ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Complications

Hartman, Corina; Shamir, Raanan; Simchowitz, Venetia; Lohner, Szimonetta; Cai, Wei; Décsi, Támas; Espghan,; Espen,; Espr,

doi:10.1016/j.clnu.2018.06.956

Cited by 91 publications

(98 citation statements)

References 146 publications

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“…Catheter‐related bloodstream infections are a common complication associated with the administration of PN via central venous catheters and contribute to the development of IFALD . The frequency of catheter‐related bloodstream infections in children receiving HPN ranges from 0.34 to 3.94 episodes per catheter year .…”

Section: Intestinal Failure Associated Liver Diseasementioning

confidence: 99%

“…Imbalances of PN solution components can also lead to metabolic abnormalities contributing to the development of IFALD. Excessive or inadequate amino acid provision and a deficiency of conditionally essential substrates such as taurine, carnitine, and glutamine have been associated with IFALD, though a definitive causal relationship has not been established . An excess of total energy, delivered either as glucose or fat, promotes hepatic steatosis .…”

Section: Intestinal Failure Associated Liver Diseasementioning

confidence: 99%

“…Excessive or inadequate amino acid provision and a deficiency of conditionally essential substrates such as taurine, carnitine, and glutamine have been associated with IFALD, though a definitive causal relationship has not been established . An excess of total energy, delivered either as glucose or fat, promotes hepatic steatosis . In addition, excessive glucose intake and continuous PN infusion are associated with hyperinsulinism and subsequent steatosis .…”

Section: Intestinal Failure Associated Liver Diseasementioning

confidence: 99%

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Lipid Emulsion Use in Pediatric Patients Requiring Long‐Term Parenteral Nutrition

Goulet

Cai

Seo

2020

J Parenter Enteral Nutr

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The ability to deliver nutrients via parenteral nutrition (PN) has markedly improved the prognosis of infants and children with intestinal failure. Technical refinements and advances in knowledge have led to the development of highly sophisticated PN solutions that are tailored to meet the needs of pediatric patients. However, children who require long‐term PN have an increased risk of complications such as catheter‐related sepsis, liver disease, and bone disease. Although the pathogenesis of intestinal failure associated liver disease (IFALD) is multifactorial, studies have identified a possible link between the dose of lipid emulsions based on soybean oil and cholestasis, shown to occur with a significantly higher frequency in patients receiving >1 g lipids/kg/d. Potential contributing factors include oxidative stress, high ω‐6 polyunsaturated fatty acid (PUFA) and phytosterol content, and relatively low α‐tocopherol levels. Lipid emulsions containing fish oil offer potential advantages compared with traditional emulsions with a high soybean oil content, such as decreased ω‐6 and increased ω‐3 PUFA concentrations, high concentrations of α‐tocopherol, and reduced phytosterol content. Studies in PN‐dependent children at risk for IFALD have shown that lipid emulsions containing fish oil reduce the risk of cholestasis and improve biochemical measures of hepatobiliary function compared with pure soybean oil emulsions. This review summarizes evidence regarding the role of lipid emulsions in the management of pediatric patients with intestinal failure requiring long‐term PN, with a particular focus on the prevention and treatment of IFALD.

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Section: Intestinal Failure Associated Liver Diseasementioning

confidence: 99%

Section: Intestinal Failure Associated Liver Diseasementioning

confidence: 99%

Section: Intestinal Failure Associated Liver Diseasementioning

confidence: 99%

See 1 more Smart Citation

Lipid Emulsion Use in Pediatric Patients Requiring Long‐Term Parenteral Nutrition

Goulet

Cai

Seo

2020

J Parenter Enteral Nutr

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“…The available international parenteral nutrition guidelines include a description of side effects but do not provide specific information during KDT. When KDT is established as parenteral nutrition treatment for refractory status epilepticus or FIRES, adverse effects already known during KDT initiation might occur (e.g.…”

Section: Recommendationsmentioning

confidence: 99%

“…The actual amount of vitamins/minerals delivered to the patient may therefore be lower than the intended dose. [32][33][34][35] There are different manufacturers of vitamins and mineral mixtures, and description depends on hospital/pharmacy protocols.…”

Section: Vitamins and Mineralsmentioning

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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Monitoring of long‐term parenteral nutrition in children with intestinal failure

Zemrani

Bines

2019

JGH Open

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Pediatric intestinal failure (IF) is a rare and complex condition associated with significant morbidity and mortality. It is defined as the reduction of gut mass or function below the minimal needed for absorption of nutrients and fluid to sustain life and growth. Since the advent of specialized multidisciplinary intestinal rehabilitation centers, IF management has considerably evolved in the last years, but serious complications of long‐term parenteral nutrition (PN) can occur. Main complications include intestinal failure‐associated liver disease, growth failure, body composition imbalance, central venous access complications, micronutrient deficiencies and toxicities, metabolic bone disease, small intestinal bacterial overgrowth, and renal disease. With improvement in survival rates of patients over the last 20 years, emphasis should be on limiting IF‐related comorbidities and improving quality of life. Close monitoring is pivotal to ensuring quality of care of these patients. The care of children with chronic IF should involve a comprehensive monitoring plan with flexibility for individualization according to specific patient needs. Monitoring of children on long‐term PN varies significantly across units and is mainly based on experience, although few guidelines exist. This narrative review summarizes the current knowledge and practices related to monitoring of children with IF. The authors also share their 20‐year experience at the Royal Children's Hospital in Melbourne Australia on this topic.

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ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Complications

Cited by 91 publications

References 146 publications

Lipid Emulsion Use in Pediatric Patients Requiring Long‐Term Parenteral Nutrition

Lipid Emulsion Use in Pediatric Patients Requiring Long‐Term Parenteral Nutrition

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

Monitoring of long‐term parenteral nutrition in children with intestinal failure

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