Predicting the Duration of Dependence on Parenteral Nutrition After Neonatal Intestinal Resection

1999 ◽  
Vol 14 (2) ◽  
pp. 80-80
Author(s):  
Edwin Simpser
Keyword(s):  
Parenteral Nutrition ◽  
Intestinal Resection

scholarly journals Role of Thiamine in Refeeding Syndrome in Children

2021 ◽  
Vol 6 (2) ◽  
Keyword(s):  
Case Report ◽  
Parenteral Nutrition ◽  
Total Parenteral Nutrition ◽  
Tertiary Care ◽  
Intestinal Resection ◽  
Current Evidence ◽  
Care Hospital ◽  
Refeeding Syndrome ◽  
Wide Range

Purpose, Setting and Subjects: We conducted a case report study of a postoperative pediatric patient on total parenteral nutrition managed by a multidisciplinary team in a tertiary care hospital. In October 2020, data of nutritional status, hypophosphatemia, electrolyte and metabolic imbalance, and the role of thiamine supplement were reviewed. Background: Refeeding Syndrome is usually defined as the possibly lethal maldistribution of fluids and electrolytes that could take place in malnourished patients receiving enteral or parenteral refeeding. This is due to hormonal and metabolic disturbances that may lead to critical clinical deterioration. The biochemical key feature of Refeeding Syndrome is hypophosphatemia. In general, the syndrome is complicated and may also incorporate abnormal electrolytes and fluid balance; changes in serum level of protein, glucose, and the metabolism of fat; thiamine deficiency; hypokalemia; and hypomagnesaemia. Case Report: an ex-preterm 6-year-old boy who underwent major intestinal resection due to necrotizing enterocolitis (NEC) during his stormy neonatal period, presented to ED with constipation for 2 days; the patient was admitted in the pediatric ward under combined care with Pediatric Surgery, as a case of large bowel obstruction for conservative management. He had cachexic appearance, global developmental delay (GDD), and faltering growth. Subsequently and during his PICU stay, he suffered a fluctuating course of electrolytes imbalance a few days after commencing total parenteral nutrition (TPN), and developed altered mental status that responded well to thiamine infusions to resume his baseline sensorium within 48 hours. Conclusions: The role of thiamine in Refeeding Syndrome is extremely underestimated, despite the current evidence of its high efficacy. However, the fussy exclusion mechanism to reach the diagnosis is probably the reason behind the delaying of treatment in most of the cases. A wide range of patients are at risk of developing Refeeding Syndrome, especially malnourished children, as in this case report. Categories: Nutrition, Surgery, Pediatrics, Gastroenterology.

Home Total Parenteral Nutrition in a “No-Bowel” Patient in Spain

1992 ◽  
Vol 26 (9) ◽  
pp. 1139-1142 ◽  
Author(s):  
Emilio Ibáñez ◽  
M. Carmen Ruiz ◽  
Ricardo Corell ◽  
Javier Guasch ◽  
Amparo Ferrándiz ◽  
...  
Keyword(s):  
Parenteral Nutrition ◽  
Total Parenteral Nutrition ◽  
Intestinal Resection ◽  
Team Members ◽  
Professional Experiences ◽  
Case Summary ◽  
History Of ◽  
Colonic Polyposis ◽  
High Output

OBJECTIVE: To report a case of a patient with no functional bowel who was receiving home total parenteral nutrition in a country that has had few professional experiences in this area of therapy. CASE SUMMARY: A woman with a history of scattered colonic polyposis developed a mesenteric tumor that caused intestinal obstruction. Tumor withdrawal required the excision of 1.5 m of jejunum—ileum. Postoperative complications required further surgical intervention and subtotal intestinal resection. Duodenocolic anastomosis was not possible and a high output and permanent fistula remained. DISCUSSION: The complications of home parenteral nutrition addressed in the literature are reviewed. The problems encountered in our patient have been resolved. CONCLUSIONS: After three years of postoperative survival, we believe the quality of life of our patient has increased and the parenteral nutrition team members are much better prepared to manage patients with similar problems.

