Blood Levels of Water-Soluble Vitamins in Pediatric Patients on Total Parenteral Nutrition Using a Multiple Vitamin Preparation

1989 ◽  
Vol 13 (2) ◽  
pp. 176-184 ◽  
Author(s):  
E. Marinier ◽  
A.M. Gorski ◽  
G. Potier De Courcy ◽  
C. Criqui ◽  
M. Bunodiere ◽  
...  
Keyword(s):  
Parenteral Nutrition ◽  
Total Parenteral Nutrition ◽  
Pediatric Patients ◽  
Water Soluble ◽  
Blood Levels ◽  
Vitamin Preparation

Evaluation of a Pediatric Multiple Vitamin Preparation for Total Parenteral Nutrition in Infants and Children I. Blood Levels of Water-Soluble Vitamins

PEDIATRICS ◽  
1986 ◽  
Vol 77 (4) ◽  
pp. 530-538
Author(s):  
M. C. Moore ◽  
H. L. Greene ◽  
B. Phillips ◽  
L. Franck ◽  
R. J. Shulman ◽  
...  
Keyword(s):  
Parenteral Nutrition ◽  
Vitamin B12 ◽  
Total Parenteral Nutrition ◽  
Preterm Infants ◽  
Reference Range ◽  
Water Soluble ◽  
Infants And Children ◽  
Blood Levels ◽  
Vitamin Preparation ◽  
Group 1

This study represents the first attempt to evaluate the response to the only intravenous vitamin preparation (MVI Pediatric) for infants and children receiving total parenteral nutrition. Eighteen preterm infants (group 1), 26 term infants and children receiving total parenteral nutrition for 2 to 4 weeks (group 2A), and eight infants and children receiving total parenteral nutrition for 3 to 6 months (group 2B) were studied. Term gestation infants and children up to 11 years of age received daily vitamin doses that approximated the 1974 Recommended Dietary Allowances and coincided with the 1975 American Medical Association Nutrition Advisory Group total parenteral nutrition dosage guidelines for children weighing more than 10 kg. Preterm infants received 65% of these dosages. RBC transketolase (vitamin B1), glutathione reductase (B2), and glutamic oxaloacetic transaminase (B6) activities were maintained at normal levels, and niacin levels were maintained within the reference range (7.1 ± 0.32 µg/mL) in all study patients. Pantothenate, biotin, and ascorbate were maintained at reference levels in groups 2A and 2B. In group 1, ascorbic acid was increased significantly during treatment from 1.53 ± 0.16 to 3.60 by seven days and to 2.54 ± 0.62 by day 28 of treatment (reference normals = 0.99 ± 0.1 mg/dL). RBC folate was maintained within the reference range of 411 ± 76 pg/mL; however, pantothenate and biotin levels increased significantly to more than 2 SD above reference values during treatment, and vitamin B12, levels, which were above the reference range initially, were maintained at more than 2 SD above the reference range throughout treatment. The elevation in vitamin B12 was seen in both group 1 and 2 patients. Overall, the recommended dosages appeared adequate to prevent deficiency; however, the elevated levels of several vitamins in premature infants indicated that further studies should be done to determine more appropriate dosage levels for this group of high-risk patients.

Evaluation of a Pediatric Multiple Vitamin Preparation for Total Parenteral Nutrition II. Blood Levels of Vitamins A, D, and E

PEDIATRICS ◽  
1986 ◽  
Vol 77 (4) ◽  
pp. 539-547
Author(s):  
H. L. Greene ◽  
M. E. Courtney Moore ◽  
B. Phillips ◽  
L. Franck ◽  
R. J. Shulman ◽  
...  
Keyword(s):  
Vitamin A ◽  
Parenteral Nutrition ◽  
Total Parenteral Nutrition ◽  
Preterm Infants ◽  
Reference Range ◽  
Infants And Children ◽  
Blood Levels ◽  
Vitamin D Levels ◽  
Group 2 ◽  
Group 1

This study represents the first attempt to evaluate the American Medical Association Nutrition Advisory Group (NAG) recommendations for intravenous vitamin A, D, and E dosages for infants and children. Patients studied included 18 preterm infants (group 1) and 26 term infants and children (group 2A) receiving total parenteral nutrition for 2 to 4 weeks and eight infants and children receiving total parenteral nutrition for 3 to 6 months (group 2B). Term gestation infants and children up to 11 years of age all received the same dosages (those that were recommended by the NAG for children weighing more than 10 kg). Preterm infants received 65% of these doses. In group 1, cord blood α-tocopherol levels were <0.22 mg/dL in seven preterm infants (reference value = 0.29 ± 0.04), but mean levels increased to 1.65 ± 0.17 mg/dL after four days of treatment. Eight infants consistently received additional vitamin E orally (80 to 150 mg daily), and their levels increased to 2.18 ± 0.26 mg/dL by four days of study and to 3.49 ± 0.57 mg/dL after 3 weeks. Oral supplementation in the preterm infants appeared to be unnecessary because intravenous vitamins alone maintained levels above 1.1 mg/dL. In group 2, α-tocopherol levels were maintained within the reference range. Patients receiving lipid emulsions containing substantial quantities of α-tocopherol had significantly higher blood levels than patients receiving lipid emulsions containing little α-tocopherol (P < .01). Mean 25-OH vitamin D levels were mintained above or within the reference range in groups 2A and 2B. Although only seven patients in group 1 had measurements performed after beginning total parenteral nutrition, their 25-OH vitamin D levels increased during total parenteral nutrition and were maintained within the reference range. Mean vitamin A levels in group 2 were maintained within the reference range of 23.5 ± 1.8 µg/dL, although three of eight patients in group 2A who had levels 2 SD less than the reference mean levels initially did not increase their levels during the 2-week period of treatment. Patients on home total parenteral nutrition (group 2B) showed a mean increase in retinol, from 29.2 ± 3.0 µg/dL to 37.4 ± 7.1 µg/dL. There was also good correlation between retinol-binding protein and retinol in all patients in group 2. Premature infant (group 1) levels were 13.9 ± 1.3 µg/dL initially (reference value = 15.7 µg/dL) and did not change after 28 days of treatment (13.5 ± 2.5 µg/dL). In addition, there was poor correlation with retinol-binding protein. The failure of retinol to increase with treatment may be secondary to losses of retinol in the delivery system. Further studies are needed to better define vitamin A and D needs during parenteral feeding of premature infants, although the dosage levels in term infants appear to maintain mean blood levels of all of the vitamins within the reference range.

