation complication. In addition, there were statistically significant relationships between the administration of single or multiple antibiotics, total parenteral nutrition and the incidence of infiltration/extravasation complication. CONCLUSION: It is recommended to use an appropriate scale for the assessment of infiltration/extravasation as well as to implement measures for preventing the occurrence of infiltration/extravasation.


Assuntos
Cateterismo Periférico/efeitos adversos , Extravasamento de Materiais Terapêuticos e Diagnósticos/epidemiologia , Unidades de Terapia Intensiva Neonatal , Antibacterianos/administração & dosagem , Peso ao Nascer , Cateterismo Periférico/métodos , Feminino , Idade Gestacional , Humanos , Incidência , Recém-Nascido , Masculino , Nutrição Parenteral Total/métodos , Estudos Prospectivos , Fatores de Risco , Turquia
17.
Pediatr Surg Int ; 34(11): 1177-1181, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30267193

RESUMO

INTRODUCTION: Hepatic dysfunction in patients reliant on total parenteral nutrition (TPN) may benefit from cycled TPN. A concern for neonatal hypoglycemia has limited the use of cycled TPN in neonates less than 1 week of age. We sought to determine both the safety and efficacy of cycled TPN in surgical neonates less than 1 week of age. METHODS: A retrospective chart review was conducted on surgical neonates placed on prophylactic and therapeutic cycled TPN from January 2013 to March 2016. Specific emphasis was placed on identifying incidence of direct hyperbilirubinemia and hypoglycemic episodes. RESULTS: Fourteen neonates were placed on cycled TPN; 8 were prophylactically cycled and 6 were therapeutically cycled. Median gestational age was 36 weeks (34, 37). Sixty-four percent (n = 9) had gastroschisis. There was no difference between the prophylactic and therapeutic groups in incidence of hyperbilirubinemia > 2 mg/dL (3 (37%) vs 5 (83%), p = 0.08) or the length of time to development of hyperbilirubinemia [24 days (4, 26) vs 27 days (25, 67), p = 0.17]. Time on cycling was similar though patients who were prophylactically cycled had a shorter overall time on TPN. Three (21%) infants had documented hypoglycemia, but only one infant became clinically symptomatic. CONCLUSION: Prophylactic TPN cycling is a safe and efficacious nutritional management strategy in surgical neonates less than 1 week of age with low rates of hypoglycemia and a shorter total course of TPN; however, hepatic dysfunction did not appear to be improved compared to therapeutic cycling.


Assuntos
Hiperbilirrubinemia/epidemiologia , Hiperbilirrubinemia/terapia , Hipoglicemia/epidemiologia , Nutrição Parenteral Total/métodos , Enterocolite Necrosante/epidemiologia , Feminino , Gastrosquise/epidemiologia , Doença de Hirschsprung/epidemiologia , Humanos , Recém-Nascido , Atresia Intestinal/epidemiologia , Volvo Intestinal/epidemiologia , Masculino , Íleo Meconial/epidemiologia , Estudos Retrospectivos
19.
Pediatr Int ; 60(7): 634-638, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29654605

RESUMO

BACKGROUND: Appropriate calcium and phosphate supplementation is essential for bone growth in preterm infants. Using Rehabix-K2™ (AY Pharmaceuticals, Tokyo, Japan) and Pleamin-P Injection™ (Fuso Pharmaceutical Industries, Osaka, Japan) as the total parenteral nutrition (TPN) and amino acid solution, respectively, we investigated ways of maximizing calcium and phosphate in the TPN solution. METHODS: Rehabix-K2, Pleamin-P, calcium gluconate, sodium phosphate, 50% glucose, and water were mixed in varying proportions to create 16 formulations. Precipitation assessment was done three times for each of the 16 formulations, and was based on the Japanese Pharmacopeia. RESULT: Precipitation was observed 24 h after mixing when the calcium and phosphate were 60 mEq/L and 30 mmol/L or 80 mEq/L and 40 mmol/L, respectively. No precipitation was observed when the calcium and phosphate were 20 mEq/L and 10 mmol/L, respectively. Precipitation was observed once out of three times, when the calcium and phosphate were 40 mEq/L and 20 mmol/L, respectively, and the amino acids were 2% and 3% (mean pH, 6.13 and 6.26, respectively). No precipitation was observed, however, when the calcium and phosphate were 40 mEq/L and 20 mmol/L, respectively, and the amino acids were 0% and 1% (mean pH, 5.88 and 6.05, respectively). CONCLUSION: Not only the concentration of calcium and phosphate, but also the pH of the TPN solution, are crucial factors for precipitation. Based on these results, a well-balanced TPN solution maximizing calcium and phosphate availability will be able to be formulated.


Assuntos
Cálcio/química , Fórmulas Infantis/química , Nutrição Parenteral Total/métodos , Fosfatos/química , Aminoácidos/química , Cálcio/administração & dosagem , Precipitação Química , Glucose/química , Humanos , Concentração de Íons de Hidrogênio , Recém-Nascido de Peso Extremamente Baixo ao Nascer , Recém-Nascido , Japão , Fosfatos/administração & dosagem
20.
J Pediatr Surg ; 53(9): 1688-1691, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29550034

RESUMO

BACKGROUND: Injury severity induces a proportionate acute metabolic stress response, associated with increased risk of hyperglycemia. We hypothesized that excess caloric delivery (overfeeding) during high stress states would increase hyperglycemia and disrupt response homeostasis. METHODS: Gestational age, daily weight, total daily caloric intake, serum C-reactive protein (CRP), prealbumin, and blood glucose concentrations in all acutely-injured premature NICU infants requiring TPN over the past 3years were reviewed. Injury severity was based on CRP and patients were divided into high (CRP ≥50mg/L) versus low (CRP <50mg/L) stress groups. Glycemic variability was used to measure disruption of homeostasis. RESULTS: Overall sample included N=563 patient days (37 patients; 42 episodes). High stress group pre-albumin levels negatively correlated with CRP levels (R=-0.62, p<0.005). A test of equal variance demonstrated significantly increased high stress glycemic variability (Ha:ratio>1, Pr(F>f)=0.0353). When high stress patients were separated into high caloric intake (≥70kg/kcal/day) versus low caloric intake (<70kg/kcal/day), maximum serum glucose levels were significantly higher with overfeeding (230.33±55.81 vs. 135.71±37.97mg/dL, p<0.004). CONCLUSION: Higher injury severity induces increased disruption of response homeostasis in critically ill neonates. TPN-associated overfeeding worsens injury-related hyperglycemia in more severely injured infants. TYPE OF STUDY: Retrospective study. LEVEL OF EVIDENCE: Level II.


Assuntos
Homeostase/fisiologia , Hiperglicemia/etiologia , Doenças do Prematuro/etiologia , Terapia Intensiva Neonatal/métodos , Nutrição Parenteral Total/efeitos adversos , Estresse Fisiológico/fisiologia , Estado Terminal , Ingestão de Energia/fisiologia , Feminino , Humanos , Hiperglicemia/terapia , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/terapia , Masculino , Nutrição Parenteral Total/métodos , Estudos Retrospectivos
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