scholarly journals Diagnosis of Carnitine Deficiency in Extremely Preterm Neonates Related to Parenteral Nutrition: Two Step Newborn Screening Approach

2019 ◽  
Vol 5 (3) ◽  
pp. 29
Author(s):  
Mamatha Ramaswamy ◽  
Victor Anthony Skrinska ◽  
Rola Fayez Mitri ◽  
Ghassan Abdoh
Keyword(s):  
Parenteral Nutrition ◽  
Newborn Screening ◽  
Premature Infants ◽  
Retrospective Cohort ◽  
Optimal Growth ◽  
Carnitine Deficiency ◽  
Preterm Neonates ◽  
Extremely Preterm ◽  
Significant Difference ◽  
Preterm Babies

Currently, there is no evidence in the literature to support the routine supplementation of all parenterally fed premature infants with l-carnitine. In our study, we found that about 8.56% of extremely preterm neonates are diagnosed with carnitine deficiency secondary to malnutrition, either due to reduced stores at birth or related to total parenteral nutrition (TPN). Our two step approach of performing newborn screening (NBS) again at 32 weeks gestational age (GA) equivalent helps to diagnose 81.4% more preterm babies with carnitine deficiency—who would otherwise be missed—and supplement them with l-carnitine for optimal growth. We performed a retrospective cohort study to diagnose carnitine deficiency related to malnutrition in two groups: those presenting at birth and those presenting later in life. We found that there was a statistically significant difference in the median GA and birth weight (BW) between the two groups, but there was no difference in the free carnitine levels.

scholarly journals The effect of early versus late lipid infusion in parenteral nutrition on the biochemical and cortical auditory evoked potential parameters in preterm neonates

2019 ◽  
Vol 67 (1) ◽  
Author(s):  
Rania Mohamed Abdou ◽  
Hoda Mahmoud Ibrahim Weheiba
Keyword(s):  
Weight Gain ◽  
Parenteral Nutrition ◽  
Biochemical Parameters ◽  
Evoked Potential ◽  
Demographic Data ◽  
Auditory Evoked Potential ◽  
Preterm Neonates ◽  
Lipid Infusion ◽  
Significant Difference ◽  
Cortical Auditory Evoked Potential

Abstract Background As brain activity depends greatly on the functions provided by lipid membranes, dietary fat in early life can affect the developing nervous system. Despite the adoption of an early more aggressive parenteral nutrition approach with amino acid infusions still reluctance to the early use of intravenous lipids in neonates. Aim To compare the effect of delayed versus early introduction of intravenous lipid in preterm on the biochemical parameters and on brain development by the cortical auditory evoked potential (CAEP) latency and amplitude. Methods This is a comparative study included 49 neonates admitted at the ain shams university NICUs. Participants were divided into two groups: 26 in group of early lipid infusion and 23 in late lipid infusion, Demographic data, and biochemical parameters were documented during the 1st 2 weeks of life. The CAEP was performed at age of 6 months. The latency and amplitude of P1 were recorded and compared between both groups. Results In the present work we found that group of early lipid infusion had reach their full oral intake earlier with shorter duration of parenteral nutrition and length of stay. They had better weight gain and significantly better glucose level control than group of late lipid infusion. There was no significant difference in the other chemical parameters between both groups expect for the higher incidence of cholestasis in the group of late lipid infusion. At 6 months of age, the group of early lipid infusion had significantly shorter latency and amplitude of P1 than the group of late lipid infusion. Conclusion Early effective nutrition positively affect feeding tolerance and weight gain and maturation of higher brain centers brain.

scholarly journals Outcomes following early parenteral nutrition use in preterm neonates: protocol for an observational study

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e029065
Author(s):  
James Webbe ◽  
Nicholas Longford ◽  
Sabita Uthaya ◽  
Neena Modi ◽  
Chris Gale
Keyword(s):  
Parenteral Nutrition ◽  
Core Outcome Set ◽  
Preterm Neonates ◽  
Research Database ◽  
Early Introduction ◽  
Registration Number ◽  
Adults And Children ◽  
Preterm Babies ◽  
Early Parenteral Nutrition ◽  
The Uk