Total Parenteral Nutrition in Pediatric Patients

1980 ◽  
Vol 2 (4) ◽  
pp. 99-106 ◽  
Author(s):  
J. S. Levy ◽  
R. W. Winters ◽  
W. C. Heird
Keyword(s):  
Parenteral Nutrition ◽  
Total Parenteral Nutrition ◽  
Pediatric Patients

Implementation of Electronic Ordering of Total Parenteral Nutrition in Pediatric Patients

2007 ◽  
Vol 42 (5) ◽  
pp. 474-480
Author(s):  
Alison G. Grisso ◽  
Mark Arrieta ◽  
Ty A. Webb
Keyword(s):  
Parenteral Nutrition ◽  
Total Parenteral Nutrition ◽  
Pediatric Patients

Vitamin Dosages in Premature Infants

PEDIATRICS ◽  
1987 ◽  
Vol 79 (4) ◽  
pp. 654-655
Author(s):  
WILLIAM F. WALSH
Keyword(s):  
Parenteral Nutrition ◽  
Total Parenteral Nutrition ◽  
Premature Infants ◽  
Package Insert ◽  
Infants And Children ◽  
Recommended Dose ◽  
Daily Dose ◽  
In Infants And Children ◽  
Vitamin Preparation

The article "Evaluation of a Pediatric Multiple Vitamin Preparation For Total Parenteral Nutrition in Infants and Children" by Moore et al (Pediatrics 1986; 77:530-538) confused me. The study of vitamin levels is crucial to making recommendations, but why would the authors choose to give all premature infants 65% of the recommended dose for infants and children, when the package insert clearly states, "Infants less than 1 kg: the daily dose should not exceed 30% of the contents. Do not exceed this daily dose"?

scholarly journals Should pediatric parenteral nutrition be individualized?

2014 ◽  
Vol 32 (4) ◽  
pp. 326-332
Author(s):  
Renata Germano Borges de Oliveira Nascimento Freitas ◽  
Roberto José Negrão Nogueira ◽  
Margareth Lopes Galvão Saron ◽  
Alexandre Esteves Souza Lima ◽  
Gabriel Hessel
Keyword(s):  
Parenteral Nutrition ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Tertiary Hospital ◽  
Inorganic Phosphorus ◽  
Nutritional State ◽  
World Health ◽  
Blood Levels ◽  
Health Organization ◽  
In The Beginning

INTRODUCTION: Parenteral nutrition (PN) formulations are commonly individualized, since their standardization appears inadequate for the pediatric population. This study aimed to evaluate the nutritional state and the reasons for PN individualization in pediatric patients using PN, hospitalized in a tertiary hospital in Campinas, São Paulo.METHODS: This longitudinal study comprised patients using PN followed by up to 67 days. Nutritional status was classified according to the criteria established by the World Health Organization (WHO) (2006) and WHO (2007). The levels of the following elements in blood were analyzed: sodium, potassium, ionized calcium, chloride, magnesium, inorganic phosphorus, and triglycerides (TGL). Among the criteria for individualization, the following were considered undeniable: significant reduction in blood levels of potassium (<3mEq/L), sodium (<125mEq/L), magnesium (<1mEq/L), phosphorus (<1.5mEq/L), ionic calcium (<1mmol), and chloride (<90mEq/L), or any value above the references.RESULTS: Twelve pediatric patients aged 1 month to 15 years were studied (49 individualizations). Most patients were classified as malnourished. It was observed that 74/254 (29.2%) of examinations demanded individualized PN for indubitable reasons.CONCLUSION: The nutritional state of patients was considered critical in most cases. Thus, the individualization performed in the beginning of PN for energy protein adequacy was indispensable. In addition, the individualized PN was indispensable in at least 29.2% of PN for correction of alterations found in biochemical parameters.

Lactic acidosis in pediatric patients with cancer receiving total parenteral nutrition

1981 ◽  
Vol 99 (2) ◽  
pp. 247-250 ◽  
Author(s):  
Russell J. Merritt ◽  
Carol E. Ennis ◽  
Daniel W. Thomas ◽  
Frank R. Sinatra
Keyword(s):  
Lactic Acidosis ◽  
Parenteral Nutrition ◽  
Total Parenteral Nutrition ◽  
Pediatric Patients ◽  
Patients With Cancer
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