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Copyright of Revista Foco (Interdisciplinary Studies Journal) is the property of Revista Foco and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: this study aimed to assess the effects of two isocaloric parenteral nutrition (PN) regimens with different protein content and non-protein calorie to nitrogen ratio (NPCNR) on the evolution of nutritional parameters and outcomes in adult inpatients. Methods: this was a retrospective quasi-experimental study performed in a 400-bed tertiary hospital. Adult inpatients were initially eligible if they had received ≥ 4 days of PN with NPCNR ≥ 100 or ≤ 90 in a period of three years. Patients were propensity-score matched to adjust for differences, resulting in two final cohorts: Cohort "Medium-P" included patients receiving PN with NCPCNR ≥ 100 and cohort "High-P", receiving PN with NCPCNR ≤ 90. The main variables were differences in plasma albumin, prealbumin, cholesterol, and lymphocyte count, days requiring PN, length of stay, and mortality at 90 days. Results: 202 patients were finally recruited and divided into the two equal cohorts. Patients were mainly male (122; 60.4 %), surgical (149; 73.8 %), critically ill (100; 49.5 %), with high nutritional risk (141; 69.8 %) and with a neoplasm (145; 71.8 %). PN provided 25 kcal/kg/day, but protein intake was 0.25 g/kg/day higher in the "High-P" cohort. Baseline characteristics and biochemistry were not different between the two cohorts. The "High-P" cohort presented a smaller difference at the end of PN for lymphocytes, more days with hyperglycaemia, and more days requiring PN. The rest of variables did not differ. Conclusions: high doses of protein (lower NPCNR) did not present advantages compared to medium doses of protein (higher NPCNR) when providing isocaloric PN in adult inpatients. [ABSTRACT FROM AUTHOR]

Introduction: medical nutritional treatment (MNT) can be complex and may be associated with potential metabolic complications, which has been recently described as nutritrauma. Objective: the aim of our work is to describe whether the application of the nutritrauma concept in real life is feasible and useful to detect the metabolic complications associated with the prescription of MNT. Material and methods: in this descriptive, prospective study at a single center we enrolled 30 consecutive critically ill patients in a 14-bed medical-surgical intensive care unit. The nutritrauma strategy implementation was based in four "M" steps: Metabolic screening, MNT prescription, biochemical Monitoring, and nutritional Management. Results: we analyzed 28 patients (mean age, 69.7 ± 11.3 years; APACHE II, 18.1 ± 8.1; SOFA, 7.5 ± 3.7; Nutric Score, modified, 4.3 ± 2.01, and mean BMI, 27.2 ± 3.8). The main cause of admission was sepsis (46.4 %). Length of ICU stay was 20.6 ± 15.1 days; 39.3 % of subjects died during their ICU stay. Enteral nutrition (82.1 %) was more frequent than parenteral nutrition (17.9 %). During nutritional monitoring, 54 specific laboratory determinations were made. Hyperglycemia was the most frequent metabolic alteration (83.3 % of measurements). Electrolyte disturbances included hypocalcemia (50 %), hypophosphatemia (29.6 %) and hypokalemia (27.8 %). The most frequent lipid profile abnormalities were hypocholesterolemia (64.8 %) and hypertriglyceridemia (27.8 %). Furthermore, nutritional prescription was modified for 53.6 % of patients: increased protein dosage (25 %), increased calorie dosage (21.4 %) and change to organ-specific diet (17.8 %). Conclusions: in conclusion, the application of the nutritrauma approach facilitates detection of metabolic complications and an evaluation of the appropriate prescription of MNT. [ABSTRACT FROM AUTHOR]

Introduction: intestinal failure (IF) is an organic failure classified into three types (I-III); it conditions inability to absorb nutrients and water, so parenteral nutrition (PN) is required. Objective: to evaluate the characteristics of hospitalized patients with IF, and their association with clinical and nutritional outcomes. Methods: historical cohort of hospitalized adults with IF and PN. Variables of the nutritional care process (screening, anthropometric, biochemical, clinical, nutritional), mortality and hospital stay were recorded. Results: six hundred and ninety-seven patients aged 56 (41-68) years, 327 women (46.8 %), with body mass index (BMI) 22.4 (18.3-25.9), were included. Diagnosis: 577 patients with IF-I, 96 patients with IF-II, and 24 patients with IF-III. The most frequent causes were malignant neoplasms, IF-I (26.7 %) and surgical complications in IF-II (21.9 %) and IF-III (37.5 %). The most common pathophysiology in all types of IF was motility disorders (40.6 % in IF-I; 43.8 % in IF-II; 33.8 % in IF-III). The majority of patients had high nutritional risk (92.4 %) and refeeding syndrome (65.6 % high and very high). In acute IF (FI-I) compared to prolonged IF (If-II/IF-III) there is a higher BMI (p = 0.039), visceral fat (p = 0.041) and over-hydration (p = 0.014), but they have a smaller phase angle (p = 0.004), with a lower adequacy percentage than what is prescribed in relation to their energy expenditure (p < 0.001). Conclusions: during the nutritional care process there are differences between the types of IF, which are relevant to optimize their multidisciplinary management and avoid related complications. [ABSTRACT FROM AUTHOR]

