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Necrotizing enterocolitis (NEC) represents a severe condition in infants, with perforation being a particularly critical pathological manifestation. However, there is an absence of guidelines regarding the refeeding of infants recovering from perforation subsequent to NEC. This study aimed to determine the optimal refeeding method for term infants recovering from perforation after NEC. The study encompassed three aspects: the timing of enteral nutrition (EN) resumption, the progression of EN, and the method of EN resumption. Ninety full-term neonates who developed perforation following NEC and underwent surgical intervention were included. These samples were divided into early enteral nutrition (EEN, < 7 days) and late enteral nutrition (LEN, ≥ 7 days) groups based on the timing of EN resumption; faster increase (FI, ≥ 20 ml/kg/d) and slower increase (SI, < 20 ml/kg/d) groups based on the progression of EN; intact protein formula (IPF), special medical formula (SMF, including EHF and AABF), and mixed feeding (MF) groups based on the method of EN resumption. EEN infants had a lower incidence of intestinal stenosis and reoperation (43.5% vs. 77.6%, p = 0.002; 60.9% vs. 82.1%, p = 0.038), and a shorter duration of hospital stay after surgery and parenteral nutrition (PN) than LEN infants (14 days vs. 20 days, p < 0.001; 11 days vs. 17 days, p < 0.001). Faster increasing feed volumes was associated with shorter duration of hospital stay and parenteral nutrition (15 days vs. 20 days, p < 0.001; 14 days vs. 17 days, p < 0.001), but a slower rate of weight gain (0.020 kg vs. 0.129 kg, p < 0.01). The time to repeat NPO in SMF group is shorter than IPF an MF groups (3 days vs. 4 days and 9 days, p = 0.025). Our study demonstrates the beneficial effects of early enteral feeding and fast advancement of feed volumes in term infants with NEC and perforation after surgery, specifically in reducing short-term complications and the duration of hospital stay following surgery and PN. Additionally, this study suggests that IPF and MF significantly contribute to stimulate intestinal adoption recovery. [ABSTRACT FROM AUTHOR]

Introduction: Patients with short bowel syndrome (SBS) on conventional oral diets often face nutritional deficiencies and dehydration, a challenge further compounded during pregnancy. This case report describes the use of a glucagon-like peptide-2 (GLP-2) analog in the nutritional management of an SBS patient dependent on total parenteral nutrition (TPN). Case Presentation: A 29-year-old woman with a significant medical history of Crohn’s disease leading to SBS was traditionally dependent on TPN for sustenance. During her pregnancy, she was successfully managed with a GLP-2 analog, which enabled her to wean off TPN. This successful management underscores the therapeutic potential of GLP-2 analogs in effectively altering the nutritional landscape for SBS patients, including during the physiologically demanding period of pregnancy. Conclusion: GLP-2 analogs helped with the nutritional management of patients with SBS during pregnancy and helped them wean off TPN. There is a need for further research and exploration into GLP-2 analogs as viable alternatives to conventional treatments such as TPN in the care and management of SBS patients during pregnancy. Introduction: Patients with short bowel syndrome (SBS) on conventional oral diets often face nutritional deficiencies and dehydration, a challenge further compounded during pregnancy. This case report describes the use of a glucagon-like peptide-2 (GLP-2) analog in the nutritional management of an SBS patient dependent on total parenteral nutrition (TPN). Case Presentation: A 29-year-old woman with a significant medical history of Crohn’s disease leading to SBS was traditionally dependent on TPN for sustenance. During her pregnancy, she was successfully managed with a GLP-2 analog, which enabled her to wean off TPN. This successful management underscores the therapeutic potential of GLP-2 analogs in effectively altering the nutritional landscape for SBS patients, including during the physiologically demanding period of pregnancy. Conclusion: GLP-2 analogs helped with the nutritional management of patients with SBS during pregnancy and helped them wean off TPN. There is a need for further research and exploration into GLP-2 analogs as viable alternatives to conventional treatments such as TPN in the care and management of SBS patients during pregnancy. Introduction: Patients with short bowel syndrome (SBS) on conventional oral diets often face nutritional deficiencies and dehydration, a challenge further compounded during pregnancy. This case report describes the use of a glucagon-like peptide-2 (GLP-2) analog in the nutritional management of an SBS patient dependent on total parenteral nutrition (TPN). Case Presentation: A 29-year-old woman with a significant medical history of Crohn’s disease leading to SBS was traditionally dependent on TPN for sustenance. During her pregnancy, she was successfully managed with a GLP-2 analog, which enabled her to wean off TPN. This successful management underscores the therapeutic potential of GLP-2 analogs in effectively altering the nutritional landscape for SBS patients, including during the physiologically demanding period of pregnancy. Conclusion: GLP-2 analogs helped with the nutritional management of patients with SBS during pregnancy and helped them wean off TPN. There is a need for further research and exploration into GLP-2 analogs as viable alternatives to conventional treatments such as TPN in the care and management of SBS patients during pregnancy. [ABSTRACT FROM AUTHOR]

Background/Objectives: Uncertainty persists about the best methods and timing for providing medical nutrition therapy (MNT) in the acute phase of critical illness. We conducted an overview of systematic reviews to examine and appraise the findings of the current systematic reviews and performed an updated meta-analysis incorporating newly published randomized controlled trials (RCTs) to investigate whether enteral nutrition (EN) is superior to the combination of EN and parenteral nutrition (PN) in patients admitted to the intensive care unit (ICU). Methods: We systematically searched three databases to retrieve systematic reviews and RCTs. Two independent reviewers performed the screening, data extraction, and quality assessment processes. The random effects model was utilized to synthesize the data regarding primary and secondary outcomes. Results: There was no difference between the two interventions regarding the efficacy and safety endpoints, apart from the bloodstream infections, which were found to be increased in the group that received the combination of EN+PN (RR = 1.27, 95%CI = 1.03 to 1.56, PI = 0.91 to 1.77, I2 = 0%). Conclusions: According to the present overview of systematic reviews and meta-analyses, there was no observed benefit on mortality, length of ICU stay or hospitalization, and duration of mechanical ventilation in critically ill patients receiving a combination of EN and PN in comparison to those receiving sole enteral nutrition in the ICU. Furthermore, no difference was observed in the rates of respiratory infections as well as the appearance of adverse events, such as vomiting and diarrhea. On the other hand, there was an increase in bloodstream infection rates in patients who received EN+PN compared to EN alone. Due to the limited implications of the results in clinical practice, further research is needed. [ABSTRACT FROM AUTHOR]

• A tool to help decision-making for challenging adult's hyperglycemia management. • The document adapts recommendations from four well developed and updated guidelines. • 75 recommendations were endorsed with high concordance among the selected guideline. Over the past decade, diabetes mellitus (DM) has emerged as a growing epidemic, with a direct link to an increased risk of hospitalization and a strong effect of glycemic control on clinical outcomes. The aim of this document was to critically appraise and adapt existing clinical practice guidelines (CPGs) to provide specific recommendations for the management of hyperglycemia in hospitalized adults with and without previously known DM, in an attempt to provide a practical tool to reduce the risk of major in-hospital complications. The first step of the adaptation process was to identify unsolved clinical questions (PICOs) in hospitalized persons with hyperglycemia. This was followed by a critical appraisal of updated existing CPGs and the selection of recommendations that were most applicable to specific clinical situations. From the four updated high-quality evidence-based CPGs, 75 recommendations were selected, focusing on five common clinical scenarios in real-world practice: 1) glycemic targets; 2) persons with comorbidities; 3) elderly adults with low consciousness or dementia with irregular feeding or parenteral/enteral nutrition; 4) special hyperglycemic scenarios (stress hyperglycemia, corticosteroid treatment, fasting); and 5) glucose-lowering therapy at discharge. Of the 75 selected recommendations (59 strong and 16 weak), 37 were based on high-quality evidence, 8 on moderate-quality evidence, and 17 on low-quality evidence, while 13 were based on consensus (best practice statements). The recommendations apply to adults who are hospitalized or discharged from the hospital. Using a systematic methodology, this guideline provides an updated and ease-to-use tool for the management of hospitalized adults with hyperglycemia. [ABSTRACT FROM AUTHOR]

