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1.
Int J Pharm Compd ; 25(2): 131-139, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33798113

RESUMO

Intravenous admixture compounding is common practice in most hospitals throughout the world, regardless of the country. Compounding intravenous medications involves risk, as there is a high potential for error due to their complexity in compounding, and working in an aseptic environment itself poses issues for the compounder. Part 9-A of this series of articles on the topic of intravenous admixture preparation considerations discusses 1) the background, 2) types of errors, 3) where errors can occur, 4) automated parenteral nutrition compounding systems, 5) accuracy and strength issues, and 6) medication error prevention. Part 9-B of this series of articles will include 1) a discussion on standardization (of both formulas and procedures), 2) competency, 3) compliance, 4) a detailed table on the sources of errors, and 5) the considerations for the prevention of errors.


Assuntos
Erros de Medicação , Nutrição Parenteral , Administração Intravenosa , Composição de Medicamentos , Humanos , Erros de Medicação/prevenção & controle
2.
Rozhl Chir ; 100(2): 49-59, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33910337

RESUMO

Nutritional support is one of the fundamental conditions of a successful outcome in malnourished or critically ill patients. Malnutrition is an important negative factor with impacts on postoperative morbidity and lethality in surgical patients. It is often observed in particularly in oncosurgical patients, in the elderly and in patients with chronic intestinal disease. The issue of malnutrition should be medically managed from the very moment the ill person becomes a patient. The effort of correcting malnutrition should extend over the entire perioperative period - from the beginning of the diagnostic procedure, during the hospital stay with surgery as applicable with postoperative nutrition therapy, to nutritional status monitoring after discharge and in the course of subsequent follow-up in the outpatient setting. Recent European and Czech guidelines adopted by the Czech Surgical Society and by the other societies exist for this complex issue. However, the use of these guidelines often encounters barriers in practice, and their implementation rate is thus rather low. Nutrition care is a mandatory part of the management of surgical patients both in the outpatient and hospital settings of the entire process. The article is a commented selection of nutritional guidelines of the European Society for Parenteral and Enteral Nutrition (ESPEN) of 2017 for surgical patients, and of those resulting from consensual voting of the working group of the Czech Society for Clinical Nutrition and Intensive Metabolic Care (SKVIMP) of 2018.


Assuntos
Desnutrição , Estado Nutricional , Idoso , Cuidados Críticos , Estado Terminal/terapia , Nutrição Enteral , Humanos , Desnutrição/terapia , Nutrição Parenteral
3.
Zhongguo Dang Dai Er Ke Za Zhi ; 23(4): 390-396, 2021 Apr.
Artigo em Chinês | MEDLINE | ID: mdl-33840412

RESUMO

OBJECTIVE: To systematically evaluate the association of early nutrition intake with the risk of bronchopulmonary dysplasia (BPD). METHODS: PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, Wanfang Data, and Weipu Periodical Database were searched for the observational studies on the association between early nutrition intake and BPD. RevMan 5.3 software was used to perform a Meta analysis of eligible studies. RESULTS: Eight observational studies were included, with 548 infants with BPD and 522 infants without BPD. The Meta analysis showed that the BPD group had a significantly lower caloric intake than the non-BPD group within the first week after birth and in the first 2 weeks after birth (P < 0.05). The BPD group had a significantly lower enteral nutrition intake than the non-BPD group (WMD=-18.27, 95%CI:-29.70 to -6.84, P < 0.05), as well as a significantly lower intake of carbohydrate, fat, and protein (P < 0.05). The BPD group had a significantly longer duration of parenteral nutrition than the non-BPD group (WMD=14.26, 95%CI:13.26-15.25, P < 0.05). CONCLUSIONS: Early nutrition deficiency may be associated with the development of BPD, and more attention should be paid to enteral feeding of infants at a high risk of BPD to achieve total enteral feeding as soon as possible.