Copyright of Hospital a Domicilio is the property of Centro Internacional Virtual de Investigacion en Nutricion and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Preterm newborns require the use of the best and most current strategies to treat and prevent both acute pathology and associated sequelae. This study aimed to compare the differences in the management of preterm newborns over 10 years in a tertiary hospital in Spain and its impact on height, weight, and neurological development in the medium term. Methods: We conducted a retrospective, observational, and analytical study examining the management and clinical variables in preterm newborns under 32 weeks of gestational age who were born in our hospital in 2011 and 2021. Results: Twenty-six newborns were included in the study. Significant differences in magnesium sulfate use, continuous positive airway pressure immediately after birth, and non-invasive mechanical ventilation during hospitalization were observed. Differences were found in the use of parenteral nutrition and the timing of initiation of enteral feeding. We did not observe differences in the neurological or weight evolution in the medium term. Conclusions: Significant differences in managing preterm newborns in these 10 years were observed. Lower mortality and alterations in central nervous system ultrasound and, significantly, less growth retardation during admission in 2021 have been observed; however, it does not manifest with improvement in long-term somatometrics or neurological prognosis. [ABSTRACT FROM AUTHOR]

Copyright of Revista Nutrición Clínica y Dietética Hospitalaria is the property of Sociedad Espanola de Dietetica y Ciencias de la Alimentacion and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Nutrición Clínica y Dietética Hospitalaria is the property of Sociedad Espanola de Dietetica y Ciencias de la Alimentacion and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Foco (Interdisciplinary Studies Journal) is the property of Revista Foco and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: parenteral nutrition is a mixture of macro and micronutrients necessary for the premature infant who cannot be fed enterally. The binary mixture contains carbohydrates, amino acids and micronutrients in one bag and intravenous lipids in another. The latter are more susceptible to microbial contamination, especially by Candida albicans. For this reason, many professional associations typically recommend the use of a single filter in line “Y”; however, this has not yet become standard hospital practice. Aim: to determine the presence of Candida albicans in devices that contain intravenous lipids used in neonates and relate it to the correct use of the 1.2 µm filter. Method: three groups of samples consisting of the remains of a lipid solution (ML) administered to the premature patient for 24 h seeded on Sabouraud agar organized as follows: (ML1), lipid solution obtained directly from the ethinyl vinyl acetate bag were evaluated. (ML2): filtered lipid solution with a 1.2 µm device connected directly to the catheter. (ML3): solution of lipids intentionally contaminated with Candida and subsequently filtered. Results: Candida albicans was not detected in any of the filtered simples (ML2 and ML3) and also not detected in any of the unfiltered simples (ML1). Conclusions: there was no presence of Candida albicans in the lipid solutions used directly with a 1.2 µm filter, however, the use of a single 1.2 µm filter in line “Y” is recommended according to international standards to save the health system. [ABSTRACT FROM AUTHOR]

En los últimos 15 años se ha incrementado en más de un 30 % la necesidad de diálisis en Argentina. En esta población existe una alta prevalencia de desnutrición, la cual se conoce como desgaste proteico energético (DPE). Su diagnóstico y tratamiento oportuno es esencial ya que es un gran predictor de morbimortalidad. Dentro de las opciones de tratamiento se encuentra la nutrición parenteral intradialítica (NPID), la cual se recomienda luego de la realización de consejería nutricional; el uso de suplemento nutricional oral (SNO) y nutrición enteral (NE). La indicación de la NPID debe evaluarse individualmente teniendo en consideración los criterios de inicio, sus ventajas, desventajas y las contraindicaciones de su uso, como así también diferentes barreras que existen para su implementación. La presente revisión abordará dichos puntos tanto para la población adulta como pediátrica.

El objetivo fue describir la nutrición parenteral en neonatos de la Unidad de Cuidados Intensivos Neonatal (UCIN) del Instituto Autónomo Hospital Universitario de Los Andes (IAHULA), Mérida Venezuela, 2019. Se presenta una serie de casos, empleando una metodología observacional descriptiva. Muestra de 13 casos con prescripción de nutrición parenteral total en un período igual o mayor a tres días, recién nacidos pretérmino con menos de 37 semanas de edad gestacional peso menor o igual a 2500 g. Resultados: 30,8% presentaba una edad gestacional de 28 a 32 semanas y 69,2% de 33 a 37 semanas. El género se distribuyó en masculino 53,8% y femenino 46,2%. La estancia hospitalaria se distribuyó en 38,5% tres días, 15,3% cuatro días, 23,1% cinco días, 15,3% seis días, 7,7% ocho días. Estado nutricional, 30,8% con peso y talla normal para la edad gestacional y 69,2% con peso y talla baja para la edad gestacional. En cuanto a las enfermedades presentes para el diagnóstico médico de ingreso, las de mayor porcentaje fueron las respiratorias/metabólicas 46,2%. No se observó ganancia de peso al final de la aplicación de la nutrición parenteral en 11 de 13 casos. Se hallaron diferencias estadísticamente significativas en el aporte calórico (Kcal/día) (p