Background: Early adequate feeding reduces mortality in patients with acute severe stroke. Supplemental parenteral nutrition (SPN) may address enteral nutrition (EN) deficiency and mitigate the risk of nosocomial infection. The benefit of the EN plus early SPN strategy over the full EN strategy is unknown in acute severe stroke patients. Methods: We retrospectively enrolled 20 patients with acute severe stroke in the SPN group who received EN plus early SPN (more than 50% of the energy target within 72 h after admission). Forty control patients in the EN group who received full EN were matched by age, sex and lesion site. The time to new-onset pneumonia or nosocomial infections was analyzed by Student's t test and the Breslow generalized Wilcoxon test. Results: The baseline characteristics did not differ significantly between the SPN group and the EN group, except for higher serum leukocyte counts, neutrophil counts, and neutrophil-to-lymphocyte ratios in the SPN group (P < 0.05). Compared with that in the EN group, the time to new-onset pneumonia was significantly delayed in the SPN group (7.6 days vs. 5.2 days; mean difference, 2.5 days; 95% CI, 0.65 to 4.31; P = 0.009), as was the time to new-onset nosocomial infections (7.1 days vs. 4.8 days; mean difference, 2.3 days; 95% CI, 0.46 to 4.07; P = 0.015). Kaplan–Meier analysis revealed similar cumulative probabilities of new-onset pneumonia and new-onset nosocomial infections in the two groups (P > 0.05). The rates of digestive intolerance events were similar between the two groups (40% in the SPN group vs. 52.5% in the EN group, P = 0.361). Conclusions: In patients with acute severe stroke, the application of EN plus early SPN could delay the onset of pneumonia and nosocomial infections especially in the early phase. [ABSTRACT FROM AUTHOR]

Introduction: Intravenous non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used in healthcare settings, but their comparative safety and resource utilization impacts remain understudied. This study aimed to compare adverse drug reactions (ADRs) and healthcare resource utilization (HCRU) between patients receiving IV-ibuprofen versus IV/IM ketorolac. Methods: A retrospective, longitudinal analysis was conducted using an all-payer database, examining records from January 1, 2014, to June 3, 2023. The study included both adult (≥18 years) and pediatric (<18 years) populations who received one or more doses of either medication. Propensity score matching was applied to both populations, and HCRU was tracked for 29 days post-final dose. The adult cohort included 31,046 IV-ibuprofen and 124,184 ketorolac records, while the pediatric cohort had 5,579 patients per treatment arm. Results: Both adult and pediatric patients receiving IV-ibuprofen demonstrated lower ADR incidence and reduced HCRU compared to those receiving ketorolac. Discussion: The findings suggest IV-ibuprofen may be a safer alternative to ketorolac, potentially improving patient care outcomes while reducing healthcare system burden. These results have implications for clinical practice and healthcare resource management. [ABSTRACT FROM AUTHOR]

Objective: To analyze the clinical characteristics and available treatment strategies for reoperation of neonatal high jejunal atresia, and recommend preventive measures to reduce the reoperation rate of high jejunal atresia. Methods: The clinical data of 16 children with high jejunal atresia who underwent reoperation in the Neonatal Surgery Department at Children's Hospital of Zhejiang University School of Medicine from January 2018 to January 2023 were retrospectively analyzed. Results: Among the 16 unplanned reoperations, 7 (43.6%) were performed for functional ileus, 3 (18.8%) for anastomotic stenosis, 3 (18.8%) for adhesive ileus, and 3 (18.8%) for postoperative proximal septum. Surgical procedures for reoperations include duodenoplasty, resection and re-anastomosis of the original anastomosis, resection of the duodenal septum and enterolysis. Among the 16 patients, 1 had short-bowel syndrome that required repeated hospital admission for parenteral nutrition treatment, and 1 patient died of recurrent pneumonia and heart failure after surgery. The other 14 patients recovered from reoperation and were discharged. The patients were followed up from 1 month to 5 years after surgery, and showed good growth. Conclusion: For children with high jejunal atresia, the operative procedure will vary according to each patient's circumstances. If postoperative functional obstruction occurs, a wider range of bowel cutting and re-anastomosis can be performed. During the first operation, the diaphragm at the proximal end of jejunal atresia should not be missed. [ABSTRACT FROM AUTHOR]

Background: We conducted a cross-sectional study to investigate whether children receiving long-term parenteral nutrition (LPN) are at risk of imbalances in selected trace elements. Methods: Serum levels of manganese, zinc, copper, selenium, and iodine were measured in 83 children on LPN and compared with 121 healthy controls. Children with signs of infection or elevated C-reactive protein levels were excluded. Elemental analysis was performed using inductively coupled plasma mass spectrometry (ICP-MS). Results: Manganese and copper levels were significantly lower in the study group compared with controls (p < 0.001) but remained within normal ranges. Iodine levels were also significantly lower in the study group (p < 0.05), though pediatric reference values are lacking. Zinc and selenium levels were significantly higher in the study group (p < 0.001), with median levels within normal ranges in both groups. Zinc, selenium, and iodine levels were higher in patients weighing ≤15 kg (p < 0.001, p < 0.001, p < 0.02). Conclusions: Serum concentrations of manganese, copper, and selenium in the study group remained within normal ranges, even though children weighing over 15 kg received doses below those recommended by scientific guidelines. An iodine intake below 1 μg/kg/day in patients weighing over 15 kg appears insufficient. Patients on LPN required a higher zinc intake than current recommendations. [ABSTRACT FROM AUTHOR]

A restricted oral diet plays a significant role in the nutritional management of patients with Short Bowel Syndrome (SBS). SBS patients often experience increased intestinal output, especially if they are classified as net "secretors" (typically having less than 100 cm of residual jejunum). This means they lose more water and sodium from their stoma than they take in by mouth. In this report, we present the case of an SBS patient with 80 cm of remaining bowel, no colon in continuity, and a high-output stoma. The patient was managed with a restrictive oral diet in combination with parenteral nutrition, pharmacological treatment, and high patient compliance. Following this regimen, the patient's condition improved significantly, leading to a reduction in stoma output and an improvement in nutritional status, including stabilization and weight gain. Upon discharge from the hospital, the patient was maintaining an oral diet with specific nutritional recommendations and receiving parenteral saline. This case report suggests that the combined use of restricted oral intake and parenteral nutrition (PN), alongside appropriate pharmacological management and high patient compliance, can effectively manage high-output stomas and improve nutritional status, even in cases where the small bowel is less than 100 cm in length. [ABSTRACT FROM AUTHOR]

Background: The effect of early parenteral nutrition (EPN) therapy on brain development in extremely premature infants at a gestational age (GA) of 22–25 weeks remains unknown. Objectives: This study investigated the effect of EPN therapy on GA 22 to 25 weeks of gestation using magnetic resonance imaging (MRI) global brain abnormality score (GBAS). Subjects: Forty-six preterm infants born before 26 weeks of gestation were divided into the GA 22–23 weeks (GA 22–23; n = 18) and GA 24–25 weeks (GA 24–25; n = 28) group. Methods: Each infant received ≥3.0 g/kg/day of amino acids from day 1 of life and ≥1.0 g/kg/day of lipid emulsion the next day. Weight change during hospitalization, GBAS at discharge, and developmental quotient (DQ) until three years old were compared between the groups. Results: GA 22–23 showed long-term postnatal weight loss, but weight at 41 weeks of postmenstrual age did not differ between the groups. The GBAS score was not significantly different, but the head circumference was smaller in GA 22–23 than in GA 24–25 until 2 years old. The DQ at 1–1.5 years old was lower in GA 22–23 than that of GA 24–25; however, there was no significant difference in DQ after 2 years old between the groups. Conclusions: The effect of nutritional support with EPN therapy in premature neonates born at <24 weeks of gestation may still be inadequate. GBAS is useful for assessing brain development in very preterm infants, and the importance of nutritional support during the first few weeks of life should continue to be explored. [ABSTRACT FROM AUTHOR]

The article explores the impact of breastfeeding and mother's breastmilk on the postoperative outcome of children with univentricular hearts. A retrospective study conducted at the University Hospital of Cologne found that breastmilk had a positive effect on the total length of hospital stay and sedative weaning during the first palliation. However, no significant benefit of breastmilk over formula was observed during the second palliation due to data limitations. The study suggests promoting breastfeeding and pumping of breastmilk for infants with univentricular hearts to improve postoperative outcomes. [Extracted from the article]

Background: Postoperative nutritional support in gastrointestinal cancer, including enteral nutrition (EN), parenteral nutrition (PN), and combined nutrition strategies, is vital for enhancing recovery and patient outcomes. Aims: We aimed to comprehensively evaluate the impact of postoperative EN, PN, and EN + PN in patients with gastrointestinal cancer. Methods: PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wan Fang, and VIP were searched from conception until January 2, 2024. Randomized controlled trials (RCTs) that compared different postoperative nutritional support (EN, PN, or EN + PN) in patients with gastrointestinal cancer were included. The Cochrane Risk of Bias Assessment tool was used to assess the quality of the RCTs. Fixed- and random-effects models were chosen according to the heterogeneity of variables for the synthesis of results. Continuous and categorical variables were analyzed using the weighted mean difference or relative risk (RR) and 95% confidence interval (CI). Results: In this meta-analysis, 11 RCTs were included. The PN + EN group exhibited significantly improved postoperative recovery, nutritional function, and immune indicators than the PN and EN groups (p < 0.05). Additionally, a higher incidence of postoperative complications such as abdominal distension (RR: 2.53; 95% CI: 1.17-5.49), nausea/vomiting (RR: 2.01; 95% CI: 1.09-3.71), and diarrhea (RR: 3.17; 95% CI: 1.41-7.10) was observed in the EN group than in the PN + EN group. Conclusion: Combining supplemental PN with enteral support improves energy intake and prognosis in gastrointestinal cancer, though limited studies restrict publication bias evaluation. [ABSTRACT FROM AUTHOR]