Assuntos
Displasia Broncopulmonar , Desnutrição , Displasia Broncopulmonar/epidemiologia , Displasia Broncopulmonar/etiologia , China , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Nutrição Parenteral
4.
Asia Pac J Clin Nutr ; 30(1): 15-21, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33787036

RESUMO

BACKGROUND AND OBJECTIVES: The novel coronavirus disease (COVID-19) epidemic is spreading all over the world. With the number of cases increasing rapidly, the epidemiological data on the nutritional practice is scarce. In this study, we aim to describe the clinical characteristics and nutritional practice in a cohort of critically ill COVID-19 patients. METHODS AND STUDY DESIGN: This is a multicenter, ambidirectional cohort study conducted at 11 hospitals in Hubei Province, China. All eligible critical COVID-19 patients in the study hospital intensive care units at 00:00, March 6th, 2020, were included. Data collection was performed via written case report forms. RESULTS: A total of 44 patients were identified and enrolled, of whom eight died during the 28-day outcome follow- up period. The median interval between hospital admission and the study day was 24 (interquartile range, 13- 26) days and 52.2% (23 of 44) of patients were on invasive mechanical ventilation. The median nutrition risk in critically ill (mNUTRIC) score was 3 (interquartile range, 2-5) on the study day. During the enrolment day, 68.2% (30 of 44) of patients received enteral nutrition (EN), while 6.8% (3 of 44) received parenteral nutrition (PN) alone. Nausea and aspiration were uncommon, with a prevalence of 11.4% (5 of 44) and 6.8% (3 of 44), respectively. As for energy delivery, 69.7% (23 of 33) of patients receiving EN and/or PN were achieving their prescribed targets. CONCLUSIONS: The study showed that EN was frequently applied in critical COVID-19 patients. Energy delivery may be suboptimal in this study requiring more attention.


Assuntos
/epidemiologia , Estado Terminal/epidemiologia , Estado Nutricional , Apoio Nutricional , Idoso , China/epidemiologia , Estudos de Coortes , Nutrição Enteral/estatística & dados numéricos , Feminino , Hospitalização , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Nutrição Parenteral/estatística & dados numéricos
5.
Zhongguo Dang Dai Er Ke Za Zhi ; 23(3): 229-235, 2021 Mar.
Artigo em Chinês | MEDLINE | ID: mdl-33691914

RESUMO

OBJECTIVE: To study the clinical effect of multi-oil fat emulsion for parenteral nutrition support in extremely low birth weight (ELBW) infants. METHODS: A retrospective analysis was performed for 49 ELBW infants who were admitted from January 1, 2018 to July 30, 2020, with an age of ≤14 days on admission and a duration of parenteral nutrition of > 14 days. According to the type of lipid emulsion received, the ELBW infants were divided into two groups: soybean oil, medium-chain triglycerides, olive oil, and fish oil (SMOF) (n=26) and medium-chain triglycerides/long-chain triglycerides (MCT/LCT) (n=23). The two groups were compared in terms of clinical features, complications, nutrition support therapy, and outcome. RESULTS: The 49 ELBW infants had a mean birth weight of (892±83) g and a mean gestational age of (28.2±2.3) weeks. There was no significant difference between the two groups in the incidence rates of hemodynamically significant patent ductus arteriosus, intraventricular hemorrhage, neonatal necrotizing enterocolitis, retinopathy of prematurity, bronchopulmonary dysplasia (BPD), grade Ⅲ BPD, sepsis, and pneumonia (P > 0.05). There was also no significant difference in the duration of parenteral nutrition, the age of total enteral nutrition, and head circumference/body length/body weight at discharge between the two groups (P > 0.05). Of all the infants, 22 (45%) had parenteral nutrition-associated cholestasis (PNAC), with 13 (50%) in the SMOF group and 9 (39%) in the MCT/LCT group but there was no significant difference in the incidence of PNAC between the two groups (P > 0.05); however, the infants with PNAC in the SMOF group had significantly lower peak values of direct bilirubin and alanine aminotransferase than those in the MCT/LCT group (P < 0.05). CONCLUSIONS: The application of multi-oil fat emulsion in ELBW infants does not reduce the incidence rate of complications, but compared with MCT/LCT emulsion, SMOF can reduce the severity of PNAC in ELBW infants.


Assuntos
Recém-Nascido de Peso Extremamente Baixo ao Nascer , Nutrição Parenteral , Peso ao Nascer , Emulsões , Emulsões Gordurosas Intravenosas , Humanos , Lactente , Recém-Nascido , Estudos Retrospectivos , Óleo de Soja
6.
Nutrients ; 13(2)2021 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-33557154

RESUMO

Total parenteral nutrition (TPN) is a life-saving intervention for infants that are unable to feed by mouth. Infants that remain on TPN for extended periods of time are at risk for the development of liver injury in the form of parenteral nutrition associated cholestasis (PNAC). Current research suggests the lipid component of TPN is a factor in the development of PNAC. Most notably, the fatty acid composition, vitamin E concentration, and presence of phytosterols are believed key mediators of lipid emulsion driven PNAC development. New emulsions comprised of fish oil and medium chain triglycerides show promise for reducing the incidence of PNAC in infants. In this review we will cover the current clinical studies on the benefit of fish oil and medium chain triglyceride containing lipid emulsions on the development of PNAC, the current constituents of lipid emulsions that may modulate the prevalence of PNAC, and potential new supplements to TPN to further reduce the incidence of PNAC.


