Survey of Nutrition Management Practices in Centers for Pediatric Intestinal Rehabilitation

Nucci, Anita; Ellsworth, Kipp; Michalski, Austin; Nagel, Emily; Wessel, Jackie

doi:10.1177/0884533617719670

Cited by 19 publications

(33 citation statements)

References 56 publications

(145 reference statements)

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“…The genetic target height based on mid‐parental height should be factored into expectations for growth . Growth failure, particularly short stature, has been reported in long‐term PN . Stunting may be due to chronic intestinal inflammation, poor nutritional intake at critical periods, the underlying disease itself, and side effects of medications .…”

Section: Growth and Body Composition Monitoringmentioning

confidence: 99%

“…Laboratory monitoring is aimed at detecting nutrient deficiencies and toxicities . The critical periods for nutrient imbalances are during periods of rapid growth, physiological stress, and during the transition from PN to enteral diet . The administration of intravenous vitamins and trace elements bypass the normal regulatory mechanisms present in the gut, resulting in toxicity risk .…”

Section: Long‐term Laboratory Monitoringmentioning

confidence: 99%

“…Intestinal failure (IF) is due to functional or anatomic loss of bowel and is characterized by insufficient absorption of nutrients and fluid requiring parenteral support to sustain life and achieve growth . Long‐term parenteral nutrition (PN) is the cornerstone of therapy in chronic IF.…”

Section: Introductionmentioning

confidence: 99%

“…Long‐term parenteral nutrition (PN) is the cornerstone of therapy in chronic IF. Since the first patient was sent on home PN in the late 1970s, considerable progress has been accomplished in the field of pediatric IF supported by multidisciplinary intestinal rehabilitation programs and advances in medical and surgical care . Despite these achievements, long‐term PN can still result in life‐threatening complications.…”

Section: Introductionmentioning

confidence: 99%

“…Attention to close monitoring of patients on long‐term PN with adjustment of nutritional and non‐nutritional therapies accordingly is key to optimizing their outcomes. There is a wide variability in practices across IF centers in terms of monitoring these complex patients and limited data to guide the development of evidence‐based recommendations . Available guidelines include the joint guidelines from the European Society for Pediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) and the European Society of Parenteral and Enteral Nutrition (ESPEN) published in 2005 and updated in 2018 and the American Society for Parenteral and Enteral Nutrition recommendations published in 2017 …”

Section: Introductionmentioning

confidence: 99%

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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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Section: Growth and Body Composition Monitoringmentioning

confidence: 99%

Section: Long‐term Laboratory Monitoringmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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

Zemrani

Bines

2019

JGH Open

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Should Clinicians Prescribe Non-FDA Regulated Dietary Supplements When Caring for Children With Hypovitaminosis D?

Mezoff

Hays

Shaikhkhalil

2022

AMA Journal of Ethics

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Hypovitaminosis D is a prevalent micronutrient deficiency that can be severe and hard to treat in children with short bowel syndrome, a condition treated with substantial bowel resection. Surgically altered bowel anatomy then results in iatrogenic digestion and absorption limitations that require short-and long-term management and follow-up. Care of children with hypovitaminosis D standardly includes prescription dietary micronutrient supplementation, sometimes in irregularly high doses. This commentary responds to a pediatric case of vitamin D toxicity and suggests micronutrient-prescribing risk mitigation strategies in light of the absence of regulatory oversight of over-the-counter dietary supplements, inadequate insurance coverage, and easily available commercial retail products.Case MP is a teenage girl with short bowel syndrome (SBS) related to gastroschisis, initially leaving her with approximately 10 centimeters of small bowel in continuity with her descending colon. Following multiple autologous intestinal reconstructive surgeries performed to address clinically relevant bowel dilation, her small bowel length was measured at 73 centimeters. Her clinical course has been complicated by intestinal failure-associated liver disease, recurrent small bowel bacterial overgrowth, limited vascular access related to thrombosis that requires anticoagulation, and multiple central line-associated bloodstream infections prior to central line removal. She achieved enteral autonomy with line removal at age 10 years.

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Gut microbiota and its diet‐related activity in children with intestinal failure receiving long‐term parenteral nutrition

Neelis

Koning

Hulst

et al. 2021

J Parenter Enteral Nutr

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BackgroundThis study characterized the gut microbiota and its diet-related metabolic activity in children with intestinal failure (IF) on parenteral nutrition (PN) compared with healthy controls and in relation to disease characteristics. MethodsSerial fecal samples were collected from 15 IF patients (n=68) and from 25 healthy children (n=25). The fecal microbiota, and short chain fatty acids (SCFA) were measured. ResultsThe microbiota of patients with IF had a lower bacterial load (p=0.003), Shannon diversity index (p<0.001), taxon evenness (p<0.001) and richness (p=0.006) than healthy controls.Patients with surgical IF had lower α-diversity (p<0.039) than those with functional IF.Patients with IF had less propionic and butyric acid (p<0.001), and more D and L-lactate than healthy controls (p<0.001). The percentage of calories supplied by PN (%PN) was negatively associated with microbiota diversity and influenced SCFA profile. IF patients had more Escherichia-Shigella (p=0.006), Cronobacter (p=0.001) and Staphylococcus (OTU 14, p<0.001) and less Faecalibacterium (p<0.001) and Ruminococcus 1 and 2 (p<0.001).Duration of PN (R 2 =6%, p=0.005), % of calories from PN (R 2 =6%, p=0.005) and fiber intake (R 2 =5%, p=0.011) were predictive of microbiota community structure. A higher intake of enteral nutrition was associated with a microbiota composition and function closer to that of the healthy status.

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Survey of Nutrition Management Practices in Centers for Pediatric Intestinal Rehabilitation

Abstract: EN and PN management strategies are relatively consistent among U.S. centers. Collaborative initiatives are necessary to define better practices and establish laboratory monitoring guidelines.

Cited by 19 publications

References 56 publications

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

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

Should Clinicians Prescribe Non-FDA Regulated Dietary Supplements When Caring for Children With Hypovitaminosis D?

Gut microbiota and its diet‐related activity in children with intestinal failure receiving long‐term parenteral nutrition

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