OBJECTIVE The investigation of nursing intervention in surgical patients with feeding weaknesses, submitted in peripheral parenteral nutrition (PPN). METHOD In the surgical department of a Greek general regional hospital, 111 patients with malnutrition were administered PPN intravenously, from February 2016 to July 2022. Of these, 65 were men and 46 were women, aged 41 to 94 years. Median age was 81 years. The duration of administration was between four and nine days, on average, six days. All patients were evaluated for body mass index (BMI), nutrition and clinical-laboratory criteria. PPN was administered through a peripheral vein via a 22 G catheter, in order to minimize venous wall irritation, by placing a TTS Pancoran 5 mg on it, a venipuncture for continuous vein dilatation. The parenteral solution was administered in 12–16 hours to give an eight hour “rest” of the vein. The purpose of these actions was to avoid the occurrence of osmotic thrombophlebitis and to maintain the vein catheter for 3–4 days. RESULTS Maddox’s grade 1st and 2nd osmotic phlebitis was reported in 32 patients (28.2%). Ten of them required peripheral nutrition to be converted to total parenteral nutrition by a central vein. In 98 patients a positive nitrogen balance was achieved, in nine patients a zero or slightly positive balance was observed, while in the remaining four patients a negative nitrogen balance was observed. CONCLUSIONS PPN is a perfectly safe way of administering nutrients to any surgical patient with malnutrition. Personalized nursing care prevents the occurrence of osmotic thrombophlebitis and achieves a positive prognosis in patients with PPN, reversing protein catabolism in the majority of cases. [ABSTRACT FROM AUTHOR]

Optimum nutrition leads to improved long-term neurodevelopmental outcomes in both preterm and term infants admitted to neonatal units (NNUs). This review delineates the phases of nutritional management from full parenteral nutrition, transitioning to enteral nutrition and on to full enteral feeds. It describes the essential components and provides practical tips in the management of nutrition in these infants. [ABSTRACT FROM AUTHOR]

Purpose: Cholestatic liver damage is frequently observed in extremely low-birth-weight infants (ELBWIs) followed by enterostomy. We retrospectively investigated the factors related to liver damage. Methods: ELBWIs who underwent enterostomy at our institution between January 2013 and December 2022 for gastrointestinal disease during the neonatal period were reviewed. Cases presenting with direct bilirubin > 2.0 mg/dl for > 1 month after enterostomy were designated as the prolonged cholestatic liver (p-CL) group and compared with cases without cholestatic liver damage, the (non-CL) group. Results: Thirty-nine patients (21 in the p-CL group and 18 in the non-CL group) were included. Survival was significantly lower in the p-CL group (52.4% [11/21] vs. 88.9% [16/18]; p = 0.020). Significant differences were found in the birth weight (587.8 g vs. 698.0 g, p = 0.040) and small intestinal length to the enterostomy (47.6 cm vs. 72.8 cm, p = 0.004). Patients in the non-CL group started enteral feeding and reached > 100 ml/kg/day earlier than those in the p-CL group. The length of time with parenteral nutrition was an independent risk factor for prolonged cholestasis (p = 0.02). Conclusion: The birth weight and stoma site level may affect time with PN and enteral feeding management, subsequently resulting in prolonged cholestatic liver damage in ELBWIs with high prematurity. [ABSTRACT FROM AUTHOR]

Background: To investigate the association between the timing of surgery from the day of NEC/SIP diagnosis and clinical outcomes in preterm infants. Study Design: A retrospective cohort study comparing clinical outcomes of infants undergoing laparotomy at three clinically relevant time points (less and more than 48 hours, 96 hours, and 168 hours [7 days]) following NEC/SIP diagnosis. Results: Infants with NEC/SIP (N = 97) receiving surgical invention >96 hours (34/97) had significantly lower gestational age (25.5 weeks [24.0; 26.9] vs 27.0 [25.0; 31.3]; p = 0.006), had lower birth weight (687 grams [600; 902] vs 940 [710; 1495]; p<0.001), had pneumoperitoneum less often on the abdominal x-ray (29.4% vs 57.1%, p = 0.017), had hemorrhagic (p = 0.04) and reparative (p = 0.003) lesions more often on intestinal histopathology, had PDA diagnosed more often (76.5% vs 50.8%, p = 0.02), required assisted ventilation more frequently (p = 0.013), and received parenteral nutrition for longer duration (112 days [76.5; 145] vs 65.0 [23.0; 112], p = 0.004) following surgery compared to the infants receiving surgical intervention before 96 hours (n = 63/97). In NEC-only sub-cohort, infants receiving laparotomy >48 hours (n = 29/75) had lower median gestational age, lower birth weight, less pneumoperitoneum, and higher acute kidney injury than those receiving surgery <48 hours. On logistic regression, the odds of death were not significantly different (OR 0.65 [0.28, 1.54], p = 0.32) for infants receiving laparotomy ≤48 hours following NEC/SIP compared to subjects undergoing surgery >48 hours. The odds of intestinal failure (>60 days of parenteral nutrition) were 4.5 times (CI 1.56, 14.3), p = 0.005) higher for those having surgery >96 hours from NEC/SIP diagnosis. Conclusion: There was no significant difference in death among infants receiving surgery within 48 hours following surgical NEC/SIP diagnosis compared to those receiving surgery at ≥ 48 hours of diagnosis. However, infants receiving surgery >96 hours were more likely to receive parenteral nutrition for longer time. A prospective study is needed to understand the continuous relationship between time to surgery and outcomes. [ABSTRACT FROM AUTHOR]

Simple Summary: In this study, we report on the safety and efficacy of initiating parenteral nutrition in the home setting (HomeStart PN) for patients with advanced peritoneal metastasis. This analysis provides data demonstrating that initiating TPN at home is as safe as initiating TPN in a hospital setting. In our retrospective review, we compared outcomes of patients who initiated TPN at home and those who was admitted to the hospital for acute conditions related to their cancer and started TPN who otherwise would have qualified for Home Start PN. These two groups had similar baseline weight and nutrition status prior to starting TPN, and following TPN nutritional support, achieved comparable weight gain/ weight stability and achievement of nutrition resuscitation goals and stability. The clinical course analysis revealed 35–45% of patients with advanced peritoneal metastasis experience hospital admission/readmissions due to the underlying cancer and therapies to treat disease for both home- and hospital-initiated TPN. Given the frequent hospitalizations for this patient population, a Home Start PN approach in this advanced oncologic patient population is advantageous and potentially reduces time spent in hospital and the associated costs. Background: Patients with peritoneal carcinomatosis often experience intestinal failure throughout the course of their disease, and total parenteral nutrition (TPN) can be used as a temporary solution or as a bridge to definitive cytoreductive surgery. Guidelines for TPN are well established for inpatients and in 2014, guidelines were established for the initiation of TPN for outpatients in a home setting. However, the safety and efficacy of home start TPN in advanced oncology patients remain unknown. This study aims to explore the safety and efficacy of starting TPN in the home setting for patients with peritoneal carcinomatosis. Method: Health records of advanced cancer patients receiving TPN during 2009–2020 were retrospectively reviewed. Data pertaining to diagnosis, demographics, nutritional parameters, and outcomes including hospital readmission rates were collected. Safety was measured based on catheter-related complications and hospital admissions related to electrolyte or fluid imbalance due to TPN. Efficacy was determined by weight gain/stability and pre-albumin and albumin levels. The Fisher's exact and Kruskal–Wallis tests were used to analyze the data. Results: Seventy TPN patients were identified, of which forty-two were home start (HS) and twenty-eight were in hospital (HP). The two groups were not significantly different in age, (HS: mean = 58.3 ± 13.9; HP: mean = 58.0 ± 13; p = 0.95), baseline body weight (p = 0.13), baseline albumin (p = 0.26) or pre-albumin (p = 0.48). At the end of treatment, the HS and HP groups had similar percentages of patients experiencing weight gain/stability (75% vs. 47%, p = 0.1), stable/increased pre-albumin (68% vs. 65%, p = 1), and stable/increased albumin levels (48% vs. 59%, p = 0.58). There was no difference in observed readmission between the groups (p = 0.79). At the end of treatment, 48% of the HS group and 36% of the HP group resumed an oral diet. Conclusions: This is the first study to present a comparison between home and hospital start TPN in advanced cancer patients, demonstrating that the initiation of outpatient TPN in the home setting is as safe and efficacious as TPN initiated in the hospital. [ABSTRACT FROM AUTHOR]

