Incidence and Risk Factors of Total Parenteral Nutrition Associated Complications in Preterm Infants

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.

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Successful Combined Treatment with Total Parenteral Nutrition Fluid Extravasation Injuries in Preterm Infants

Journal of Korean Medical Science ◽

10.3346/jkms.2007.22.3.588 ◽

2007 ◽

Vol 22 (3) ◽

pp. 588 ◽

Cited By ~ 13

Author(s):

Ky Young Cho ◽

Soo Jung Lee ◽

Jin Sik Burm ◽

Eun Ae Park

Keyword(s):

Parenteral Nutrition ◽

Total Parenteral Nutrition ◽

Preterm Infants ◽

Combined Treatment ◽

Fluid Extravasation

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Associative Tolerance of Intravenously Administered Lipid and Gestational Age in Preterm Infants Receiving Total Parenteral Nutrition

Macedonian Journal of Medical Sciences ◽

10.3889/mjms.1857-5773.2009.0032 ◽

2009 ◽

Vol 2 (1) ◽

pp. 63-68 ◽

Cited By ~ 3

Author(s):

Snezhana Palchevska-Kocevska ◽

Ljiljana Kojik

Keyword(s):

Parenteral Nutrition ◽

Total Parenteral Nutrition ◽

Preterm Infants ◽

Gestational Age

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Correction: Serial arginine and citrulline levels and nitric oxide production in preterm Infants while weaning off total Parenteral nutrition

Journal of Investigative Medicine ◽

10.1136/jim-2018-000974.665.corr1 ◽

2019 ◽

Vol 67 (4) ◽

pp. 770-770

Keyword(s):

Nitric Oxide ◽

Parenteral Nutrition ◽

Total Parenteral Nutrition ◽

Preterm Infants ◽

Nitric Oxide Production ◽

Oxide Production

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Risk factors and outcomes for hyperbilirubinaemia after heart surgery in children

Cardiology in the Young ◽

10.1017/s1047951120000967 ◽

2020 ◽

Vol 30 (6) ◽

pp. 761-768

Author(s):

Daniel M. Pasternack ◽

Manal AlQahtani ◽

Rafael Zonana Amkie ◽

Lisa J. Sosa ◽

Marcelle Reyes ◽

...

Keyword(s):

Risk Factors ◽

Cardiac Surgery ◽

Length Of Stay ◽

Parenteral Nutrition ◽

Extracorporeal Membrane Oxygenation ◽

Total Parenteral Nutrition ◽

Morbidity And Mortality ◽

Prolonged Length ◽

Conjugated Hyperbilirubinaemia ◽

Neonates And Infants

AbstractIntroduction:Liver dysfunction, associated with morbidity and mortality, is common in patients with CHD. We investigate risk factors for and outcomes of hyperbilirubinaemia in neonates and infants after cardiac surgery.Materials and methods:In a retrospective analysis of neonates and infants undergoing cardiac surgery at our institution between January 2013 and December 2017, we identified those with post-operative conjugated hyperbilirubinaemia. We tested various demographic and surgical risk factors, and use of post-operative interventions, for an association with conjugated hyperbilirubinaemia. We also tested hyperbilirubinaemia for association with post-operative mortality and prolonged length of stay.Results:We identified 242 post-operative admissions, of which 45 (19%) had conjugated hyperbilirubinaemia. The average conjugated bilirubin level in this group was 2.0 mg/dl versus 0.3 mg/dl for peers without hyperbilirubinaemia. The post-operative use of both extracorporeal membrane oxygenation (OR 4.97, 95% CI 1.89–13.5, p = 0.001) and total parenteral nutrition (OR 2.98, 95% CI 1.34–7.17, p = 0.010) was associated with conjugated hyperbilirubinaemia. No demographic variable analysed was found to be a risk factor. Hyperbilirubinaemia was associated with higher odds of mortality (OR 3.74, 95% CI 2.69–13.8, p = 0.005) and prolonged length of stay (OR 2.87, 95% CI 2.02–7.97, p = 0.005), which were independent of other risk factors.Discussion:We identified the post-operative use of total parenteral nutrition and extracorporeal membrane oxygenation as risk factors for hyperbilirubinaemia. These patients were more likely to experience morbidity and mortality than control peers. As such, bilirubin may be marker for elevated risk of poor post-operative outcomes and should be more frequently measured after cardiac surgery.

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