Background: the administration of aluminum-contaminated parenteral nutrition (PN) leads to an accumulation of aluminum. The aim of this study was to assess blood aluminum concentrations (BACs) of inpatients receiving multichamber-bag (MCB) PN compared to those receiving compounded PN. Methods: available BACs were retrospectively gathered from patient charts of adult inpatients receiving PN from 2015 to 2020, and compared depending on the type of PN administered. Long-term PN patients, defined as ≥ 20 days of PN, receiving at least > 10 days of compounded PN, were compared to long-term patients receiving only MCB. Results: a total of 160 BACs were available from 110 patients. No differences were found according to type of PN (mean BAC: 3.11 ± 2.75 for MCB versus 3.58 ± 2.08 µg/L for compounded PN). Baseline total bilirubin, surgery and days with PN were related to higher BACs (coefficient: 0.30 [95 % CI, 0.18-0.42], 1.29 [95 % CI, 0.52-2.07], and 0.06 [95 % CI: 0.01-0.11], respectively). Regarding long-term PN, patients receiving only MCB (n = 21) showed lower BACs compared to the compounded PN (n = 17) [2.99 ± 1.55 versus 4.35 ± 2.17 µg/L, respectively; p < 0.05]. Conclusions: although there were no differences in BAC according to type of PN administered, in long-term PN, MCB PN was associated with lower BACs as compared to compounded PN. [ABSTRACT FROM AUTHOR]

Copyright of Cirugía y Cirujanos is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Parenteral Nutrition (PN) is a means of providing the necessary nutrients intravenously when the clinical situation requires it. The provision of PN carries a risk due to the invasive nature of the procedure, which usually varies depending on the type used. Therefore, the medical devices used must be characterized according to the criteria of safety, comfort, effectiveness and economic cost to optimize and maximize the resources available in the administration of PN. Method: A narrative bibliographic review was carried out based on the search, in different databases such as Medline, Science Direct and Scopus, of all the articles published, up to March 2022, on devices for the administration of PN. Results: The administration of PN requires medical devices that guarantee the techno-pharmaceutical properties of the PN, as well as the safety of its administration. Conclusions: Infusion bags and pumps, together with catheters and their filters, are the key devices on which their characteristics and safety systems must be improved in order to optimize administered PN. [ABSTRACT FROM AUTHOR]

Copyright of Medicina (Buenos Aires) is the property of Medicina (Buenos Aires) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Cirugía y Cirujanos is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: the study describes the evolution over the years of the use of artificial nutrition, in particular after the introduction of a dedicated Clinical Nutrition and Dietetic Service. Methods: a single-center, retrospective observational study performed with data collected from 2014 to 2019 at the Regional Hospital of Locarno, Switzerland. Results: from 2014 to 2019, there has been an increase in the number of patients identified as being at risk of malnutrition. We observed a reduction in the use of parenteral nutrition in all services, especially after the introduction of the dedicated Clinical Nutrition and Dietetic Service. There would seem to be a switch from enteral to oral nutrition with increased use of oral nutritional supplements. Conclusions: the introduction of a dedicated Clinical Nutrition and Dietetic Service in the care of patients with nutritional issues would seem to reduce the use of artificial invasive nutrition, despite an increase in the number of patients identified as being at risk of malnutrition. [ABSTRACT FROM AUTHOR]

Introduction: The end of life (OL) implies a period in which a certain disease or other situation leads to an inexorable path towards death. The clinical situation makes the approach to VF very complex, especially in those stages where the parenteral route is the only way to provide nutritional support. Method: A narrative bibliographic review was carried out based on the search in different databases such as Medline, Science Direct and Scopus of all the articles published until March 2021 that show a series of nutritional and technological considerations of supplemented parenteral nutrition (PN) and your possible benefits at EOL. Results: It is necessary to carry out adequate monitoring of FV with PN to determine the importance of adding nutritional supplements, due to their beneficial effects, such as glutamine, arginine, zinc, chromium, citrulline, selenium, zinc or coenzyme Q to attenuate the alterations typical of FV and avoid new complications. Also, a series of technological criteria must be considered to guarantee the stability of the NP and its nutrients. Conclusions: The supplemented PN that is administered in the FV involves controlling a series of factors that are involved in its stability. Beneficial actions have been observed with NP supplemented with zinc, selenium, chromium and taurine. [ABSTRACT FROM AUTHOR]

Introduction: Objectives: the study describes the evolution over the years of the use of artificial nutrition, in particular after the introduction of a dedicated Clinical Nutrition and Dietetic Service. Methods: a single-center, retrospective observational study performed with data collected from 2014 to 2019 at the Regional Hospital of Locarno, Switzerland. Results: from 2014 to 2019, there has been an increase in the number of patients identified as being at risk of malnutrition. We observed a reduction in the use of parenteral nutrition in all services, especially after the introduction of the dedicated Clinical Nutrition and Dietetic Service. There would seem to be a switch from enteral to oral nutrition with increased use of oral nutritional supplements. Conclusions: the introduction of a dedicated Clinical Nutrition and Dietetic Service in the care of patients with nutritional issues would seem to reduce the use of artificial invasive nutrition, despite an increase in the number of patients identified as being at risk of malnutrition. [ABSTRACT FROM AUTHOR]