Candida species is the most common cause of invasive fungal infection in the critically ill population admitted to the intensive care unit (ICU). Numerous risk factors for developing invasive candidiasis (IC) have been identified, and some, like the breach of protective barriers, abound within the ICU. Given that IC carries a significant mortality, morbidity, and healthcare cost burden, early diagnosis and treatment have become an essential topic of discussion. Several expert panels and task forces have been established to provide clear guidance on the management of IC. Unfortunately, IC remains a diagnostic and therapeutic challenge attributable to the changing fungal ecology of Candida species and the emergence of multidrug-resistant strains. This narrative review will focus on the following: (1) the incidence, outcomes, and changing epidemiology of IC globally; (2) the risk factors for developing IC; (3) IC risk stratification tools and their appropriate use; (4) diagnosis of IC; and (5) therapeutic agents and regimens. Plain Language Summary Title: A review of severe Candida infection in patients admitted to the Intensive Care Unit Plain Language Summary: Candida infections are the most common type of serious fungal infections that affect patients in Intensive Care Units (ICUs). There are many known risk factors for developing these infections, especially in ICU patients who often experience situations like damage to protective barriers in the body. Since these infections can lead to death, serious illness, and higher healthcare costs, it’s important to diagnose and treat them as early as possible. However, diagnosing and treating invasive Candida infections is still very difficult. This is because the types of Candida fungi are changing, and some strains are becoming resistant to multiple antifungal medications. The goal of this review is to help improve understanding and management of these serious infections in ICU settings. [ABSTRACT FROM AUTHOR]

The objective of this study was to investigate the efficacy and safety of intradialytic parenteral nutrition (IDPN) using ENEFLUID® (310 kcal, 550 mL) in mild-moderate malnutrition patients receiving maintenance hemodialysis. A total of 40 adult patients with a Nutritional Risk Index-Japanese Hemodialysis (NRI-JH) score of 5–10 were enrolled in this multicenter, randomized, open-label study. Patients in the intervention group received IDPN using ENEFLUID® via the dialysis circuit 3 times a week for 12 weeks; those in the control group did not. The primary endpoint was change in serum transthyretin (TTR). The secondary endpoints were changes in nutritional laboratory tests, nutritional parameters, food intake, plasma amino acids, and blood glucose. For both groups, mean age (72.1±11.4 years) and BMI (20.3±3.0), and median NRI-JH score [7.0 (interquartile range, 6–8)], did not differ. One patient withdrew before intervention, leaving 20 intervention and 19 control patients. Mean (95% confidence interval) change in serum TTR (mg/dL) at 12 weeks did not differ between groups: Intervention, 1.0 (-1.1–3.2); Control, -0.3 (-2.4–1.9); Intragroup difference, 1.3 (-1.7–4.3); P = 0.41. The values reflecting protein intake at 12 weeks compared to those on the study initiation day increased in the intervention group [the changes of blood urea nitrogen, 9.4 (2.6–16.2) mg/dL; P = 0.007, and normalized protein catabolic rate, 0.10 (0.02–0.18) g/kg/day; P = 0.02]. Mean food protein intake (g/kg/day) at 12 weeks increased in the intervention group and decreased in the control group, and differed between groups: Intervention, 0.12 (-0.03–0.28); Control, -0.18 (-0.43–0.08); Inter-group difference, 0.30 (0.00–0.60); P = 0.050. No adverse events occurred. In patients with mild to moderate malnutrition receiving ENEFLUID® for 12 weeks as IDPN, serum TTR was not improved, decreases in protein intake was mitigated, no adverse events occurred. Trial registration Name of the registry: Japan Registry of Clinical Trials Registration number: jRCTs031220296. [ABSTRACT FROM AUTHOR]

Background and Objectives: The objective of this study was to examine the effects of nutritional therapy in adult patients with severe burns. Methods and Study Design: Sixty adult patients with severe burns were enrolled. Data on nutritional intake through enteral nutrition (EN) or parenteral nutrition (PN) on days 7, 14, 21, and 28 post-injury were collected. Patients were divided into target and non-target groups according to whether their energy or protein intake reached the target. Age, length of ventilation, and total bilirubin (TBIL), albumin (ALB), prealbumin (pALB), and C-reactive protein (CRP) concentrations of patients were recorded. Results: The percentage of protein targets with protein delivery was lower than that of energy target with energy delivery. The ratio of PN protein to total protein was lower than that of PN energy to total energy on days 7, 14, 21, and 28 (p<0.001, p<0.001, p=0.001, and p=0.003, respectively). Compared to the non-target group on day 21, the target group was younger, had lower TBIL on day 7, higher ALB and pALB on day 21, and lower CRP on day 14 (p=0.025, p=0.021, p=0.028, p=0.029, and p=0.049, respectively). Multivariate logistic regression analysis showed that older age and longer ventilation were independent risk factors in patients who did not meet the nutritional target on day 21 (p=0.026 and p=0.043, respectively). Conclusions: The protein intake of adult patients with severe burns was low. Compared to the non-target group, the target group had better laboratory test results. Older age and longer ventilation were independent risk factors for patients not meeting the nutritional target. [ABSTRACT FROM AUTHOR]

The timeline of the 3 Pediatric International Nutrition Studies (PINS) coincided with the publication of 2 major guidelines for the timing of parenteral nutrition (PN) and recommended energy and protein delivery dose. The study's main objective was to describe changes in the nutrition delivery practice recorded in PINS1 and PINS2 (PINS1-2) (conducted in 2009 and 2011, preexposure epoch) vs PINS3 (conducted in 2018, postexposure epoch), in relation to the published practice guidelines. This study is a secondary analysis of data from a multicenter prospective cohort study. Data from 3650 participants, aged 1 month to 18 years, admitted to 100 unique hospitals that participated in 3 PINS was used for this study. The time in days from pediatric intensive care unit admission to the initiation of PN and enteral nutrition delivery were the primary outcomes. Prescribed energy and protein goals were the secondary outcomes. A frailty model with a random intercept per hospital with stratified baseline hazard function by region for the primary outcomes and a mixed-effects negative binomial regression with random intercept per hospital for the secondary outcomes. The proportion of patients receiving enteral nutrition (88.3% vs 80.6%; P <.001) was higher, and those receiving PN (20.6% vs 28.8%; P <.001) was lower in the PINS3 cohort compared with PINS1-2. In the PINS3 cohort, the odds of initiating PN during the first 10 days of pediatric intensive care unit admission were lower, compared with the PINS1-2 cohort (hazard ratio 0.8, 95% CI 0.67 to 0.95; P =.013); and prescribed energy goal was lower compared with the PINS1-2 cohort (incident rate ratio 0.918, 95% CI 0.874 to 0.965; P =.001). The likelihood of initiation of PN delivery significantly decreased during the first 10 days after admission in the PINS3 cohort compared with PINS1-2. Energy goal prescription in children receiving mechanical ventilation significantly decreased in the postguidelines epoch compared with the preguidelines epoch. [ABSTRACT FROM AUTHOR]

Purpose A leachable cyclic amide (caprolactam) can be found in normal saline (NS) and 5% dextrose in water (D5W) plastic bags widely used in clinical practice if they contain polyamide in a multilayer sheeting. This contamination and the parameters that could influence its content have never been studied in a public work such as a scientific publication. Methods Two independent laboratories validated a caprolactam dosing method and studied contamination levels in several containers. Results Caprolactam content in multilayer polypropylene/polyamide/polypropylene plastic bags ranged from a mean (SD) of 5.43 (0.21) mg/L (D5W 1,000 mL) to 22.83 (1.26) mg/L (NS 50 mL). NS and D5W can be intravenously administered with a total daily dose of 3 L, corresponding to a minimal daily dose of 16.3 mg of caprolactam. Conclusion The high levels of contamination we have reported and the possibility of administering caprolactam to high-risk patients (eg, neonates, the elderly) should make it imperative for pharmaceutical companies to communicate publicly on the safety of caprolactam. [ABSTRACT FROM AUTHOR]

Background: Within Diagnosis Related Groups, based on service capability, efficiency, and quality safety assessment, clinical pharmacists contribute to promoting rational drug utilisation in healthcare institutions. However, a deficiency of pharmacist involvement has been observed in the total parenteral nutrition support to patients following haematopoietic cell transplantation (HCT) within DRGs. Methods: This study involved 146 patients who underwent HCT at the Department of Haematology, the Second Affiliated Hospital of Dalian Medical University, spanning from January 2020 to December 2022. Results: Patients were allocated equally, with 73 in the control group and 73 in the pharmacist-involved group: baseline characteristics showed no statistics significance, including age, body mass index, nutrition risk screening-2002 score, liver and kidney function, etc. Albumin levels, prealbumin levels were significantly improved after a 7-day TPN support (34.92 ± 4.24 vs 36.25 ± 3.65, P = 0.044; 251.30 ± 95.72 vs 284.73 ± 83.15, P = 0.026). The body weight was increased after a 7-day support and before discharge (58.77 ± 12.47 vs 63.82 ± 11.70, P = 0.013; 57.61 ± 11.85 vs 64.92 ± 11.71, P < 0.001). The length of hospital stay, costs and the rate of re-admissions were significantly shortened (51.10 ± 1.42 vs 46.41 ± 1.86, P = 0.048; 360,162.67 ± 91,831.34 vs 324,070.16 ± 112,315.51, P = 0.035; 61.64% vs 43.84%, P = 0.046). Conclusions: Pharmacist-joint TPN support enhances the service efficiency score of medical units, ensuring the fulfilment of orders and rational medication. [ABSTRACT FROM AUTHOR]