Assuntos
Colestase/etiologia , Emulsões Gordurosas Intravenosas/administração & dosagem , Emulsões Gordurosas Intravenosas/efeitos adversos , Hepatopatias/etiologia , Nutrição Parenteral/efeitos adversos , Nutrição Parenteral/métodos , Humanos , Recém-Nascido
7.
Zhongguo Dang Dai Er Ke Za Zhi ; 23(2): 111-115, 2021 Feb.
Artigo em Chinês | MEDLINE | ID: mdl-33627202

RESUMO

OBJECTIVE: To explore the reasonable and effective enteral nutrition regimen for children with abdominal Henoch-Schönlein purpura (HSP). METHODS: A retrospective analysis was performed on the medical data of children with abdominal HSP who were hospitalized from August 2013 to August 2018. According to the starting time of enteral nutrition after abdominal pain relief, the children were divided into three groups: < 24 hours (n=68), 24-48 hours (n=64), and 48-72 hours (n=60). According to the type of enteral nutrition, they were divided into another three groups:amino acid-based formula (n=53), extensively hydrolyzed lactoprotein formula (n=67), and normal diet (n=72). The recurrence rate of clinical symptoms and degree of satisfaction among family members were compared between groups. Based on the retrospective analysis, 166 children with abdominal HSP were enrolled in a prospective study. They were given extensively hydrolyzed lactoprotein formula after abdominal pain relief. According to the feeding time after abdominal pain relief, they were divided into three groups: < 24 hours (n=52), 24-48 hours (n=59), and 48-72 hours (n=55). The three groups were compared in terms of the recurrence rates of abdominal pain, rash, and hematochezia, the rate of use of parenteral nutrition and intravenous steroids, and the incidence rate of weight loss at discharge. RESULTS: The retrospective analysis showed that the children who were given extensively hydrolyzed lactoprotein formula for enteral nutrition at 24-48 hours after abdominal pain relief had a lower recurrence rate of clinical symptoms and the highest degree of satisfaction among their family members (P < 0.0167). The prospective study showed that the children who were given extensively hydrolyzed lactoprotein formula for enteral nutrition at 24-48 hours after abdominal pain relief had lower recurrence rates of rash and abdominal pain, a lower rate of use of parenteral nutrition, and a lower incidence rate of weight loss at discharge (P < 0.05). CONCLUSIONS: It is reasonable and effective to start the feeding with extensively hydrolyzed lactoprotein formula at 24-48 hours after abdominal pain relief in children with abdominal HSP.


Assuntos
Nutrição Enteral , Púrpura de Schoenlein-Henoch , Criança , Humanos , Nutrição Parenteral , Estudos Prospectivos , Púrpura de Schoenlein-Henoch/terapia , Estudos Retrospectivos
8.
Nihon Ronen Igakkai Zasshi ; 58(1): 119-125, 2021.
Artigo em Japonês | MEDLINE | ID: mdl-33627547

RESUMO

AIM: The controlling nutrition status (CONUT) score assesses the nutritional status of subjects by considering the serum albumin level, total lymphocyte count, and total cholesterol level. We estimated the efficacy of total parenteral nutrition for improving the nutritional status and zinc deficiency. METHODS: In total, 493 elderly inpatients who were admitted to the internal medicine department of an emergency hospital over 7 years were divided into 2 groups: patients who were discharged (320 patients) and those who died in the hospital (173 patients). The discharged patients were further divided to four groups according time of discharge from the hospital; oral nutrition, enteral nutrition, peripheral parenteral nutrition, and total parenteral nutrition. Using analysis of variance (ANOVA), we compared the albumin and zinc levels and the CONUT score within 10 days post-admission and before discharge from the hospital. RESULTS: Japanese society is rapidly aging. In patients who were leaving the hospital, the CONUT score improved with oral and enteral nutrition. The zinc level improved with oral, enteral, peripheral parenteral, and total parenteral nutrition. While the nutritional status of patients at the time of discharge improved with oral and enteral nutrition, total parenteral nutrition without oral or enteral nutrition did not improve the status. CONCLUSION: To discharge patients alive, efforts must be made to continue oral and enteral nutrition for as long as possible.