Introduction: Aggressive parenteral nutrition with delivery of high amino acid and energy doses is used to improve growth and neurodevelopmental outcomes in very low birth weight (VLBW) preterm infants. Recent findings, however, suggest that this approach may cause electrolyte imbalances. The aim of our study was to compare the prevalence of hypercalcaemia, hypophosphataemia, and hypokalaemia in 2 groups of preterm infants that received parenteral nutrition with different amounts of amino acids and to analyse perinatal and nutritional variables associated with the development of electrolyte imbalances. Methods: We conducted a retrospective observational study comparing 2 groups of preterm infants born before 33 weeks’ gestation with birth weights of less than 1500 g managed with parenteral nutrition. One of the groups received less than 3 g/kg/day of amino acids and the other received 3 g/kg//day of amino acids or more. We analysed the prevalence of electrolyte imbalances and possible associations with aggressive parenteral nutrition, adjusting for potential confounders. Results: We studied 114 infants: 60 given less than 3 g/kg/day of amino acids (low-intake group) and 54 given at least 3 g/kg/day (high-intake group). The prevalence of electrolyte imbalances was similar in both groups. The prevalence of hypercalcaemia was 1.67% in the low-intake group and 1.85% in the high-intake group (P > .99), the prevalence of severe hypophosphataemia 11.7% vs 9.3%, and the prevalence of hypokalaemia 15.0% vs 11.1% (P > .99). A calcium to phosphorus ratio greater than 1.05 had a protective effect against hypophosphataemia (P = .007). Conclusions: We did not find an association between hypercalcaemia, hypophosphataemia, and hypokalaemia and the amino acid dose delivered by PN in the high-intake group of preterm infants. Resumen: Introducción: La nutrición parenteral agresiva con aportes energéticos y proteicos altos se utiliza para mejorar el crecimiento y el neurodesarrollo en recién nacidos prematuros de muy bajo peso. No obstante, hallazgos recientes sugieren que su uso puede ocasionar alteraciones electrolíticas. El objetivo del estudio era comparar la prevalencia de hipercalcemia, hipofosfatemia e hipopotasemia en dos grupos de recién nacidos prematuros que recibieron nutrición parenteral con distintos aportes de aminoácidos, y analizar variables perinatales y nutricionales asociadas a la ocurrencia de alteraciones electrolíticas. Métodos: Estudio retrospectivo observacional, con comparación de 2 grupos de recién nacidos prematuros con peso < 1500 g y edad gestacional < 33 semanas manejados con nutrición parenteral. Uno de los grupos recibió < 3 g/kg/d de aminoácidos mientras que el otro recibió ≥3 g/kg/d. Se analizó la prevalencia de distintas alteraciones electrolíticas y su asociación con la nutrición parenteral agresiva, con ajustes para posibles factores de confusión. Resultados: El análisis incluyó 114 recién nacidos: 60 que recibieron < 3 g/kg/d de aminoácidos (ingesta baja) y 54 que recibieron ≥ 3 g/kg/d (ingesta alta). La prevalencia de alteraciones electrolíticas fue similar en ambos grupos. La prevalencia de hipercalcemia fue de 1,67% en el grupo de ingesta baja y 1,85% en el grupo de ingesta alta (p > 0,99). Los respectivos valores para las otras alteraciones fueron 11,7% vs. 9,3% en el caso de la hipofosfatemia grave y 15,0% vs. 11,1% en el caso de la hipopotasemia (p > 0,99). Se observó que una relación calcio:fósforo superior a 1,05 ofrecía un efecto protector frente a la hipofosfatemia (p = 0,007). Conclusiones: No se observó asociación entre la hipercalcemia, hipofosfatemia o la hipopotasemia y el aporte de aminoácidos mediante nutrición parenteral en la población de recién nacidos prematuros con ingestas altas de aminoácidos.

Conocer cómo se realiza la terapia nutricional domiciliario (TND) en los países miembros de FELANPE.

Introduction: Objective: this study aimed to assess the main factors related to mortality in a cohort of hospitalized adult patients who required parenteral nutrition (PN) considering their characteristics, type of admission, procedures, nutritional data, and adverse events. Methods: a retrospective study was performed in a 400-bed university hospital. All adult inpatients that had received ≥ 4 days as first course of PN within 24 months were included. Patients with long-term (> 90 days) or home PN were excluded. The main variable was all-cause mortality at 90 days after the end of PN. Initial independent variables were anthropometric and demographic data, admission characteristics, severity, comorbidity, surgical/medical procedures, baseline biochemical parameters, nutritional risk, and other nutritional data, medications, and adverse events during PN. A Cox proportional hazards regression model was planned to analyze time-to-event data. Results: a total of 634 patients entered the study and 140 (22.1 %) died. Patients were mainly: surgical 471 (74.3 %), male 393 (62.0 %), and age 69.0 (67.8-70.1) years old. The survival time for the entire cohort was 74.0 (95 % CI: 71.6-76.6) days. The final model included 14 variables, with severity and comorbidity being the main ones, but including also anastomotic suture dehiscence, sepsis during PN, days with hyperglycemic events, use of potent opioids, failed attempts at enteral nutrition, and, as a protective one, energy provided in PN. Conclusions: the factors related to mortality in hospitalized adult patients who required PN were mainly severity and comorbidities, but several other important factors were also relevant and could be modified to maximize outcomes in these patients. [ABSTRACT FROM AUTHOR]