Background: Intestinal complications (IC) represent serious adverse events after liver transplantation (LT), however limited research has been conducted in pediatric cohorts. This study aims to describe IC after pediatric LT and to identify associated factors. Methods: Retrospective review of 153 patients having undergone LT, aged 0–18 years, treated in the Swiss Pediatric Liver Center in Geneva. Pre‐, per‐ and postoperative data were analyzed. IC were defined as pathologies or lesions directly associated with LT and attributable to the surgical procedure. Results: 16/153 (11%) patients developed IC: 10/16 mechanical obstructions, 4/16 intestinal perforations and 2/16 sub‐mesocolic abscesses. IC patients had a significantly lower Body Mass Index (BMI) (15.5 vs. 16.4, p = 0.019). Children with IC had significantly higher incidence of previous Kasai hepatoportoenterostomy associated with Ladd procedure (13% vs. 2%, p = 0.055), a history of intraoperative iatrogenic intestinal perforation(s) (31% vs. 5%, p = 0.003) and prolonged LT surgery duration (536 vs. 415 min, p = 0.007). Significantly more children with IC had received basiliximab (69% vs. 40%, p = 0.048). Patients with IC exhibited a higher incidence of post‐LT sub‐occlusions (p < 0.001) and an increased requirement for post‐LT parenteral nutrition (p = 0.027). Additionally, IC patients underwent significantly more reoperations (p < 0.001). Conclusion: One in 10 children post‐LT experiences IC, which are associated with significant morbidity. Pre‐LT nutritional status appears as an associated factor with IC, along with the necessity for adhesiolysis during LT, often leading to prolonged operative time. These associated factors should alert medical teams to promote early IC diagnosis in patients after LT. [ABSTRACT FROM AUTHOR]

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Background: Propofol and clevidipine (PC) are commonly used in the treatment of critically ill patients. While both medications are lipid emulsions, there is limited evidence concerning the incidence of hypertriglyceridemia (HTG) when these agents are used individually or concurrently. Objective: The objective of this study is to determine the effects of propofol, clevidipine, or concurrent PC on triglycerides (TGs) and related outcomes in critically ill adults. Methods: This was a retrospective cohort study conducted at an academic medical center. Patients were included if they received ≥24 hours of continuous propofol and/or clevidipine. Excluded were those without TG levels after ≥24 hours of infusion, baseline HTG, acute pancreatitis at admission, or receiving total parenteral nutrition with lipids. The primary outcome was incidence of HTG (defined as a TG level >400 mg/dL). Secondary outcomes included median and peak TG levels, hospital length of stay, intensive care unit length of stay, total lipid infused, time to peak TG level, peak lipase level, and development of pancreatitis. Results: In total, 190 patients were studied: 109 in the propofol group, 50 in the clevidipine group, and 31 in the PC group. Incidence of HTG was similar (19 [17.4%] vs 6 [12%] vs 4 [12.9%] patients, P = 0.6246). Peak and median TG levels were similar for propofol, clevidipine, and PC groups (216 mg/dL vs 189.5 mg/dL vs 205 mg/dL, P = 0.7069; 177 mg/dL vs 185.5 mg/dL vs 177 mg/dL, P = 0.6791). Conclusions and Relevance: There was a similar incidence of HTG in all groups. The results of this study suggest that the concurrent use of PC should not modify the frequency of TG level monitoring. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the effects of music intervention on the vital signs, weight gain, feeding, hospital stays, and cost of premature infants. Methods: 100 premature infants were randomized into two groups: the experimental group (given music for 30 min at a time, once every day until discharge) and the control group (without music). To compare the vital signs (RR, HR, SPO2) before, during, and after the music intervention, as well as the weight gain and feeding, follow up to 3 months after discharge. Results: Although respiratory rate (RR) showed a decreasing trend at certain time points during and after music exposure, these changes did not reach statistical significance after adjusting for multiple comparisons. The experimental group had a shorter time to regain birth weight (6.07 ± 2.47 days) compared to the control group (8.93 ± 4.31 days) and a shorter time of intravenous nutrition (8.6 ± 3.87 days vs. 11.66 ± 5.85 days). The experimental group also exhibited a lower fasting rate, a faster-sucking speed, a lower hospital stay (10.36 ± 4.36 days vs. 12.46 ± 5.73 days), lower cost, higher NBNA scores, and a lower re-hospitalization rate within 3 months after the first discharge. Conclusions: Early music intervention may contribute to the growth and development of preterm infants, improve feeding, reduce hospitalization duration and costs, and improve short-term prognosis, though effects on respiratory rate require further study with a larger sample size. [ABSTRACT FROM AUTHOR]

Abstract Background YouTube™ ( http://www.youtube.com ), the most widely used video website worldwide, is becoming a competitive platform for patients to gain health information and knowledge. This study aims to evaluate if YouTube™ is a useful source of information on home parenteral nutrition (HPN) for the public. Methods According to MeSH (Medical Subject Headings), the combinations of search terms related to parenteral (intravenous) and nutrition (feeding) were searched through YouTube™. In total 131 videos were evaluated, which were cataloged into three categories Education, News & Politics, and People & Blogs. Then a usefulness score was devised to assess video quality and to classify all videos into Slightly useful, Useful, and Very useful. Results The majority of videos included are under the Education category (n = 92, 70.23%). 6 videos were identified as Very useful, which were all under the Education category, 27 videos were identified as Useful, while the rest 98 videos were identified as Slightly useful. The number of likes, the number of views, views per day, and the duration of the Very useful videos are significantly higher than those of Slightly useful videos. Conclusion YouTube™ is a good source of information on home parenteral nutrition. In this study, videos categorized under Education were rated as the highest in usefulness. Due to the highly technical content of HPN, and the existence of a lot of low-credibility information on the internet, patients and professional staff are supposed to view other reliable videos in the field of healthcare information.

Background Aim Methods Results Conclusions Central line‐associated bloodstream infections (CLABSIs) are a potential complication for home parenteral nutrition (HPN) patients.We sought to analyse risk factors of developing HPN‐related CLABSI and assess CLABSI management in the Australian context.A retrospective observational cohort study was conducted on 34 adult patients receiving HPN via a central venous catheter (CVC) at a Queensland tertiary referral centre between 2016 and 2023. Patient charts were reviewed, and Kaplan–Meier analysis was employed to determine associations between characteristics and time to CLABSI in the first CVC using Peto‐Peto Prentice test.A total of 39 CLABSI episodes occurred in 19 patients. Patients with ≥1 CLABSI used regular opioids more than those without CLABSI (P = 0.016). Fourteen (41%, n = 14/34) patients developed a CLABSI in their first CVC. No patient or line characteristics were found to be predictive of CLABSI in their first CVC. The CLABSI rate was 1.02/1000 catheter days. Most CLABSIs were caused by Enterobacterales (22%, n = 12/55) and Candida sp. (22%, n = 12/55). Empiric antimicrobial therapy was adequate in only 25% (n = 7/28), and the median time to effective antibiotic therapy was 22.7 h (interquartile range 4.8–29.8). There were three successful CVC salvages (8%, n = 3/39).In this cohort of patients, regular opioid use was associated with increased risk of developing CLABSI. Based on our findings, an empiric antimicrobial regime of vancomycin, cefepime and caspofungin will provide adequate coverage for most HPN‐related CLABSIs in Australian IF units with a similar antimicrobial distribution and resistance pattern. [ABSTRACT FROM AUTHOR]

Background: This study was designed to evaluate the clinical benefit of double-lumen port catheters in patients receiving chemotherapy and parenteral nutrition concurrently or in those with vascular access failure. The advantages, complications, indications and duration of use of double port-a-cath were considered. Methods: Thirteen Brazilian patients received a double-lumen port catheter that was implanted under ultrasonographic and fluoroscopic guidance in the radiologic interventional suite. Results: All double-lumen port systems were successfully implanted in all patients without immediate complications. The port-a-cath was removed in two patients due to infection of the reservoir. Three deaths occurred due to underlying disease with no correlation to the port-a-cath. No temporal interference between the administration of chemotherapy and parenteral nutrition was observed. Conclusion: The double-door approach is a safe technique with low complication rates. Indications for use of the dual port are numerous and should be encouraged because of the considerable benefits for critically ill patients. [ABSTRACT FROM AUTHOR]

