ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Amino acids

Goudoever, Johannes B. van; Pipaon, Miguel Sainz de; Braegger, Christian; Bronský, Jiří; Cai, Wei; Campoy, Cristina; Carnielli, Virgilio P.; Darmaun, Dominique; Décsi, Támas; Domellöf, Magnus; Embleton, Nicholas D.; Fewtrell, Mary; Mis, Nataša Fidler; Franz, Axel; Goulet, Olivier; Hartman, Corina; Hill, Susan; Hojsak, Iva; Iacobelli, Simona; Jochum, Frank; Joosten, Koen; Kolaček, Sanja; Koletzko, Berthold; Książyk, Janusz; Lapillonne, Alexandre; Lohner, Szimonetta; Mesotten, Dieter; Mihályi, Krisztina; Mihatsch, Walter A.; Mimouni, Francis; Mølgaard, Christian; Moltu, Sissel J.; Nomayo, Antonia; Picaud, Jean Charles; Prell, Christine; Puntis, John; Riskin, Arieh; Pipaón, Miguel Sáenz de; Senterre, Thibault; Shamir, Raanan; Simchowitz, Venetia; Szitányi, Peter; Tabbers, Merit M.; Akker, Chris H.B. Van Den; Goudoever, Johannes B. van; Kempen, Anne A. M. W. van; Verbruggen, Sascha; Wu, Jiang; Yan, Weihui

doi:10.1016/j.clnu.2018.06.945

Cited by 166 publications

(204 citation statements)

References 97 publications

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“…In addition, high protein intake has been associated with higher FM in healthy children, but on the other hand, studies have shown that increased protein intake is important for accretion and maintenance of FFM . We did not find any associations between parenteral protein intake and body composition parameters, although the median parenteral amino acid intake (2.0 g/kg/day) was quite high in comparison with the recommended daily parenteral intake of 1.0–2.0 g/kg/day . Another factor that might play an important role is decreased physical activity.…”

Section: Discussioncontrasting

confidence: 68%

“…40 We did not find any associations between parenteral protein intake and body composition parameters, although the median parenteral amino acid intake (2.0 g/kg/day) was quite high in comparison with the recommended daily parenteral intake of 1.0-2.0 g/kg/day. 15,41 Another factor that might play an important role is decreased physical activity. Although no formal assessment of physical activity was performed and most patients received PN only overnight and were able to participate in usual daily activities including school, clinical experience shows that the group of children with IF may be less active than healthy children.…”

Section: Discussionmentioning

confidence: 99%

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Body Composition Using Air Displacement Plethysmography in Children With Intestinal Failure Receiving Long‐Term Home Parenteral Nutrition

Neelis

Kouwenhoven

Olieman

et al. 2019

J Parenter Enteral Nutr

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Background Children with intestinal failure (IF) are at risk of growth failure, but little information about body composition is available. Our aim was to assess body composition using air displacement plethysmography (ADP) and relate it to clinical and growth parameters. Methods In this prospective descriptive observational 2‐center cohort study, children aged 2–18 years receiving home parenteral nutrition (PN) for ≥6 months underwent ADP measurement. Fat mass index (FMI) and fat‐free mass index (FFMI) standard deviation scores (SDSs) were calculated to normalize for small body size. Results Twenty‐one out of 22 children, median age 7.4 years, underwent successful ADP measurement after a median PN duration of 5.5 years. They were significantly lighter (median weight for age SDS −0.71, P = 0.004) and shorter (median height for age SDS −1.55, P < 0.001) than the normal population mean; 52% were growing below target height range. They had low FFMI (median SDS −1.53, P < 0.001) and high FMI (median SDS 0.80, P = 0.002). Weight for height and body mass index (BMI) were significantly associated with FFMI and BMI with FMI, but children with the same weight and height showed different body composition. In 13 patients with 1‐year follow‐up, growth and body composition did not change significantly. Conclusion Children with IF receiving long‐term PN show lower FFM and higher FM than healthy children. Additionally, children with similar routine growth parameters showed different body composition. Further studies should evaluate the effect of a patient‐tailored approach including physical activity and nutrition advice based on body composition.