Copyright of Cirugía y Cirujanos is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: the ESPEN Guideline offers a multidisciplinary focus on clinical nutrition in inflammatory bowel disease (IBD). Methodology: the guideline is based on a extensive systematic review of the literature, but relies on expert opinion when objective data are lacking or inconclusive. The conclusions and 64 recommendations have been subject to full peer review and a Delphi process, in which uniformly positive responses (agree or strongly agree) were required. Results: IBD is increasingly common and potential dietary factors in its etiology are briefly reviewed. Malnutrition is highly prevalent in IBD -- especially in Crohn's disease. Increased energy and protein requirements are observed in some patients. The management of malnutrition in IBD is considered within the general context of support for malnourished patients. Treatment of iron deficiency (parenterally, if necessary) is strongly recommended. Routine provision of a special diet in IBD is not, however, supported. Parenteral nutrition is indicated only when enteral nutrition has failed or is impossible. The recommended perioperative management of patients with IBD undergoing surgery accords with general ESPEN guidance for patients having abdominal surgery. Probiotics may be helpful in UC but not in Crohn's disease. Primary therapy using nutrition to treat IBD is not supported in ulcerative colitis but is moderately well supported in Crohn's disease, especially in children, where the adverse consequences of steroid therapy are proportionally greater. However, exclusion diets are generally not recommended and there is little evidence to support any particular formula feed when nutritional regimens are constructed. Conclusions: available objective data to guide nutritional support and primary nutritional therapy in IBD are presented as 64 recommendations, of which 9 are very strong recommendations (grade A), 22 are strong recommendations (grade B), and 12 are based only on sparse evidence (grade 0); 21 recommendations are good practice points (GPP). [ABSTRACT FROM AUTHOR]

Introduction: Background: it is unknown whether patients with acute respiratory distress syndrome (ARDS) secondary to COVID-19 are at greater risk of developing complications associated with parenteral nutrition (PN). Aim: to describe the incidence, risk factors, and clinical impact of complications in patients with ARDS-COVID-19 receiving PN. Methods: a prospective cohort study of 87 patients with ARDS-COVID-19 infection. The incidence of complications and odds ratios of risk factors were analysed. Results: age ≥ 65 years (OR, 2.52, 95 % CI: 1.16 to 5.46), obesity (OR, 3.34, 95 % CI: 2.35 to 4.33) and treatment with propofol (OR, 2.45, 95 % CI: 1.55 to 3.35) or lopinavir/ritonavir (OR, 4.98, 95 % CI: 3.60 to 6.29) were risk factors for hipertriglyceridemia. Obesity (OR, 3.11, 95 % CI: 1.10 to 8.75), dyslipidemia (OR, 3.22, 95 % CI: 1.23 to 8.40) or treatment with propofol (OR, 5.47, 95 % CI: 1.97 to 15.1) were risk factors for intravascular catheter-related infection. No risk factors were described for hiperglycemia. Mortality was higher in patients with intravascular catheter-related infection (46.7 % vs 10.8 %, p = 0.014). Mortality risk was higher in older patients (OR, 2.74, 95 % CI: 1.08 to 6.95) or patients with intravascular catheter-related infection (OR, 3.22, 95 % CI: 1.23 to 8.40). Conclusions: the incidence of complications associated with PN in patients with COVID-19-related ARDS is frequent. The mortality risk is higher in older patients or those with catheter-related infection. [ABSTRACT FROM AUTHOR]

Introducción: Los neonatos tienen una reserva nutricional limitada que los hace extremadamente vulnerables, por lo que es necesario un adecuado soporte nutricional. Los pacientes neonatales con procedimientos quirúrgicos son frecuentemente admitidos en la unidad de cuidados intensivos neonatales (UCIN). El objetivo del estudio fue analizar la frecuencia y características de las complicaciones metabólicas en los recién nacidos posoperatorios que recibieron soporte nutricional parenteral en la unidad de cuidados intensivos en el Hospital Pediátrico Dr. Hugo Mendoza en República Dominicana. Material y métodos: Estudio descriptivo y retrospectivo. Resultados: Las complicaciones más frecuentes fueron hiperglucemia para un 33,3%, seguido de trombocitopenia (21%) e hiponatremia (18%). Conclusiones: No se evidencia relación entre los días de administración de NP y la incidencia de complicaciones, ni se muestra relación entre la cantidad de días de nutrición parenteral y días de internamiento.

Objectives: The main aim was to compare the effects of two parenteral lipid emulsions on retinopathy of prematurity (ROP) incidence, severity, and need for treatment. Secondary aim was to compare the effect on weight gain in the first 6 weeks of life., Methods: Single-center, observational, retrospective study analyzing preterm infants with a gestational age < 31 weeks and a birth weight < 1,251 g, born between April 2015 and December 2018. The infants' medical records were reviewed to collect clinical data. Parenteral nutrition details were obtained from the hospital pharmacy database., Results: In total, 180 patients were included: 90 received ClinOleic® and 90 received SMOFlipid®. No significant differences were observed for the incidence of ROP (40% in ClinOleic® group and 41% in SMOFlipid® group, p=0.88) or ROP requiring treatment (4% and 10% respectively, p=0.152). Weekly weight gain was similar in the two groups., Conclusions: This study showed no difference between the two groups regarding ROP, ROP requiring treatment or weekly weight gain in the first 6 weeks of life., (Copyright © 2023 Sociedad Española de Farmacia Hospitalaria (S.E.F.H). Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: Aim: to communicate the home parenteral nutrition (HPN) data obtained from the HPN registry of the NADYA-SENPE group (www.nadya-senpe.com) for the year 2019. Material and methods: a descriptive analysis of the data collected from adult and pediatric patients with HPN in the NADYA-SENPE group registry from January 1 to December 31, 2019. Results: a total of 283 patients (51.9 % women), 31 children, and 252 adults from 47 Spanish hospitals were registered, which represents a prevalence rate of 6.01 patients per million inhabitants for year 2019. The most frequent diagnosis in adults was "palliative oncological" and "others" (21.0 %). In children, it was Hirschsprung's disease together with necrotizing enterocolitis, alterations in intestinal motility, and chronic intestinal pseudo-obstruction, with 4 cases each (12.9 %). The first reason for the indication was short-bowel syndrome in both children (51.6 %) and adults (37.3 %). The most used type of catheter was tunnelled both in children (75.9 %) and in adults (40.8 %). Sixty-eight episodes ended, all in adults, and the most frequent cause was death (54.4 %); 38.2 % were switched to oral. Conclusions: the number of collaborating centers and professionals in the NADYA registry is increasing. The main indications and reasons for HPN termination remain stable. [ABSTRACT FROM AUTHOR]