Background: The initiation time and formula for supplemental parenteral nutrition after surgery require optimization, especially in older patients undergoing major gastrointestinal surgery. This study aimed to assess the effect of early supplementation with a branched-chain amino acid (BCAA)-enriched formula (BAF) on short-term postoperative outcomes in older patients undergoing gastric surgery. Methods: This single-center, prospective, double-blinded, randomized clinical trial was conducted from March 10, 2020, to September 15, 2022. Patients aged 65–80 years with gastric cancer scheduled for curative resection were assessed for eligibility and randomly allocated to a high-proportion BCAA (HBCAA) (early supplementation with the BAF) or control (routine nutrition) group. The primary outcome was the standardized length of hospital stay (LOS). Results: A total of 150 patients were randomized. Thirteen patients were excluded due to the resection of other organs, presence of metastasis, or withdrawal of consent. Finally, we included 70 and 67 patients in the HBCAA and control groups, respectively (mean age: 70.5 ± 4.2 years; 96 men [70.1%]). The standardized LOS was significantly shorter in the treatment group than in the control group (median [interquartile range]: 8.0 [7.8, 8.0] vs. 8.5 [8.0, 9.0] days; mean difference, 0.38; 95% confidence interval [CI], 0.02–0.74 days; P <.001). Patients in the HBCAA group showed better gastrointestinal function with faster defecation (4.0 [3.6, 5.0] vs. 5.0 [4.0, 5.5] days; mean difference, 0.6 days; 95% CI, 0.26–0.94 days; P <.001) and semi-liquid diet initiation (8.0 [7.5, 8.0] vs. 8.0 [8.0, 8.8] days; mean difference, 0.36 days; 95% CI, 0.03–0.7 days; P <.001) and had lesser weight loss at postoperative day 5 than those in the control group did (3.5 [2.7, 6.5] vs. 4.9 [3.3, 7.6]%; mean difference, 1.23%; 95% CI, 0.27–2.19%; P =.011). Conclusions: In this randomized clinical trial, compared with routine nutrition, early supplementation with a BAF was associated with a shorter standardized LOS in older patients undergoing gastric surgery, suggesting that it may be a favorable strategy for patients with a poor tolerance to external nutrition who are undergoing major surgery. Trial registration: ClinicalTrials.gov; Identifier: ChiCTR2000029635. [ABSTRACT FROM AUTHOR]

Aim: The aim of this work was to investigate the incidence of enterocutaneous fistula (ECF), including both small bowel and colonic fistulas, in a defined population of 1.04 million during a 10‐year period and to describe aetiology, treatments, care consumption and outcome. Method: A comprehensive search algorithm including diagnostic and procedural codes, enterostomal therapy nurse notes and in‐hospital care for >60 days yielded 1970 search hits. After reviewing medical records, 187 patients with ECF were identified. Results: The annual incidence of ECF was 2.3 per 100 000, the incidence of ECF with intestinal failure type II was 0.9 per 100 000. Spontaneous closure of the fistula occurred in 16.0% of patients, while closure was seen in 97.3% of patients who underwent reconstructive surgery with recurrences in 6.7% and 8.3%, respectively. Cumulative ECF‐related in‐hospital care until closure or end of follow‐up was 4 (range 0–61) weeks. Eighty‐eight patients (47%) received home‐based healthcare including parenteral feeding and/or fistula wound care. The estimated overall mortality at 1, 3 and 5 years was 33.7%, 42.1% and 47.6% respectively. Mortality was mainly in patients without spontaneous closure or reconstructive surgery, and the risk of ECF‐related death was 30.2%. Conclusion: This study defines the population‐based incidence of ECF and reports a high overall mortality rate. Initial survivors were characterized by either spontaneous closure or eligibility for later reconstructive surgery, but with an eventual mortality rate of approximately 20%. ECF patients are high consumers of care: 55.1% needed ≥4 weeks in hospital and many received home‐based healthcare. [ABSTRACT FROM AUTHOR]

The growing incidence rate of cancer and its associated morbidity and mortality prompts the need to identify factors that could improve the quality of life (QoL) and survival of a patient with cancer. Cancer-associated malnutrition is a common complication that could start at the early stages of cancer and could further develop into advanced cachexia. Response to treatment, length of hospital stay, progression of infection, and other complications of cancer including chemotherapy adverse events could all be influenced by the progression of malnutrition. Nutritional interventions may vary from oral to enteral and parenteral therapy. Parenteral nutrition (PN) therapy may benefit patients at certain stages of cancer in whom contraindications or inefficacy of other modalities of nutritional support are present. This method may seem invasive, costly, and risky but at the same time may improve certain patients' QoL and chance of survival. In trained settings with proper facilities, this method of nutritional support can benefit patients; However, the indication for starting PN must be carefully supervised considering that other nutritional support methods may be equally efficient and at the same time easier to access and apply. [ABSTRACT FROM AUTHOR]

Introduction: Pediatric hematopoietic stem cell transplantation requires individualized nutritional therapy, and the use of early enteral nutrition is beneficial. This study aims to analyze the use of enteral nutrition therapy in pediatric patients undergoing autologous transplantation. Methods: This is a descriptive cohort study conducted with data from electronic medical records of pediatric patients undergoing autologous transplantation from 2017 to 2022, using enteral nutrition. Nutritional and clinical variables and biochemical markers were assessed at four time points: day 0, day +5, day +10 and day +15. Results: The sample consisted of 50 patients. On average, the nasoenteral tube was inserted on D-4 and the enteral feeding started on D-3. On D0, most patients used a normocaloric polymeric enteral formula, but on D + 10, when diarrhea (p = 0.017) and mucositis (p < 0.001) worsened, the most commonly used enteral formula was a hypocaloric pediatric semi-elemental formula. On D + 15, 35% of patients were receiving parenteral nutrition. At discharge, the patient's nutritional status had worsened compared to admission (p < 0.001). Discussion: Early use of enteral nutrition was observed, as adopted in other transplant centers and recommended in the literature. Protocols and guidelines are needed to support enteral nutritional therapy in pediatric transplantation. [ABSTRACT FROM AUTHOR]

Background and Aim: Patients with intestinal failure (IF) have abnormal intestinal anatomy, secretion, and dysmotility, which impairs intestinal homeostatic mechanisms and may lead to small intestinal bacterial overgrowth (SIBO). We conducted a systematic review and meta‐analysis to determine the prevalence of SIBO in patients with IF and to identify risk factors for SIBO. Methods: MEDLINE (PubMed) and Embase electronic databases were searched from inception to December 2023 for studies that reported the prevalence of SIBO in IF. The prevalence rates, odds ratio (OR), and 95% confidence intervals of SIBO in IF and the risk factors for SIBO in IF were calculated using random effects model. Results: Final dataset included nine studies reporting on 407 patients with IF. The prevalence of SIBO in IF was 57.5% (95% CI 44.6–69.4), with substantial heterogeneity in this analysis (I2 = 80.9, P = 0.0001). SIBO prevalence was sixfold higher in patients with IF who received parenteral nutrition (PN) compared with IF patients not on PN (OR = 6.0, 95% CI 3.0–11.9, P = 0.0001). Overall, the prevalence of SIBO in patients with IF using PPI/acid‐suppressing agents (72.0%, 95% CI 57.5–83.8) was numerically higher compared with IF patients not using these agents (47.6%, 95% CI 25.7–70.2). Conclusions: This systematic review and meta‐analysis suggests that there is an increased risk of SIBO in patients with IF and that PN, and potentially, the use of PPI/acid‐suppressing agents is risk factors for SIBO development in patients with IF. However, the quality of evidence is low and can be attributed to lack of case–control studies and clinical heterogeneity seen in the studies. [ABSTRACT FROM AUTHOR]

Preterm newborns with very low birth weight, defined as less than 1,500 g, often face challenges in meeting heightened nutritional demands due to physiological and metabolic stress and underdeveloped gastrointestinal systems. This study explored current guidelines and practices in nutritional management for very low birth weight infants, focusing on strategies, including providing human breast milk, donor human milk, parenteral nutrition, and combined nutrition. This retrospective cohort analysis, conducted in an institutional neonatal intensive care unit, reviewed data from medical records of preterm infants weighing 1,000-1,500 g admitted between March-November 2021. Nutritional management involved parenteral or combined nutrition. Data analysis included descriptive statistics, t-tests, Mann-Whitney tests, chi-square tests, and relative risk analysis. Of the 421 reviewed records, 106 met the inclusion criteria. A total of 31 infants received parenteral nutrition, while 75 received combined nutrition. Infants on combined nutrition demonstrated higher weight gain compared to infants on parenteral nutrition (P < 0.05). Relative risk analysis revealed varied associations between nutrition type and comorbidities, suggesting potential benefits and risks of each approach. Combined nutrition effectively met caloric and nutritional needs in very low birth weight infants without increasing morbidity and mortality. It positively impacted weight gain, indicating its viability as an alternative feeding approach. [ABSTRACT FROM AUTHOR]

Infantile refractory diarrhea presents after first few days of life leading to intestinal insufficiency. It is a diagnostic challenge due to varied etiologies like food senstive enteropathy, anatomical defects and dysmotility disorders, transport and enzymatic defects, pancreatic malabsorption - cystic fibrosis (CF), primary epithelial causes like microvillus inclusion disease (MVID), tufting enteropathy and heparan sulfate deficiency, immunodeficiencies, metabolic diseases and autoimmune enteropathy. It is refractory to treatment making the patient dependent on total parenteral nutrition. Immune dysregulation, polyendocrinopathy, enteropathy, X-linked syndrome (IPEX), is one of the rarest causes of intractable diarrhea. It occurs due to mutations in the FOXP3 gene, leading to dysfunction of T-regulatory cells and is characterised by diarrhoea, diabetes, and dermatitis. We aim to evaluate various causes of infantile refractory chronic diarrhea, and to present one such case of IPEX syndrome from this part of the world due to mutation not been reported in literature so far. [ABSTRACT FROM AUTHOR]

