Dose of intravenous lipids and rate of bacterial clearance in preterm infants with blood stream infections

Shouman, Basma; Abdel‐Hady, Hesham; Badr, Rawia; Hammad, Enas; Salama, Mona F.

doi:10.1007/s00431-011-1619-y

Cited by 10 publications

(10 citation statements)

References 34 publications

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“…On the other hand, it may also be true that the longer hospital stay was caused by an interference of TPN with rate of bacterial clearance. Shouman et al demonstrated recently that reducing the amount of lipids in TPN was associated with a more rapid sterilization of blood cultures in preterm neonates [21]. However, the design of our study does not allow us to determine any causal relationships.…”

Section: Discussionmentioning

confidence: 68%

Nutritional Status of Children Hospitalized for Parapneumonic Effusion

et al. 2014

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Background & AimsAmong children hospitalized for pneumonia, those with parapneumonic effusion (PPE) are at particular risk for nutritional deterioration. This study aimed to 1) investigate the evolution of the nutritional status during hospitalization and at outpatient follow-up; 2) determine clinical risk factors for weight loss during hospitalization; 3) describe the nutritional interventions for these children.MethodsRetrospective chart review (January ‘07 - September ‘12) of 56 children with pneumonia, complicated by PPE in two Belgian hospitals for data on body weight and height at admission (t0) and discharge (t1), and two weeks (t2) and one month (t3) after discharge. Length of hospitalization (LoS), length of stay in paediatric intensive care (LoSPICU) and maximal in-hospital weight loss (tmax) were calculated and nutritional interventions were recorded.ResultsThe median (range) age was 3.5 (1.0–14.8) years. Weight or height was lacking in five (8.9%) children at t0 and in 28 (50%) at t1; 21.4% was weighed only once during hospitalization. At tmax, respectively 17/44 and 5/44 children lost ≥5% and ≥10% of their weight. Median (range) LoS and LoSPICU were 18.0 (10–41) and 4.0 (0–23) days. One-fourth received a nutritional intervention. Weight for height at admission (WFH(t0)) significantly predicted maximal weight loss (β (95% CI) = −0.34 (−2.0–−0.1); p = 0.03). At t2 and t3, 13/32 and 5/22 of the children with available follow-up data did not reach WFH(t0), whilst in 4/35 and 5/26 body weight remained ≥5% under the weight(t0).ConclusionsOne-third of children with pneumonia complicated by PPE and monitored for weight and height, lost ≥5% of their body weight during hospitalization. One-fourth did not reach initial WFH one month after discharge. Those with a higher WFH at admission were at higher risk of weight loss. More attention for monitoring of weight loss and the nutritional policy during and after hospitalization is warranted.

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Section: Discussionmentioning

confidence: 68%

Nutritional Status of Children Hospitalized for Parapneumonic Effusion

et al. 2014

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“…17 Our study reported herein is the first investigation to report an association between increased frequency of lipid emulsion infusion and development of CRBSI. Shouman et al 18 showed bacterial clearance was decreased in animals as well as in preterm infants with bacteremia who received IV lipid emulsion, 19-21 as the reticuloendothelial system may be impaired, [22][23][24] although actual infection risk may not be increased, at least among inpatients during short-term hospitalizations, 22,[25][26][27] with the exception of a study in trauma patients in whom the use of lipid emulsion within the first 10 days of PN was associated with increased infection rate, ICU stay, and total length of hospitalization. 28 Based on the results of our retrospective study, it will be important moving forward to determine in a prospective manner whether the use of soybean oil-based lipid emulsions as a full caloric source are a significant risk for the development of CRSBI and, if so, whether their use solely as a source of essential fatty acids should be considered outside of special circumstances, such as the fluid-overloaded patient, the patient with high serum glucose concentration, and so on.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for the Development of Catheter‐Related Bloodstream Infections in Patients Receiving Home Parenteral Nutrition

Buchman

Opilla²,

Kwasny

et al. 2013

J Parenter Enteral Nutr

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“…The experimental dose of MOFE, involving a restricted dose of 1 g/kg/d, was associated with significantly rapid clearance of bacteremia and reduction in antibiotic use duration in comparison with a standard dose with increases up to 3.5 g/kg/d. This study proposed that the protective effect of this MOFE is perhaps restricted to lower doses of fat load 41 …”

Section: Ivfes and Sepsismentioning

confidence: 96%

Emerging Clinical Benefits of New‐Generation Fat Emulsions in Preterm Neonates

2017

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Soybean oil-based intravenous fat emulsions (IVFEs) have been the predominant parenteral nutrition IVFE used in the United States for neonates over the past 45 years. Even though this emulsion has proven useful in supplying infants with energy for growth and essential fatty acids, there have been concerns over its composition in the development of several morbidities, ranging from sepsis to liver disease, bronchopulmonary dysplasia, and impaired neurodevelopment and growth. The exact mechanisms that drive these morbidities in preterm infants are multifactorial, but potential contributors include high ω-6 (n-6) fatty acid composition, low docosahexaenoic acid and antioxidant supplementation, and the presence of potentially harmful nonnutritive components (eg, phytosterols). To address these issues, new-generation IVFEs with various types and amounts of fat have been developed containing greater amounts of the medium-chain fatty acids, long-chain polyunsaturated fatty acid, docosahexaenoic acid, lower concentrations of ω-6 polyunsaturated fatty acids, supplemental vitamin E, and low or negligible amounts of phytosterols. This review examines the clinical outcomes associated with different morbidities of parenteral nutrition in neonates who have received either soybean oil-based or new-generation IVFEs and addresses whether the proposed benefits of new-generation IVFEs have improved outcomes in the neonatal population.

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Dose of intravenous lipids and rate of bacterial clearance in preterm infants with blood stream infections

Abstract: Restriction of the dose of IVLE to 1 g kg(-1) day(-1) in preterm infants with BSI is associated with earlier negative blood cultures and reduced duration of antibiotic therapy but was associated with a lower daily weight increments.

Cited by 10 publications

References 34 publications

Nutritional Status of Children Hospitalized for Parapneumonic Effusion

Nutritional Status of Children Hospitalized for Parapneumonic Effusion

Risk Factors for the Development of Catheter‐Related Bloodstream Infections in Patients Receiving Home Parenteral Nutrition

Emerging Clinical Benefits of New‐Generation Fat Emulsions in Preterm Neonates

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