La evolución en la nutrición parenteral en las últimas décadas ha permitido considerarla como una estrategia terapéutica segura y eficaz ante entidades clínicas que condicionan disfunción del tracto gastrointestinal y que se han asociado con períodos prolongados de ayuno, escasa ingesta o intolerancia a la nutrición enteral que ocasiona desnutrición secundaria, esto conlleva un mayor riesgo de deterioro de la función inmunológica sistémica e intestinal, así como una disminución de la absorción y motilidad intestinal y la alteración de la barrera intestinal.

El SIC es una reducción congénita o adquirida por resección quirúrgica en la longitud del ID ocasionando malabsorción. Las causas más comunes son atresia intestinal, enfermedad de Hirschsprung, gastrosquisis, enterocolitis necrotizante, vólvulo, trombosis vascular, tumor, traumatismo y síndrome de intestino inflamatorio. Su fisiopatología, presentación clínica, manejo y pronóstico son influenciados por determinantes específicos. Requiere de un proceso de adaptación intestinal para recuperar funcionalidad. Presenta múltiples complicaciones y el manejo se basa en programas de rehabilitación intestinal, NP, NE, suplementación de déficits nutricionales, terapia farmacológica y procedimientos quirúrgicos, con lo cual su pronóstico y prevalencia han aumentado en las últimas décadas. Sin embargo, persiste con una alta morbimortalidad.

Introduction: Introduction: it is common to add rapid-acting insulin to parenteral nutrition (NP) bags for the management of hyperglycemia. However, insulin can be adsorbed in NP bags due to electrostatic interactions. Objective: to determine the influence of the presence of lipids and of insulin concentration in NP bags on the adsorption of insulin in these bags, as well as its stability for 5 days. Method: seven NP bags were prepared with the same volume and with a similar composition except for the presence of lipids and micronutrients, and insulin concentration. Insulin was determined by electrochemiluminescent immunoassay. Samples of 2 mL were taken after preparation and on day 5. Results: on day 1, the mean loss of insulin was 15.26 % (± 7.08) in the bags with lipids and 18.45 % (± 5.67) (p = 0.60) in the bags without lipids. The percentage of insulin lost by day 5 in the PN bags with lipids was 30.13 % (± 4.14), and in the PN bags without lipids it was 44.71 % (± 12.94) (p = 0,052). No correlation was observed between the amount of insulin added to the PN bags and the percentage of insulin lost between day 1 (ρ = -0.407, p = 0.365) or day 5 (ρ = -0.295, p = 0.521). Conclusions: there is an increase in insulin adsorption in NP EVA bags over time. The presence of lipids in the bags decreases adsorption. Further studies are needed to demonstrate the factors associated with insulin adsorption in EVA bags. [ABSTRACT FROM AUTHOR]

Cuando la falla intestinal ocurre luego de una resección intestinal masiva se denomina síndrome de intestino corto. Es una entidad rara, con un espectro clínico que va desde una disfunción leve y reversible hasta una condición grave e incapacitante. Presenta una elevada morbimortalidad, altos costos de atención médica e importante impacto en la calidad de vida. El 50% de los pacientes con síndrome de intestino corto no se adaptan espontáneamente ni mejoran la absorción por el intestino remanente, por lo que deben recurrir de por vida a la nutrición parenteral. La terapia nutricional especializada y el tratamiento hormonal focalizado en el intestino son pilares en la rehabilitación promoviendo la adaptación intestinal, logrando independencia de la nutrición parenteral y evitando el trasplante intestinal. Actualmente, teduglutide es el tratamiento de referencia en estos pacientes, pero hasta el momento inaccesible en Uruguay por su elevado costo. Presentamos el único caso en nuestro país de un paciente de 23 años portador de falla intestinal crónica por síndrome de intestino corto que depende de la nutrición parenteral desde hace 17 años y presenta complicaciones graves asociadas a esta técnica.