Background: Patients requiring extracorporeal membrane oxygenation (ECMO) are at increased risk of malnutrition due to high rates of protein catabolism, unclear metabolic needs, and safety risks with both parenteral and enteral nutrition (EN). Malnourishment is associated with increased morbidity and mortality, and improved EN and protein intake are associated with decreased 60-day mortality. A standardized practice for nutrition therapy in this population is unestablished. We aim to provide an update on current nutritional practices in pediatric and neonatal patients receiving ECMO support. Subjects and Methods: An online survey was distributed to ECMO medical directors in the US and Canada who had previously participated in survey-based research and those who requested participation during a pediatric ECMO presentation of this study. Each medical director was asked to forward the survey to their center's registered dietitians (RDs). Results: Of 100 institutions surveyed, 36 physicians and 19 RDs responded yielding a physician response rate of 36% and an RD response rate of 19%. Physicians report "always" providing nutrition parenterally 28% and enterally 17% of the time with 11% of institutions using a protocolized approach. Nutrition therapy aids reduction of morbidity and mortality; however, there is variability in its delivery. Conclusions: Compared to 2015, EN is reported to be less utilized (47% vs. 55%) with less protocol use (11% vs. 38%). These data support the need for the development of a stepwise nutritional support algorithm, which is congruent with the recommendations in the Extracorporeal Life Support Organization Nutrition Guidelines. [ABSTRACT FROM AUTHOR]

Background: Short bowel syndrome is considered a low prevalence disease. The scant information available about intestinal failure in Latin America was the driving force to expand this registry. Methods: A prospective, multicenter observational registry was created for patients with chronic intestinal failure short bowel at specialized centers in Latin America. Demographics, clinical characteristics, nutrition assessment, parenteral nutrition management, intestinal rehabilitation, related complications, clinical outcome, and survival were analyzed. Results: From May 2020 to July 2023, 167 patients (115 adults, 52 children) from 20 centers were enrolled. For the adults, the mean age was 37.2 ± 18 years, 48% were female, and the mean follow‐up was 22.6 ± 18.3 months. The main etiology was surgical resections (postsurgical complications: 37%; ischemia: 25%); the mean intestinal length was 73 ± 55 cm. The complications were as follows: infections: 0.4/1000 catheter‐days; thrombosis: 0.24/1000 catheter‐days; liver disease: 2.6%. The outcomes were as follows: 28% were rehabilitated, 15% died, 9.6% were lost to follow‐up, 0.9% underwent transplant, and 45.6% continued follow‐up. For the children, the mean age 48 ± 52 months, 48% were female, 52% were premature. The mean follow‐up was 17.2 ± 5.6 months; the mean remaining intestinal length was 38 ± 45 cm. The leading etiologies were atresia (25%), NEC (23%), and gastroschisis (21%). The complication were as follows: infections: 2/1000 catheter‐days; thrombosis: 2.22/1000 catheter‐day; 25% developed liver disease. The outcomes were as follows: 7.7% died, 3.8% were rehabilitated, and 88.5% continued follow‐up. Conclusion: The RESTORE amendment served as a registry and educational tool for the participating teams. The aspiration is to objectively show current aspects of intestinal failure in the region and carry them to international standards. Including all Latin American countries and etiologies of chronic intestinal failure besides short gut would serve to complete this registry. [ABSTRACT FROM AUTHOR]

Background: Parenteral nutrition (PN) without enteral nutrition (EN) leads to marked atrophy of gut‐associated lymphoid tissue (GALT), causing mucosal defense failure in both the gut and the extraintestinal mucosal system. We evaluated the effects of beta‐hydroxy‐beta‐methylbutyrate (HMB) on GALT and gut morphology in PN‐fed mice. Methods: Experiment 1: male Institute of Cancer Research mice were assigned to the Chow (n = 12), Control (standard PN: n = 10), or H600 and H2000 (PN containing 600 mg/kg or H2000 mg/kg body weight of Ca‐HMB: n = 12 and 10, respectively) groups. After 5 days of dietary manipulation, all mice were killed and the whole small intestine was harvested. GALT lymphocyte cell numbers and phenotypes of Peyer patch (PP), intraepithelial space, and lamina propria lymphocytes were evaluated. Experiment 2: 47 mice (Chow: n = 12; Control: n = 14; H600: n = 11; and H2000: n = 10) were fed for 5 days as in experiment 1. Proliferation and apoptosis of gut immune cells and mucosa, and protein expressions (mammalian target of rapamycin [mTOR], caspase‐3, and Bcl2) were evaluated in the small intestine. Results: Compared with the Controls, the Chow and HMB groups showed significantly higher PP cell numbers, prevented gut mucosal atrophy, inhibited apoptosis of gut cells, and increased their proliferation in association with increased mTOR activity and Bcl2 expression. Conclusion: HMB‐supplemented PN is a potentially novel method of preserving GALT mass and gut morphology in the absence of EN. [ABSTRACT FROM AUTHOR]

Background: Tigecycline is widely used to treat infections in intensive care units. Drugs often need to be delivered to critically ill patients feeding by parenteral nutrition (PN). Before two preparations are administered in the same infusion line, the safety of this combination should be established. The objective of this study was to determine the compatibility of tigecycline with selected multichamber bag PN (MCB‐PN). Methods: Tigecycline was diluted in 0.9% sodium chloride solution and 5% glucose solution to obtain two 0.5 mg/ml solutions. Then the solutions were combined with selected MCB‐PN in appropriate proportions. The samples were visually assessed, and pH, osmolality, turbidity, particle size, and zeta potential were measured. These measurements were made immediately after combining the solutions and after 4 h of storage at 23°C ± 1°C. Results: It was determined that the pH values of the mixtures after combining with tigecycline changed by ≤0.1 unit. An increase in zeta potential was recorded, excluding one combination of tigecycline with the mixture. For all samples tested, the particle size distribution was within the acceptable range immediately after combination and after 4 h of storage. The difference in osmolality did not exceed ±3%, whereas the zeta potential decreased for only one combination. The turbidity of none of the samples exceeded a critical value. Conclusion: The physical compatibility of the tigecycline with five MCB‐PN was proved. They can therefore be administered to patients in one infusion line using the Y‐site. [ABSTRACT FROM AUTHOR]

Background: Serial transverse enteroplasty is used to treat patients with chronic intestinal failure owing to short bowel syndrome. Current literature lacks discussion of its role for other etiologies of intestinal failure and its impact on adult patients' nutrition support needs and quality of life. Methods: We performed a case series on adults with parenteral nutrition (PN) dependence who underwent serial transverse enteroplasty at Emory University Hospital, a quaternary referral center between 2011 and 2022. Data collected included demographics, operative technique, and preoperative and postoperative PN requirements. A phone survey was administered to evaluate the impact of PN and the operation on quality of life. Results: Ten patients underwent the procedure of interest during the study period. Indications included short bowel syndrome following multiple abdominal operations or intra‐abdominal catastrophe and chronic partial bowel obstruction with dysmotility. Bowel length increased by a median of 83%. All patients were discharged home after a median hospital stay of 21 days. At 1‐year follow‐up, survival was 100%, two (20%) patients fully weaned from PN, three others (30%) reduced PN frequency, and six (60%) decreased their daily parenteral energy requirement. Two additional patients fully weaned from PN by 18 months postoperatively. Conclusion: This represents one of the largest case series of serial transverse enteroplasty in adults. Small intestinal length nearly doubled, and PN dependence was reduced in most patients. Given the low morbidity and good quality of life observed in this series, this procedure should be more widely investigated for patients with chronic intestinal failure. [ABSTRACT FROM AUTHOR]