Assuntos
Estado Nutricional , Alta do Paciente , Idoso , Hospitais , Humanos , Pacientes Internados , Medicina Interna , Nutrição Parenteral , Nutrição Parenteral Total , Zinco
9.
Nutr. hosp ; 38(1): 5-10, ene.-feb. 2021. tab
Artigo em Espanhol | IBECS | ID: ibc-198833

RESUMO

INTRODUCCIÓN: las emulsiones lipídicas (EL) pueden asociar distintos efectos inmunomoduladores dependiendo de su composición de ácidos grasos. Las EL enriquecidas con aceite de pescado y las basadas en aceite de oliva (EBAO) han mostrado ventajas frente a las derivados del aceite de soja, aunque son muy escasos los estudios que las comparan entre sí y no existe ninguno en pacientes críticos quirúrgicos. OBJETIVOS: demostrar la no inferioridad de la eficacia terapéutica de SMOFlipid(R) (enriquecida con aceite de pescado) frente a Clinoleic(R) (EBAO) en relación con la aparición de infecciones nosocomiales y otros parámetros evolutivos. Demostrar la no inferioridad de la seguridad de SMOFlipid(R) frente a Clinoleic(R) expresada como aparición de mortalidad y acontecimientos adversos. MATERIAL Y MÉTODO: ensayo clínico de fase III, de no inferioridad, realizado en pacientes críticos posquirúrgicos. Los sujetos se aleatorizaron para recibir SMOFlipid(R) o Clinoleic(R). Para comparar variables cualitativas se obtuvieron la frecuencia y el porcentaje de casos, realizando la prueba del chi cuadrado o el test de Fisher. Las medias entre dos grupos se compararon empleando el test de la "t" de Student. Se consideró estadísticamente significativo un valor de p menor de 0,05. Para el análisis principal de no inferioridad de la variable principal se aplicaron los test de Farrington-Manning, Miettinen-Nurminen y Gart-Nam. RESULTADOS: se incluyeron 73 pacientes, de los cuales 37 recibieron Clinoleic(R) y 36 SMOFlipid(R). En la variable "disminución de infecciones nosocomiales", SMOFlipid(R) demostró no ser inferior a Clinoleic(R). En la variable principal "mortalidad", SMOFlipid(R) demostró no ser inferior a Clinoleic(R). Tampoco existieron diferencias estadísticamente significativas en cuanto a la aparición de efectos adversos. CONCLUSIONES: en nuestro estudio, SMOFlipid(R) demostró no ser inferior a Clinoleic(R) en términos de eficacia y seguridad


INTRODUCTION: a lipid emulsion (LE) may result in different immunomodulatory effects depending on its fatty acid composition. LEs enriched with fish oil and those based on olive oil (OOBE) have shown advantages over those derived from soybean oil, although very few studies have compared these with each other, and none was performed in critically ill surgical patients. OBJECTIVES: to demonstrate non-inferiority for the therapeutic efficacy of SMOFlipid(R) (enriched with fish oil) versus Clinoleic(R) (OOBE) in relation to the occurrence of nosocomial infection and other evolutionary parameters. To demonstrate non-inferiority in the safety profile of SMOFlipid(R) versus Clinoleic(R) in terms of mortality and adverse events. MATERIAL AND METHOD: a phase-III, non-inferiority clinical trial performed in critically ill postsurgical patients. The subjects were randomized to receive SMOFlipid(R) or Clinoleic(R). For comparison of qualitative variables case frequencies and percentages were obtained using the Chi-squared test or Fisher's exact test. Means were compared between groups using Student's t-test. A p-value lower than 0.05 was considered statistically significant. The Farrington-Manning, Miettinen-Nurminen, and Gart-Nam tests were applied in the main non-inferiority analysis of the primary endpoint. RESULTS: during de inclusion period 73 patients were selected, 37 of whom received Clinoleic(R) and 36 SMOFlipid(R). Regarding the variable "decrease in nosocomial infections", SMOFlipid(R) proved to be non-inferior to Clinoleic(R). Regarding the main variable "mortality", SMOFlipid(R) proved to be non-inferior to Clinoleic(R). There were no statistically significant differences in the occurrence of adverse effects either. CONCLUSIONS: in our study, SMOFlipid(R) proved to be non-inferior to Clinoleic(R) in terms of efficacy and safety


Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Emulsões Gordurosas Intravenosas , Cuidados Críticos , Resultado do Tratamento , Segurança do Paciente , Nutrição Parenteral/métodos , Cuidados Pós-Operatórios , Ácidos Graxos/administração & dosagem , Óleos de Peixe/administração & dosagem , Protocolos Clínicos
10.
Nutr. hosp ; 38(1): 11-15, ene.-feb. 2021. graf
Artigo em Espanhol | IBECS | ID: ibc-198834

RESUMO

INTRODUCCIÓN: la instauración de nutrición parenteral al prematuro ha supuesto un importante avance en su pronóstico. Los últimos años han sido muy fructíferos en cuanto a la publicación de guías en este ámbito. OBJETIVOS: conocer los procedimientos de formulación y elaboración de las nutriciones parenterales neonatales (NPN) en los hospitales españoles. MÉTODOS: se llevó a cabo una encuesta multicéntrica dirigida a los servicios de farmacia sobre los procesos anteriormente citados. RESULTADOS: 55 hospitales cumplieron criterios de inclusión. El 51 % disponía de sistemas informáticos de prescripción, y el 65,5 % formulaba siempre de forma individualizada, mientras que el 34,4 % disponía de fórmulas prediseñadas. Los preparados tricamerales eran utilizados por el 13,0 %. En el 52,7 % de los casos se preparaban las nutriciones de primer día bajo demanda, y ésta se iniciaba antes de las 8 horas de vida en un 88,1 % de los casos. El fosfato inorgánico era la primera opción en un 10,4 %. Se añadían diariamente vitaminas, oligoelementos y zinc en el 92,7 %, 90,9 % y 70,9 % de los casos, respectivamente. El 45,4 % de los hospitales elaboraba siempre las NPPN incluyendo los lípidos en la misma bolsa, frente al 34,5 % en los que estos se administraban por separado en todos los casos. El 50,9 % de los hospitales nunca añadía heparina a sus nutriciones. Las bolsas fotoprotectoras eran utilizadas por un 89,1 %. La estabilidad de las nutriciones variaba desde 24 horas a 15 días. CONCLUSIONES: la elaboración de la NPN en España está sujeta a gran variabilidad. Existe controversia respecto al uso de heparina y mezclas ternarias, reflejada en la variabilidad de la práctica clínica


INTRODUCTION: the introduction of parenteral nutrition in preterm infants has meant a major advance in their prognosis, being the last few years very fruitful in terms of publication of guidelines in this area. OBJECTIVES: to know the formulation and preparation procedures of neonatal parenteral nutrition (NPN) in Spanish hospitals. METHODS: a multi-centre survey was conducted in Pharmacy Services on the aforementioned processes. RESULTS: fifty-five hospitals met inclusion criteria. Electronic prescription systems were use by 51 %, 65.5 % always formulated individually, while 34.4 % had predesigned formulas. Tricameral preparations were used by 13.0 %. In 52.7 % of cases, first day nutrition was prepared on demand, starting before 8 hours of life in 88.1 % of cases. Inorganic phosphate was the first option in 10.4 %, vitamins, trace elements and zinc were added daily in 92.7 %, 90.9 % and 70.9 % of cases, respectively. NPN including lipids in the same bag was formulated by 45.4 % of the hospitals, compared to 34.5 % where it was administered separately in all cases. In 50.9 % of hospitals they never added heparin to their NPN. The 89.1 % used photoprotected bags. The stability of the admixture varied from 24 hours to 15 days. CONCLUSION: the elaboration of the PPN in Spain is subject to great variability. There is controversy regarding the use of heparin and ternary mixtures, which is reflected in the variability of clinical practice


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Alimentos Formulados , Nutrição Parenteral/métodos , Nutrição Parenteral/normas , Inquéritos e Questionários , Assistência Farmacêutica/estatística & dados numéricos , Estudos Transversais
11.
Nutr. hosp ; 38(1): 16-22, ene.-feb. 2021. tab
Artigo em Espanhol | IBECS | ID: ibc-198835

