We present a prospective case series of 3 premature neonates with abnormal vitamin A, vitamin E, and selenium levels after being managed on prolonged parenteral nutrition (PN). All 3 patients experienced gastrointestinal complications including spontaneous intestinal perforation, necrotizing enterocolitis, and/or short bowel syndrome. Additionally, all 3 patients developed PN-associated liver disease, which required the use of a mixed lipid emulsion and a fish oil–based lipid emulsion for a short period of time. We evaluated the micronutrient levels of these patients after they had been receiving PN for 1 to 2 months. After the early identification of these abnormalities, we promptly attempted to correct the levels through supplementation and restriction, as appropriate. One barrier we experienced in the treatment of these patients was the conflicting guidance of daily micronutrient dosing in PN and when to evaluate levels in premature infants from the European and American pediatric nutrition organizations, the European Society for Paediatric Gastroenterology Hepatology and Nutrition and the American Society for Parenteral and Enteral Nutrition. Additionally, after we assessed micronutrient levels, we experienced a lack of guidance on how to adjust dosing and when to monitor subsequent levels.

The utility of the mucolytic dornase alfa in bronchiolitis has not been established, yet it is commonly used. The objective of this study was to compare outcomes of dornase alfa to standard of care treatments for bronchiolitis in mechanically ventilated pediatric patients. This was a retrospective, cohort study conducted at a single-center children's hospital evaluating pediatric patients with a diagnosis of bronchiolitis that required hospitalization and mechanical ventilation from January 1, 2010 to December 31, 2019. The primary outcome evaluated was length of time on mechanical ventilation. Secondary outcomes were pediatric intensive care unit (PICU) length of stay and length of hospitalization. Multiple linear regressions were used to assess the association of age, oxygen saturation index (OSI), positive endexpiratory pressure values, blood pH levels, respiratory syncytial virus status, and the use of other mucolytics, bronchodilator therapy, or chest physiotherapy treatment. Seventy-two patients were included in the study with 41 patients who were treated with dornase alfa. The patients who received dornase alfa had an average of 33.04 h longer on mechanical ventilation than those who did not (p = 0.0487). On average, they also had longer PICU and hospital stays by 2.05 days (p = 0.053) and 2.74 days (p = 0.02), respectively. In this study, pediatric patients who received dornase alfa had higher baseline OSI measurements than those who received standard of care, which impacted the primary outcome of time on mechanical ventilation and secondary outcome of time in the PICU. However, OSI, or any other variable, did not significantly affect results for the other secondary outcome of length of hospitalization. This study supports existing evidence that dornase alfa is not beneficial for bronchiolitis in pediatric patients, even in severe cases. Further prospective, randomized controlled trials are necessary to validate these outcomes.