IntroductionPreterm babies are among the highest users of parenteral nutrition (PN) of any patient group, but there is wide variation in commencement, duration, and composition of PN and uncertainty around which groups will benefit from early introduction. Recent studies in critically unwell adults and children suggest that harms, specifically increased rates of nosocomial infection, outweigh the benefits of early administration of PN. In this study, we will describe early PN use in neonatal units in England, Wales and Scotland. We will also evaluate if this is associated with differences in important neonatal outcomes in neonates born between 30+0and 32+6weeks+daysgestation.Methods and analysisWe will use routinely collected data from all neonatal units in England, Wales and Scotland, available in the National Neonatal Research Database (NNRD). We will describe clinical practice in relation to any use of PN during the first 7 postnatal days among neonates admitted to neonatal care between 1 January 2012 and 31 December 2017. We will compare outcomes in neonates born between 30+0and 32+6weeks+daysgestation who did or did not receive PN in the first week after birth using a propensity score-matched approach. The primary outcome will be survival to discharge home. Secondary outcomes will include components of the neonatal core outcome set: outcomes identified as important by former patients, parents, clinicians and researchers.Ethics and disseminationWe have obtained UK National Research Ethics Committee approval for this study (Ref: 18/NI/0214). The results of this study will be presented at academic conferences; the UK charity Bliss will aid dissemination to former patients and parents.Trial registration numberNCT03767634

Early versus delayed extubation in extremely preterm neonates: a retrospective cohort study

2019 ◽  
Vol 40 (1) ◽  
pp. 118-123
Author(s):  
Amit Mukerji ◽  
Abdul Razak ◽  
Akanksha Aggarwal ◽  
Eyal Jacobi ◽  
May Musa ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Preterm Neonates ◽  
Extremely Preterm ◽  
Delayed Extubation

scholarly journals Effect of a Comprehensive Total Parenteral Nutrition Training Program on Knowledge and Practice of Nurses in NICU

2016 ◽  
Vol 8 (10) ◽  
pp. 135 ◽  
Author(s):  
Zahra Daneshvar Ameri ◽  
Ali Vafaee ◽  
Tahere Sadeghi ◽  
Zhila Mirlashari ◽  
Djavad Ghoddoosi-Nejad ◽  
...  
Keyword(s):  
Parenteral Nutrition ◽  
Training Program ◽  
Total Parenteral Nutrition ◽  
Preterm Neonates ◽  
Multiple Choice Questions ◽  
Significant Difference ◽  
Before And After ◽  
The Mean ◽  
Knowledge And Practice ◽  
Nurses Knowledge

<p><strong>Background: </strong>Parenteral nutrition is a lifesaving therapy for many infants who are unable to tolerate enteral feedings. It fulfils preterm neonates’ needs for growth and development when their sizes or conditions preclude enteral feeding. Virtuous nursing care and close biochemical monitoring are absolutely essential for successful parenteral nutrition therapy. Since poor knowledge in parenteral nutrition can causes severe impairment to neonatal infants, the conduction of this study is essential.</p><p><strong>Aims: </strong>The present study aims to: (1) examine the knowledge and practice of nurses in total parenteral nutrition (TPN); (2) employ training programs for improving knowledge and practice in management of TPN in new-borns.<strong></strong></p><p><strong>Method: </strong>A quasi-experimental study was carried out in Sarem Maternity Hospital in Tehran, Iran. The study population included nurses working in Neonatal Intensive Care Unit (NICU) who were included in the study using headcount census method (n=30). A two-part questionnaire including demographic information; 20 multiple choice questions on the nurses’ knowledge of TPN therapy and 19-item 3-point Likert-type checklist on administration of TPN completed by observing the nurses’ practice. To examine the reliability of the practice part, Cronbach's alpha method was used (α=0.78). Study interventions were mentoring education by the researcher and researcher-developed training manual and educational video and guidelines about neonatal parenteral nutrition. Before and after intervention data were collected and compared using paired t-test.<strong></strong></p><p><strong>Results: </strong>The mean scores of nurses' knowledge before and afterward parenteral nutrition (PN) training program were 11.93±1.91 and 17.56±1.59, respectively. The mean scores of the nurses' practice earlier and after training program were 38.84±2.96 and 40.15±3.02, respectively. Comparing the mean scores of the nurses' familiarity, before and after taking the training course, demonstrated a significant difference (p&lt;0.0001). The knowledge of the nurses in all areas of parenteral nutrition prescription was significantly improved after the employment of mentoring method (p&lt;0.05). Despite an increase in the post-intervention total score, the nurses’ practice, before and after, the intervention was not statistically significant (p&lt;0.05).<strong></strong></p><p><strong>Conclusion: </strong>There is a breach between nursing knowledge and practice in prescribing parenteral nutrition. The gap between knowledge and practice in this area can lead to more morbidity and negative influences on the infant. Therefore, it is required that the gap between knowledge and practice is known as the infant gets less damage.</p>

scholarly journals Stability of the Glutathione Supplementation into Parenteral Nutrition to Protect Very Preterm Babies from Oxidative Stress