Purpose: The STAT trial is a multicenter randomized controlled trial in 12 centers worldwide aiming to determine the most effective operation for neonates with necrotizing enterocolitis (NEC) requiring intestinal resection: stoma formation (ST) or primary anastomosis (PA). Methods: Infants having a primary laparotomy for NEC were randomized intraoperatively to PA or ST if the operating surgeon thought that both were viable treatment options for that patient. The primary outcome (duration of parenteral nutrition [PN]) was evaluated by Cox regression. Results: Eighty patients were recruited from 2010 to 2019. Infants undergoing anastomosis finished PN significantly earlier than patients undergoing stoma (hazard ratio PA vs. ST 2.38, 95% CI 1.36–4.12 p = 0.004). There was no difference in mortality between the two groups (PA 4/35 vs. ST 8/38 p = 0.35) or in the rate of complications requiring further unplanned operations (p = n.s.). Multiple intestinal complications were more frequent in the stoma group compared to the anastomosis group (ST 12/26 vs. PA 5/31, p = 0.02, Fisher's Exact test). Conclusion: At laparotomy for NEC, when there is no disease distal to resected intestine, primary anastomosis should be performed as it enhances the recovery from NEC, reduces the risk of multiple intestinal complications and does not increase adverse outcomes. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to investigate the effectiveness of dipeptidyl peptidase IV inhibitors (DPP4-I) against liver damage, especially fibrosis and lipid accumulation, in a rat intestinal failure-associated liver disease (IFALD) model. Methods: SD rats were divided into two groups: the Control (n = 7; normal saline + IFALD model) and DPP4-I (n = 7; DPP4-I + IFALD model; short bowel syndrome (SBS) + total parenteral nutrition) groups. All rats were euthanized 21 days postoperatively to obtain tissue samples. Liver fibrosis was evaluated by Sirius Red and α-SMA staining. Liver damage was assessed using the steatosis, activity, and fibrosis score. Inflammation cytokines were examined by ELISA. Results: The survival rate was comparatively different, being 87.5% in the DPP4-I group and 70.0% in the Control group. Two rats of the Control group showed progressive liver fibrosis in the periportal area with fibrous streaks. Further, the mean area percentage of α-SMA immune-positive cells was significantly lower in the DPP4-I group than in the Control group. TGF-β levels were significantly lower in the DPP4-I group than in the Control group. Conclusion: DPP4-I administration reduced liver fibrosis in IFALD, possibly by inhibiting DPP4-I-induced adipogenesis and suppressing TGF-β. These results may contribute to elucidating the mechanism of IFALD. [ABSTRACT FROM AUTHOR]

Background/Objectives: The aetiology of inflammatory bowel disease (IBD), particularly if occurring early in childhood, is a diverse and patient-focused treatment that is required when standard therapy is ineffective. Materials and Methods: A clinical case report is presented of a child with very early-onset IBD (VEOIBD) and evidence of high serum IL-18 responding to anti-IL-18 immunotherapy. Detailed cytokine profiling was performed by ELISA and multiplex assay flow cytometry. Results: A four-year-old girl with recalcitrant VEOIBD from six weeks old due to an IL-18opathy, characterised by high blood IL-18 concentration, responded to therapy with a novel neutralising anti-IL-18 antibody (GSK1070806). After two years of hospitalisation, the child's systemic inflammation and extensive upper and lower gastrointestinal mucosal ulceration remitted with this cytokine inhibitor, allowing the discontinuation of total parenteral nutrition and the resumption of normal oral intake and daily activities. After 18 months on regular GSK1070806, the patient remains in disease remission. Conclusions: VEOIBD can be associated with evidence of an underlying IL18opathy and responds to anti-IL-18 antibody therapy. IL-18 should be measured in patients with IBD unresponsive to conventional treatments, and, if elevated, anti-IL-18 antibody therapy should be considered as a potential therapy. [ABSTRACT FROM AUTHOR]

Rationale: The epidemiology and clinical impact of COVID‐19‐associated candidemia (CAC) remained uncertain, leaving gaps in understanding its prevalence, risk factors and outcomes. Methods: A systematic review and meta‐analysis were conducted by searching PubMed, Embase and Scopus for reports of CAC prevalence, risk factors and clinical outcomes up to June 18, 2024. The generalised linear mixed model was employed to determine the prevalence and 95% confidence intervals (CIs). The risk factors and clinical outcomes were compared between patients with and without CAC using the inverse variance method. Results: From 81 studies encompassing 29 countries and involving 351,268 patients, the global prevalence of CAC was 4.33% (95% Cl, 3.16%–5.90%) in intensive care unit (ICU) patients. In ICUs, the pooled prevalence of CAC in high‐income countries was significantly higher than that of lower‐middle‐income countries (5.99% [95% Cl, 4.24%–8.40%] vs. 2.23% [95% Cl, 1.06%–4.61%], p = 0.02). Resistant Candida species, including C. auris, C. glabrata (Nakaseomyces glabratus) and C. krusei (Pichia kudriavzveii), constituted 2% of ICU cases. The mortality rate for CAC was 68.40% (95% Cl, 61.86%–74.28%) among ICU patients. Several risk factors were associated with CAC, including antibiotic use, central venous catheter placement, dialysis, mechanical ventilation, tocilizumab, extracorporeal membrane oxygenation and total parenteral nutrition. Notably, the pooled odds ratio of tocilizumab was 2.59 (95% CI, 1.44–4.65). Conclusions: The prevalence of CAC is substantial in the ICU setting, particularly in high‐income countries. Several risk factors associated with CAC were identified, including several that are modifiable, offering the opportunity to mitigate the risk of CAC. [ABSTRACT FROM AUTHOR]

Candidemia is emerging as a significant concern in children, particularly among those with underlying conditions like malignancies or prematurity. The interpretation of epidemiological data on candidemias and their antifungal resistance plays a vital role in aiding diagnosis and guiding clinicians in treatment decisions. From 2014 to 2021, a retrospective analysis was conducted in İstanbul, Turkey; comparing Candida albicans and non-albicans (NAC) spp in both surviving and deceased groups. Furthermore, an examination of Candida parapsilosis and other species was performed, assessing various clinical and laboratory parameters. Among 93 patients, with a median age of 17 months, C. parapsilosis emerged as the predominant isolated species (44%), followed by C. albicans (34.4%). Resistance to fluconazole, voricanozole, and echinocandins, along with a history of broad-spectrum antibiotic use were found to be significantly higher in the non-albicans Candida group compared to C. albicans group. In the C. parapsilosis group, statistically lower age was identified in comparison to the other groups (P  = .018). In addition, high fluconazole and voriconazole resistance was detected in Candida parapsilosis spp. Our study highlights a notable prevalence of C. parapsilosis, particularly in younger children, which is different from similar studies in childhood. This trend may be attributed to the common use of total parenteral nutrition and central venous catheter in gastrointestinal disorders and metabolic diseases. Furthermore, as anticipated, high azole resistance is noted in C. parapsilosis and other non-albicans Candida species. Interestingly, resistance to both amphotericin B and echinocandins within this group has been notably high. It is crucial to emphasize the considerable antifungal resistance seen in C. parapsilosis isolates. [ABSTRACT FROM AUTHOR]

Purpose: In critically ill adults, withholding parenteral nutrition until 1 week after intensive care admission (Late-PN) facilitated recovery as compared with early supplementation of insufficient enteral nutrition with parenteral nutrition (Early-PN). However, the impact on long-term mortality and functional outcome, in relation to the estimated nutritional risk, remains unclear. Methods: In this prospective follow-up study of the multicenter EPaNIC randomized controlled trial, we investigated the impact of Late-PN on 2-year mortality (N = 4640) and physical functioning, assessed by the 36-Item Short Form Health Survey (SF-36; in 3292 survivors, responding 819 [738–1058] days post-randomization). To account for missing data, we repeated the analyses in two imputed models. To identify potential heterogeneity of treatment effects, we investigated the impact of Late-PN in different nutritional risk subgroups as defined by Nutritional Risk Screening-2002-score, modified NUTrition Risk in the Critically Ill-score, and age (above/below 70 years), and we evaluated whether there was statistically significant interaction between classification to a nutritional risk subgroup and the effect of the randomized intervention. Secondary outcomes were SF-36-derived physical and mental component scores (PCS & MCS). Results: Two-year mortality (20.5% in Late-PN, 19.8% in Early-PN; P = 0.54) and physical functioning (70 [40–90] in both study-arms; P = 0.99) were similar in both groups, also after imputation of missing physical functioning data. Likewise, Late-PN had no impact on 2-year mortality and physical functioning in any nutritional risk subgroup. PCS and MCS were similar in both groups. Conclusion: Late-PN did not alter 2-year survival and physical functioning in adult critically ill patients, independent of anticipated nutritional risk. [ABSTRACT FROM AUTHOR]

Background/Objectives: Parenteral nutrition (PN) is used when enteral feeding is not possible. It is a complex mixture of nutrients that must meet a patient's needs but can face stability issues, such as lipid emulsion destabilisation and precipitate formation. Stability studies are complex, and the methodologies used are very varied in the literature. In addition, many studies are outdated and use outdated components. This study conducts a stability analysis of PN solutions using optical microscopy. Methods: Samples were prepared according to clinical practice standards and previous studies. We used a counting chamber for optical microscopic observations and different storage conditions (RT, 4 °C 1–14 days). Results: Precipitates larger than 5 µm were found in 8 out of 14 samples after 14 days of storage at room temperature, and none were observed in refrigerated samples. More lipid globules larger than 5 µm were detected in samples stored at room temperature than in those stored in a refrigerator after 14 days. Additionally, the number of large globules generally increased from day 1 to day 14 in most samples. Conclusions: The observed precipitates were probably calcium oxalate crystals, the formation of which is possible in PN but is not expected under the usual storage conditions in a hospital environment. Prolonged storage time and storage at room temperature increases the formation of these precipitates. These findings highlight the importance of using filters during both the preparation and administration of PN to prevent large particles from reaching patients. [ABSTRACT FROM AUTHOR]