Introduction: Introduction: optimal nutrition in the critically ill patient is a key aspect for recovery. Objectives: to promote training in and knowledge of mixed nutrition support (MNS) by means of a clinical algorithm among intensivists for improving the nutritional status of critically ill patients. Methods: a before-and-after study with the participation of 19 polyvalent intensive care units (ICUs) in 10 autonomous communities. Five members of the scientific committee trained the trainers by means of oral presentations and a clinical algorithm on MNS. Then, trainers were responsible for explaining the algorithm to local intensivists in their ICUs. The 30-item study questionnaire was completed before and after the intervention by 179 and 105 intensivists, respectively. Results: a clear improvement of knowledge was found in six (20 %) specific MNS-related questions. In 11 items (36.6 %), adequate knowledge on different aspects of nutritional support that were already present before the intervention were maintained, and in five items (16.7 %) an improvement in the rate of correct responses was recorded. There were no improvements in correct responses for four items (13.3 %), and for four (13.3 %) additional items the percentage of correct responses decreased. Conclusions: the use of the MNS algorithm has achieved a solid consolidation of the main concepts of MNS. Some aspects regarding how to manage the malnourished patient, how to identify them and what type of nutrition to guide from the beginning of admission to the ICU, nutritional contributions in special situations, and the monitoring of possible complications such as refeeding are areas for which further training strategies are needed. [ABSTRACT FROM AUTHOR]

Introduction: Objectives: in routine clinical practice many disorders are found that can disrupt the sequence of reactions in digestion and absorption, leading to malnutrition and requiring the use of oral nutritional supplements (ONS). The objective of our study was to evaluate in a real world setting the use of and compliance with a peptide-based ONS in malnourished adult patients with intestinal compromise after more than 14 days of parenteral nutrition. Material and methods: the study was carried out in 44 malnourished patients who required total parenteral nutrition for at least 14 days without using the oral route during their hospital stay. All patients were administered, on an outpatient basis, 1 brick per day of Vital 1.5® for 12 weeks. At the beginning of treatment and after the intervention period evaluated, the following variables were collected: weight, height, body mass index (BMI), global subjective assessment test, nutritional biochemistry, 3-day nutritional survey, adverse effects generated by the formula, and completion rate. Results: 44 patients were enrolled. Mean age was 70.4 ± 10.4 years (20 women & 24 men). After the intervention the following parameters had increased: BMI (0.51 ± 0.1 kg/m2; p = 0.02), weight (1.4 ± 0.3 kg; p = 0.03), prealbumin (3.5 ± 4.1 mg/dl; p = 0.01), albumin (1.3 ± 0.1 mg/dl; p = 0.03), and transferrin (71.5 ± 24.1 mg/dl; p = 0.02). Dietary intake of the ONS represented 14.4 % of the diet's total caloric intake at 3 months, 17.5 % of carbohydrates, 12.9 % of proteins, and 12.3 % of fats. Mean compliance was 87.7 ± 7.2 % of the prescribed intakes. In relation to the nutritional situation, at the beginning of the study, 52.3 % (n = 23) of patients were in the global subjective assessment test in category B (moderate malnutrition or nutritional risk), and 47.7 % (n = 21) in category C (severe malnutrition). After the intervention, 75 % of patients were in category A (n = 33), 13.6 % (n = 6) in category B, and 11.4 % (n = 5) in category C. Conclusions: the use of a peptide-based ONS with short-chain triglycerides in outpatients showed a beneficial effect on biochemical and anthropometric parameters, and improved the nutritional status of patients with high compliance and good tolerance rates. [ABSTRACT FROM AUTHOR]

Introduction: 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. [ABSTRACT FROM AUTHOR]

Introduction: 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® (enriched with fish oil) versus Clinoleic® (OOBE) in relation to the occurrence of nosocomial infection and other evolutionary parameters. To demonstrate non-inferiority in the safety profile of SMOFlipid® versus Clinoleic® 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® or Clinoleic®. 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® and 36 SMOFlipid®. Regarding the variable "decrease in nosocomial infections", SMOFlipid® proved to be non-inferior to Clinoleic®. Regarding the main variable "mortality", SMOFlipid® proved to be non-inferior to Clinoleic®. There were no statistically significant differences in the occurrence of adverse effects either. Conclusions: in our study, SMOFlipid® proved to be non-inferior to Clinoleic® in terms of efficacy and safety. [ABSTRACT FROM AUTHOR]

Introduction: 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. [ABSTRACT FROM AUTHOR]

Objective: To analyze the errors in the preparation of parenteral nutrition in a Pharmacy Service, detected through an already consolidated gravimetric and product quality control, and compare them with those detected during the initial years of implementing this quality control., Methods: All errors detected through quality control in the compounding of pediatric and adult parenteral nutritions between 2019 and 2021 were prospectively analyzed. This quality control consisted of 3 sequential processes: a visual check, a gravimetric control, and a product control. Errors were classified as gravimetric, when the nutrition had a deviation of more than 5% from the theoretical weight, or as product errors when a qualitative or quantitative error was detected upon reviewing the remainder of the components used. These errors were analyzed in terms of type and the component involved. A comparison was made with the errors detected during the implementation phase of this quality control from 2016 to 2018., Results: A total of 41,809 parenteral nutritions were reviewed, and 345 errors were detected (0.83% of the preparations); of these, 59 errors were found in pediatric nutritions (0.68% of them), and 286 in adult nutritions (0.86% of them). Among these errors, 193 were of gravimetric nature, while 152 were detected through product control. The main components involved in product errors were electrolytes, primarily due to the addition of excessive volumes and the use of incorrect components. A significant absolute reduction of 0.71% (P < .05) in the total number of errors was observed when compared to the implementation phase. This reduction was consistent in both gravimetric errors (-0.59%) and product-related errors (-0.12%) (P < .05)., Conclusions: Comprehensive quality control of parenteral nutrition preparation is an easily implementable tool that effectively detected and prevented significant errors. Furthermore, its widespread adoption contributed to a reduction in the overall error count., (Copyright © 2023 Sociedad Española de Farmacia Hospitalaria (S.E.F.H). Publicado por Elsevier España, S.L.U. All rights reserved.)