Prediction of complex gastroschisis: The evolution of therapeutic techniques and their relation with fetal sonographic features

2021 ◽  
pp. 1-9
Author(s):  
G. Mazzoni ◽  
D. Alberti ◽  
F. Torri ◽  
M. Motta ◽  
C. Platto ◽  
...  
Keyword(s):  
Parenteral Nutrition ◽  
Total Parenteral Nutrition ◽  
Bowel Resection ◽  
Intestinal Resection ◽  
Adverse Outcomes ◽  
Prenatal Ultrasound ◽  
Neonatal Outcomes ◽  
Single Center Study ◽  
Adverse Neonatal Outcomes ◽  
Length Of Hospitalization

BACKGROUND: To analyze prenatal ultrasound (US) markers to predict treatment and adverse neonatal outcome in fetal gastroschisis. METHODS: It was conducted a retrospective single-center study considering all pregnancies with isolated gastroschisis that were treated in our department between 2008 and 2020. 17 US markers were analyzed. Moreover, the association between prenatal ultrasound signs and neonatal outcomes was analyzed: need of bowel resection, techniques of reduction, type of closure, adverse neonatal outcomes, time to full enteral feeding, length of total parenteral nutrition and length of hospitalization. RESULTS: The analysis included 21 cases. We found significant associations between intestinal dilation (≥10 mm) appeared before 30 weeks of gestation and the need of bowel resection (p = 0.001), the length of total parenteral nutrition (p = 0,0013) and the length of hospitalization (p = 0,0017). Intrauterine growth restriction (IUGR) is a risk factor for serial reduction (p = 0,035). There were no signs significantly associated with the type of closure. Hyperbilirubinemia is related with gestational age (GA) at the diagnosis of intra-abdominal bowel dilation (IABD) (p = 0.0376) and maximum IABD (p = 0.05). All newborns with sepsis had echogenic loops in uterus (p = 0.026). The relation between the GA at delivery and the GA at the extra-abdominal bowel dilation (EABD)≥10 mm was r = 0.70. CONCLUSION: We showed the significant role of the early presence of bowel dilation in predicting intestinal resection and adverse outcomes. All IUGR fetuses needed staged reduction through the silo-bag technique. The echogenic bowel was related to neonatal sepsis, while IABD was associated with hyperbilirubinemia.

scholarly journals Impairment of arginine metabolism in rats after massive intestinal resection: effect of parenteral nutrition supplemented with citrulline compared with arginine

2008 ◽  
Vol 115 (5) ◽  
pp. 159-166 ◽  
Author(s):  
Sylwia Osowska ◽  
Nathalie Neveux ◽  
Samir Nakib ◽  
Virginie Lasserre ◽  
Luc Cynober ◽  
...  
Keyword(s):  
Parenteral Nutrition ◽  
Total Parenteral Nutrition ◽  
Protein Content ◽  
Short Bowel Syndrome ◽  
Nitrogen Balance ◽  
Extensor Digitorum Longus ◽  
Intestinal Resection ◽  
Extensor Digitorum ◽  
Noticeable Effect ◽  
Short Bowel

Arginine homoeostasis is impaired in short bowel syndrome, but its supplementation in short bowel syndrome patients remains controversial. Recently, we demonstrated the benefits of citrulline supplementation by the enteral route in resected rats. Since the first step in managing short bowel syndrome is to initiate total parenteral nutrition, we hypothesized that parenteral citrulline supplementation would be more appropriate in this situation than arginine supplementation. In the present study, 24 rats were assigned to four groups. The sham group underwent transection whereas the three other groups underwent resection (R) of 80% of the small intestine. All rats were then fed exclusively by total parenteral nutrition as follows: supplementation with citrulline (R+CIT), with arginine (R+ARG) or no supplementation (R). All of the rats received isocaloric and isonitrogenous nutrition for 4 days. Nitrogen balance was measured daily. Rats were then killed and the blood was collected and the intestinal mucosa and extensor digitorum longus muscle were removed for amino acid and protein analysis. Citrulline and arginine increased mucosal protein content in the ileum (compared with sham and R, P<0.05). However, only citrulline prevented extensor digitorum longus atrophy (R+CIT, 130±3 mg compared with R, 100±6 mg and R+ARG, 110±2 mg, P<0.05). In addition, arginine worsened nitrogen balance (R+ARG, 104±46 mg/72 h compared with R, 249±69 mg/72 h, P<0.05). Only citrulline was able to prevent muscle atrophy and it was achieved independently from any noticeable effect on the gut in particular because citrulline and arginine share the same effect on mucosal ileal protein content. These results suggest that citrulline should be considered as a potential supplement for total parenteral nutrition of short bowel syndrome patients.

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