RESUMO

OBJETIVO: cuantificar el número de pacientes neonatos en tratamiento con nutriciones parenterales individualizadas (NPI), candidatos a recibir nutriciones parenterales estandarizadas (NPE), así como el número de días. MATERIAL Y MÉTODOS: estudio prospectivo observacional y descriptivo de cohortes. Los criterios de inclusión fueron: pacientes neonatos con indicación de nutrición parenteral (NP) y prescripción individualizada. Los criterios de exclusión fueron: pacientes que no hubieran iniciado la diuresis, con necesidades nutricionales específicas, con alteraciones del equilibrio ácido-base y/o con contraindicación de la NPE. Se emplearon variables relacionadas con el paciente (sexo, peso, semanas de gestación y días de vida) y relacionadas con el tratamiento (aportes de la NPI). Fijando como criterio de conversión el volumen de NP, se calcularon los aportes teóricos con la NPE. El criterio para que un paciente fuera candidato a recibirla fue que todos los aportes teóricos estuvieran dentro de los requerimientos de referencia. RESULTADOS: se incluyeron 33 neonatos (9 mujeres) en tratamiento con NPI y con 94 prescripciones. La mediana de peso de los pacientes incluidos en el estudio fue de 2,14 (RIC: 0,9) kg, nacidos a las 35 (RIC: 3) semanas de gestación y en los que se inició NP entre los días 0 y 4. El 71 % (22/31) de los pacientes en el 54,1 % (46/85) de sus prescripciones fueron candidatos a recibir NPE administrada por vía central durante 1 a 8 días, mientras que ningún paciente fue candidato a recibirla por vía periférica. CONCLUSIONES: en nuestro centro, el 71 % de los pacientes nenonatos en tratamiento con NPI administrada por vía central son candidatos a recibir NPE, lo que fomenta la normalización del soporte nutricional en esta población


OBJETIVE: to quantify the number of neonates treated with individualized parenteral nutrition (IPN) who were candidates to receive standardized parenteral nutrition (SPN), and to calculate their treatment duration. MATERIAL AND METHODS: this was a prospective, observational, descriptive cohort study. Inclusion criteria were: neonates with indication of parenteral nutrition (PN) and individualized prescription. Exclusion criteria included: patients who had not started diuresis, with specific nutritional needs, altered acid-base balance, and/or contraindication to receive SPN. Included variables were patient-related (gender, weight, weeks of gestation, and days of life) and treatment-related regarding IPN composition. Setting the volume of PN as the conversion criterion, theoretical contributions were calculated with the SPN. The criterion for a patient to be a candidate to receive SPN was that all the theoretical contributions calculated were within the reference requirements range. RESULTS: a total of 33 neonates (9 women) received IPN with 94 prescriptions. The median weight of the patients included in the study was 2.14 (IQR, 0.9) kg, and they were born at 35 (IQR, 3) weeks of gestation. PN began between 0 and 4 days of life. In all, 71 % (22/31) of the patients in 54.1 % of their (46/85) prescriptions were candidates to receive SPN via central administration for 1 to 8 days, whereas no patient was candidate to receive SPN via peripheral administration. CONCLUSIONS: in our center, 71 % of neonates treated with central administration of IPN are candidates to receive SPN, thus promoting the normalization of nutritional support in this population


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Nutrição Parenteral/métodos , Segurança do Paciente/normas , Apoio Nutricional/métodos , Necessidades Nutricionais , Nutrição Parenteral/normas , Unidades de Terapia Intensiva Neonatal/normas , Terapia Intensiva Neonatal/normas , Estudos Prospectivos
14.
Nutrients ; 13(1)2021 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-33406683

RESUMO

Uremic sarcopenia is a frequent condition present in chronic kidney disease (CKD) patients and is characterized by reduced muscle mass, muscle strength and physical performance. Uremic sarcopenia is related to an increased risk of hospitalization and all-causes mortality. This pathological condition is caused not only by advanced age but also by others factors typical of CKD patients such as metabolic acidosis, hemodialysis therapy, low-grade inflammatory status and inadequate protein-energy intake. Currently, treatments available to ameliorate uremic sarcopenia include nutritional therapy (oral nutritional supplement, inter/intradialytic parenteral nutrition, enteral nutrition, high protein and fiber diet and percutaneous endoscopic gastrectomy) and a personalized program of physical activity. The aim of this review is to analyze the possible benefits induced by nutritional therapy alone or in combination with a personalized program of physical activity, on onset and/or progression of uremic sarcopenia.