2021 ◽  
Author(s):  
Clémence Guiraut ◽  
Nadine El Raichani ◽  
Guillaume Morin ◽  
Ibrahim Mohamed ◽  
Jean-Claude Lavoie
Keyword(s):  
Oxidative Stress ◽  
Parenteral Nutrition ◽  
Bronchopulmonary Dysplasia ◽  
Preterm Neonates ◽  
Maximum Loss ◽  
Very Preterm ◽  
Premature Babies ◽  
Therapeutic Benefits ◽  
Preterm Babies ◽  
Glutathione Deficiency

Most very premature newborns (&lt; 32 weeks of gestation) receive parenteral nutrition (PN) that is inherently contaminated with peroxides. Oxidative stress induced by PN is associated with bronchopulmonary dysplasia, a main pathological complication in these babies who have weak antioxidant capacity to detoxify peroxides because of their glutathione deficiency. In animals, glutathione supplementation of PN prevented oxidative stress and alveolar loss (the main characteristic of bronchopulmonary dysplasia). Of its two forms - disulfide (GSSG) and free thiol (GSH) - GSSG was used because of its better stability in PN. However, a 30% loss of GSSG in PN is observed. The potentially high therapeutic benefits of GSSG supplementation on the health of very premature babies makes the study of its stability highly important. Thus, GSSG was incubated in combination with the following components of PN: dextrose, multivitamins, Primene, Travasol, as well as with cysteine, cystine and peroxides for 24h. Total glutathione in these solutions was measured 0-24h after the addition of GSSG. The combination of cysteine and multivitamins caused the maximum loss of glutathione. Removing the cysteine prevented the degradation of glutathione. GSSG reacts with cysteine to form cysteine-glutathione disulfide, another suitable glutathione substrate for preterm neonates.

scholarly journals Total Parenteral Nutrition for Neonates

2021 ◽  
Vol 1 (9) ◽  
Author(s):  
Kwakye Peprah ◽  
Melissa Walter
Keyword(s):  
Parenteral Nutrition ◽  
Total Parenteral Nutrition ◽  
Length Of Hospital Stay ◽  
Clinical Effectiveness ◽  
Late Preterm ◽  
Preterm Neonates ◽  
Treatment Groups ◽  
Relevant Evidence ◽  
Significant Difference ◽  
Evidence Based Guidelines

The 2 included studies reported conflicting findings regarding weight gain, length, and time to regained birth weight in moderate-to-late preterm neonates weighing 1,500 g or more at birth treated with peripherally administered parenteral nutrition (P-PN) versus 10% dextrose or dextrose-containing fluids. However, both studies reported no statistically significant difference in safety and other measures such as head circumference, time to full enteral feeds, and length of hospital stay between the treatment groups. The strength of the evidence was limited because analyses of the outcomes did not include measures that could minimize false-positive results, and a definitive conclusion could not be drawn regarding the clinical effectiveness of total parenteral nutrition (TPN) for a term or moderate-to-late preterm neonates weighing 1,500 g or more at birth. No relevant evidence-based guidelines regarding using TPN in term or moderate-to-late preterm neonates weighing 1,500 g or more at birth was identified.

Neonatal Transfusion Practice: When do Neonates Need Red Blood Cells or Platelets?

2016 ◽  
Vol 33 (11) ◽  
pp. 1079-1084 ◽  
Author(s):  
Antonio Del Vecchio ◽  
Caterina Franco ◽  
Flavia Petrillo ◽  
Gabriele D'Amato
Keyword(s):  
Premature Infants ◽  
Neonatal Intensive Care ◽  
Platelet Transfusion ◽  
Evidence Base ◽  
Transfusion Practice ◽  
Red Blood Cell Transfusion ◽  
Preterm Neonates ◽  
Transfusion Trigger ◽  
Extremely Preterm ◽  
Critically Ill Neonates

Based on small studies and not on statistically valid clinical trials, guidelines for neonatal transfusions remain controversial and practices vary greatly. Premature infants and critically ill neonates in the neonatal intensive care unit (NICU) often require blood transfusions and extremely preterm neonates receive at least one red blood cell transfusion during their hospital stay. Transfusions to neonates convey both benefits and risks and consequently it is imperative to establish specific guidelines to improve practice and avoid unnecessary transfusions. Appropriate and lifesaving platelet transfusion in thrombocytopenic bleeding neonates pertains to 2% of all neonates in NICUs. Inversely, 98% of platelet transfusions are given prophylactically, in the absence of bleeding, with the assumption that this reduces the risk of a serious hemorrhage. To date, no evidence base is available for assigning a platelet transfusion trigger to NICU patients. Each NICU should approve specific guidelines that best suit its local clinical practice. Therefore, whatever guidelines are chosen in deciding when to transfuse, what is most important is to adhere strictly to the guidelines adopted, thus limiting unnecessary transfusions that convey no benefits and carry both known and unknown risks.

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