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Section: Discussioncontrasting

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Body Composition Using Air Displacement Plethysmography in Children With Intestinal Failure Receiving Long‐Term Home Parenteral Nutrition

Neelis

Kouwenhoven

Olieman

et al. 2019

J Parenter Enteral Nutr

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“…Critically ill patients are at risk of malnutrition principally as a result of protein breakdown that is directly related to the seriousness of their condition, which is more profound at a very young age (infants and young children). A minimal protein intake of 1.5g/kg ideal weight is essential to prevent malnutrition …”

Section: Recommendationsmentioning

confidence: 99%

“…A minimal protein intake of 1.5g/kg ideal weight is essential to prevent malnutrition. 24,28,29 In the literature, studies recommend aiming for 1g protein/kg/d but in daily practice an intake of 0.5g/kg to 0.8g/ kg seems to be more realistic. 12,15 Only the study of Dressler et al 19 reported a median protein intake of 2g/kg/d with a range of 1.5g/kg to 2g/kg in KD-PN, owing to very young age (median age of the children 1y 10mo), resulting in a median diet ratio of 0.9:1.…”

Section: Proteinmentioning

confidence: 99%

Optimal clinical management of children receiving ketogenic parenteral nutrition: a clinical practice guide

Louw

Aldaz

Harvey

et al. 2019

Develop Med Child Neuro

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AimTo give evidence‐based recommendations on the application of ketogenic diet parenteral nutrition (KD‐PN) in emergency situations.MethodAn international group of experts (n=14) researched the literature and distributed a survey among 150 expert centers. International accepted guidelines (European Society for Clinical Nutrition and Metabolism/European Society for Paediatric Gastroenterology Hepatology and Nutrition and the American Society for Parenteral and Enteral Nutrition) and handbooks for parenteral nutrition were considered general standards of care.ResultsIn the literature, we identified 35 reports of patients treated by KD‐PN. International guidelines and handbooks provided some conflicting information. Twenty‐four expert teams from nine countries responded to the survey, reflecting the limited clinical experience.InterpretationThis paper highlights 23 consensus‐based recommendations for safe and effective KD‐PN (e.g. diet initiation, calculation, application, monitoring, and evaluation) based on the best evidence available and expert opinions.What this paper adds In acute settings, ketogenic diet therapy (KDT) can be administered parenterally.Parenteral administration of KDT should be started only at the intensive care unit.Initiate ketogenic parenteral nutrition stepwise to the highest ratio possible with the lowest level of complications.Evaluate the risk–benefit ratio of parenteral administration continuously.Restart enteral feeding as soon as appropriate.

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“…The so-called factorial method estimates that infants born at 24–28 weeks’ gestation require an AA intake of around 3.5–4 g/kg/day if fetal protein accretion rates of approximately 2 g/kg are to be enabled [3]. However, even relatively well preterm neonates are metabolically unstable, and hyperglycemia and hyperlipidemia are common.…”

Section: Commentarymentioning

confidence: 99%

Commentary on “Higher versus Lower Amino Acid Intake in Parenteral Nutrition for Newborn Infants”

Embleton

McGuire

2019

Neonatology

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ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Amino acids

Cited by 166 publications

References 97 publications

Body Composition Using Air Displacement Plethysmography in Children With Intestinal Failure Receiving Long‐Term Home Parenteral Nutrition

Body Composition Using Air Displacement Plethysmography in Children With Intestinal Failure Receiving Long‐Term Home Parenteral Nutrition

Optimal clinical management of children receiving ketogenic parenteral nutrition: a clinical practice guide

Commentary on “Higher versus Lower Amino Acid Intake in Parenteral Nutrition for Newborn Infants”

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