Assuntos
Suplementos Nutricionais , Ingestão de Energia , Estado Nutricional , Sarcopenia/metabolismo , Sarcopenia/urina , Acidose , Dieta Rica em Proteínas , Fibras na Dieta , Nutrição Enteral , Exercício Físico , Ácidos Graxos Ômega-3 , Hospitalização , Humanos , Força Muscular , Apoio Nutricional , Nutrição Parenteral , Diálise Renal , Insuficiência Renal Crônica , Sarcopenia/diagnóstico
15.
BMC Geriatr ; 21(1): 80, 2021 01 28.
Artigo em Inglês | MEDLINE | ID: mdl-33509118

RESUMO

BACKGROUND: Enteral feeding and parenteral nutrition (PN) using gastrostomy (GS) and a nasogastric tube feeding (NGT) and PN should be initiated for older patients based on their prognoses. This study aimed to investigate the long-term prognosis of patients aged ≥75 years who underwent enteral feeding via GS and NGT as well as PN. METHODS: A population-based cohort study was conducted using Japan's universal health insurance claims in the Nara Prefecture. This study enrolled 3,548 patients aged ≥75 years who received GS (N=770), NGT (N=2,370), and PN (N=408) during hospital admissions between April 2014 and March 2016. The GS group was further categorized into secondary GS (N=400) with preceding NGT or PN within 365 days and primary GS (N=370) without preceding NGT or PN groups. In the secondary GS group, 356 (96%) patients received NGT (versus PN). The outcome was mortality within 730 days after receiving GS, NGT, and PN. Cox regression analyses in cases with or without malignant diseases, adjusted for sex, age, comorbidity, and hospital type, were performed to compare mortality in the groups. RESULTS: Of the 3,548 participants, 2,384 (67%) died within 730 days after the initiation of GS and NGT and PN. The 2-year mortality rates in the secondary GS, primary GS, NGT, and PN groups were 58%, 66%, 68%, and 83% in patients without malignancies and 67%, 71%, 74%, and 87% in those with malignancies, respectively. In the non-malignant group, Cox regression analysis revealed that secondary GS (hazard ratio (HR) = 0.43, 95% CI: 0.34-0.54), primary GS (HR = 0.51, 95% CI: 0.40-0.64), and NGT (HR = 0.71, 95% CI: 0.58-0.87) were statistically significantly associated with lower mortality compared with PN. CONCLUSIONS: Approximately 58% to 87% patients aged ≥75 years died within 730 days after initiation of nutrition through GS, NGT, or PN. Patients with non-malignant diseases who received secondary GS exhibited better 2-year prognosis than those who received NGT or PN. Healthcare professionals should be aware of the effectiveness and limitations of enteral feeding and PN when considering their initiation.


Assuntos
Nutrição Enteral , Nutrição Parenteral , Idoso , Estudos de Coortes , Humanos , Intubação Gastrointestinal , Prognóstico
16.
Zhonghua Wei Chang Wai Ke Za Zhi ; 24(1): 94-100, 2021 Jan 25.
Artigo em Chinês | MEDLINE | ID: mdl-33461259

RESUMO

Intestinal failure (IF) is defined as the critical reduction of functional intestines below the minimum needed to absorb nutrients and fluids, so that intravenous supplementation with parenteral nutrition (PN) is required to maintain health and/or growth. Although the benefits are evident, patients receiving PN can suffer from serious cholestasis due to lack of enteral feeding and small intestinal bacterial overgrowth (SIBO). One such complication that may arise is intestinal failure-associated liver disease (IFALD). Evidences from recent studies suggest that alterations in the intestinal microbiota, as well as intraluminal bile acid driven signaling, may play a critical role in both hepatic and intestinal injury. Since Marshall first proposed the concept of the gut-liver axis in 1998, the role of gut-liver axis disorders in the development of IFALD has received considerable attention. The conversation between gut and liver is the key to maintain liver metabolism and intestinal homeostasis, which influences each other and is reciprocal causation. However, as a "forgotten organ" , intestinal microbiota on the pathogenesis of IFALD has not been well reflected. As such, we propose, for the first time, the concept of gut-microbiota-liver axis to emphasize the importance of intestinal microbiota in the interaction of gut-liver axis. Analysis and research on gut-microbiota-liver axis will be of great significance for understanding the pathogenesis of IFALD and improving the prevention and treatment measures.