La desnutrición intrahospitalaria sigue siendo un gran problema en la actualidad alcanzando una prevalencia de 50,2 %, según el Estudio Latino-americano de Desnutrición (ELAN). Dado que en Perú no hay cifras reportadas, el presente estudio tiene el objetivo de determinar la prevalencia del riesgo de desnutrición y la situación de la terapia nutricional en pacientes adultos hospitalizados de enero a marzo de 2019.

El quilotórax es una condición caracterizada por derrame pleural secundaria a lesión o bloqueo del conducto torácico. El volumen del quilo drenado es influenciado por los lípidos presentes en la alimentación (nutrición enteral o vía oral), por lo que el reposo del tracto gastrointestinal es una práctica común en esta población. En la actualidad no existe consenso acerca de la vía de alimentación asociada a un menor gasto de quilo y a una recuperación más acelerada.

El paciente pediátrico se caracteriza por ser más sensible a las restricciones energéticas y de nutrientes. Los equipos de soporte nutricional han optimizado la práctica nutricional intrahospitalaria.

Editorial del Dr. José Mario Pimiento

El soporte nutricional del paciente pediátrico crítico influencia directamente en su morbimotalidad. Diversas condiciones hacen al niño particularmente vulnerable a la desnutrición cuando tiene enfermedades graves. La respuesta metabólica al estrés es principalmente hipercatabolismo de proteínas que ocasiona un balance nitrogenado negativo. Es importante adoptar estrategias que permitan proporcionar una adecuada y oportuna nutrición, realizando una buena valoración nutricional, calculando el gasto de los requerimientos energéticos, priorizando el aporte de proteínas como el macronutriente de mayor relevancia, iniciando el soporte nutricional temprano, mediante la vía correcta y realizando el monitoreo y seguimiento oportuno. En conclusión, el soporte nutricional debe formar parte importante de la estrategia terapéutica en todo niño crítico. DOI 10.25176/RFMH.v18.n4.1737

El cáncer afecta seriamente el estado nutricional del paciente. La pérdida de peso, y principalmente de masa libre de grasa, puede ser de gran magnitud, como sucede cuando afecta órganos sólidos. Asimismo, se producen anormalidades metabólicas que impiden la adecuada utilización de los nutrientes, por lo cual es necesario ajustar, en forma individual, el plan de alimentación. Los efectos secundarios generados por los medicamentos anticancerosos dificultan aún más una alimentación adecuada. Un pobre estado nutricional limita el tratamiento, sea de quimioterapia o de radioterapia, pues aumenta la intolerancia, lo cual impide la administración de las dosis usuales o su aumento en magnitud o frecuencia. También el estado de desnutrición significa un mayor reconocido riesgo cuando se emprende un tratamiento quirúrgico. La implementación del tratamiento médico nutricional (evaluación, diagnóstico, intervención, vigilancia y seguimiento) es fundamental para el manejo multimodal que requieren estos pacientes. La selección del tipo de soporte nutricional debe ser personalizada y su principal objetivo también debe estar encaminado a mejorar la calidad de vida. En muchos casos la fortificación de los alimentos, especialmente con proteína de alto valor biológico, logra mejorar el estado nutricional. Cuando esta no es suficiente, o sea aquella que cubre menos del 60% del requisito proteico-calórico diario, se deben considerar alternativas, como la nutrición entérica por sonda o la parenteral suplementaria. Cuando el pronóstico de supervivencia es mayor de tres meses o cuando la localización del tumor o las alteraciones gastrointestinales impiden el empleo de la vía entérica, se sugiere la nutrición parenteral total, la cual, idealmente, debería ser ambulatoria. Hoy en día se considera que la nutrición y el ejercicio son factores fundamentales en el manejo de estos pacientes, y que no hay bases para considerar que alimentar al individuo es alimentar el tumor.

Objective: To determine the frequency and magnitude of neonatal hypophosphataemia (32 weeks with weight 32 semanas con peso

Introduction: Introduction: parenteral nutrition (PN) is commonly used as a nutritional support option. It may cause complications, partly due to a central venous access. Chylothorax is an accumulation of lymphatic fluid in the pleural space. Case report: a 57-year-old man was admitted for cholecystectomy. A complicated postoperative period required PN. Cardiorespiratory symptoms started while receiving PN, and a bilateral pleural and pericardial effusion was identified. It was initially interpreted as chylothorax due to its milky appearance and high triglyceride content. A CT scan confirmed a malposition of the CVC with PN leakage at the level of the innominate venous trunk. It was surgically repaired. Discussion: PN leakage is an unusual complication of PN. It should be included in the differential diagnosis of pleural effusion. [ABSTRACT FROM AUTHOR]