Assuntos
Microbioma Gastrointestinal , Enteropatias , Hepatopatias , Fígado/fisiopatologia , Nutrição Parenteral/efeitos adversos , Síndrome do Intestino Curto/fisiopatologia , Infecções Bacterianas/etiologia , Infecções Bacterianas/fisiopatologia , Ácidos e Sais Biliares/fisiologia , Colestase/etiologia , Colestase/microbiologia , Colestase/fisiopatologia , Nutrição Enteral , Microbioma Gastrointestinal/fisiologia , Humanos , Enteropatias/etiologia , Enteropatias/microbiologia , Enteropatias/fisiopatologia , Intestinos/microbiologia , Intestinos/fisiologia , Intestinos/fisiopatologia , Fígado/microbiologia , Fígado/fisiologia , Hepatopatias/etiologia , Hepatopatias/microbiologia , Hepatopatias/fisiopatologia , Síndrome do Intestino Curto/complicações , Síndrome do Intestino Curto/dietoterapia , Transdução de Sinais
17.
Expert Opin Drug Saf ; 20(3): 307-320, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33356650

RESUMO

Introduction: Intestinal failure-associated liver disease (IFALD) refers to hepatic dysfunction that results from prolonged parenteral nutrition (PN) use. IFALD is multifactorial in origin and remains a major cause of morbidity and mortality. Prior to 2004, IFALD was associated with mortality as high as 90% in infants who remained on PN greater than 1 year. The advent of new strategies for intravenous lipid emulsion (ILE) administration and improved catheter care now allow many patients to remain on PN and recover from this once fatal condition. Several additional treatment modalities are often used to further improve outcomes for IFALD patients and they are reviewed here.Areas covered: The etiology of IFALD is presented, as well as the rationale behind the use of ILEs that contain fish oil. Other management strategies are addressed, including the effects of several pharmacologic and nutritional interventions.Expert opinion: Like its etiology, the management of IFALD is multifactorial. Prompt recognition of patients at risk, avoiding macronutrient excess, and preventing central line associated bloodstream infections will improve outcomes. In patients who develop IFALD, the use of fish oil monotherapy seems to be efficacious. The most effective intervention, however, continues to be discontinuation of PN and achieving full enteral feedings.


Assuntos
Enteropatias/terapia , Hepatopatias/etiologia , Nutrição Parenteral/efeitos adversos , Animais , Emulsões Gordurosas Intravenosas/administração & dosagem , Óleos de Peixe/administração & dosagem , Humanos , Lactente , Hepatopatias/mortalidade , Hepatopatias/terapia , Nutrição Parenteral/métodos
20.
Nutrients ; 12(12)2020 Dec 10.
Artigo em Inglês | MEDLINE | ID: mdl-33321828

RESUMO

Despite the importance of early recognition of metabolic bone disease (MBD) of prematurity, there is still significant variability in screening practices across institutions. We conducted an observational study of infants born at ≤32 weeks of gestation with a birth weight of ≤1500 g (n = 218) to identify clinical factors associated with biochemical indicators of MBD. Bone mineral status was assessed by measuring alkaline phosphatase and phosphate levels between weeks 3 and 5 of life. Two comparisons were performed after classifying infants as either MBD (cases) or non-MBD (controls), and as either high or low risk for MBD, as determined based on the results of MBD screening. In total, 27 infants (12.3%) were classified as cases and 96 (44%) as high-risk. Compared with controls, MBD infants had a significantly lower gestational age and birth weight, and a longer duration of parenteral nutrition and hospital stay. Respiratory outcomes were significantly poorer in high- versus low-risk infants. Multivariate logistic regression showed that birth weight was the only independent risk factor for MBD (odds ratio [OR]/100 g, 0.811; confidence interval [CI95%], 0.656-0.992; p = 0.045) and that birth weight (OR/100 g, 0.853; CI95%, 0.731-0.991; p = 0.039) and red blood cell transfusion (OR, 2.661; CI95%, 1.308-5.467; p = 0.007) were independent risk factors for high risk of MBD. Our findings provide evidence of risk factors for MBD that could help clinicians to individualize perinatal management. The association of red blood cell transfusion with MBD is a novel finding that may be related to iron overload and that merits further study.


Assuntos
Doenças Ósseas Metabólicas/diagnóstico , Doenças do Prematuro/diagnóstico , Recém-Nascido Prematuro/sangue , Triagem Neonatal/métodos , Fosfatase Alcalina/sangue , Peso ao Nascer , Transfusão de Eritrócitos/estatística & dados numéricos , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Tempo de Internação/estatística & dados numéricos , Modelos Logísticos , Masculino , Razão de Chances , Avaliação de Resultados em Cuidados de Saúde , Nutrição Parenteral/estatística & dados numéricos , Fosfatos/sangue , Estudos Prospectivos , Estudos Retrospectivos , Medição de Risco , Fatores de Risco
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