Extrauterine growth restriction is much popular in China and it is still challenge job for pediatricians. This article described the benefits for PICC in route of PN choice. New fat emulsions were appeared recently years, however they are no strong evidence for using in premature infants and need do more clinical trial. Parenteral nutrition associated with liver damage still is a serious complication of TPN and we encourage early enteral feeding, appropriate calore intake, anti sepsis for prevention.
Enteral Nutrition ; Humans ; Infant, Newborn ; Infant, Premature ; Nutritional Support ; Parenteral Nutrition, Total ; adverse effects

BACKGROUND: Lipid emulsions have been used to treat various drug toxicities and for total parenteral nutrition therapy. Their usefulness has also been confirmed in patients with local anesthetic-induced cardiac toxicity. The purpose of this study was to measure the hemodynamic and composition effects of lipid emulsions and to elucidate the mechanism associated with changes in intracellular calcium levels in myocardiocytes. METHODS: We measured hemodynamic effects using a digital analysis system after Intralipid(R) and Lipofundin(R) MCT/LCT were infused into hearts hanging in a Langendorff perfusion system. We measured the effects of the lipid emulsions on intracellular calcium levels in H9c2 cells by confocal microscopy. RESULTS: Infusion of Lipofundin(R) MCT/LCT 20% (1 ml/kg) resulted in a significant increase in left ventricular systolic pressure compared to that after infusing modified Krebs-Henseleit solution (1 ml/kg) (P = 0.003, 95% confidence interval [CI], 2.4-12.5). Lipofundin(R) MCT/LCT 20% had a more positive inotropic effect than that of Intralipid(R) 20% (P = 0.009, 95% CI, 1.4-11.6). Both lipid emulsion treatments increased intracellular calcium levels. Lipofundin(R) MCT/LCT (0.01%) increased intracellular calcium level more than that of 0.01% Intralipid(R) (P < 0.05, 95% CI, 0.0-1.9). CONCLUSIONS: These two lipid emulsions had different inotropic effects depending on their triglyceride component. The inotropic effect of lipid emulsions could be related with intracellular calcium level.
Animals ; Blood Pressure* ; Calcium* ; Drug-Related Side Effects and Adverse Reactions ; Emulsions ; Heart* ; Hemodynamics ; Humans ; Microscopy, Confocal ; Myocardial Contraction ; Parenteral Nutrition, Total ; Perfusion ; Rats* ; Triglycerides

No abstract availble.
Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Pancreatitis, Acute Necrotizing/diagnosis/*therapy ; Parenteral Nutrition, Total/*adverse effects ; Wernicke Encephalopathy/*diagnosis/etiology

OBJECTIVETo observe the therapeutic effects of S-Adenosyl-L-methionine(SAMe) in the treatment of cholestasis after total parenteral nutrition (TPN).

METHODSThirty SD rats were randomly divided into control group, hypercalorie group, hypercalorie adds SAMe group; sepsis group and sepsis adds SAMe group; their stages of cholestasis were compared. Sixteen patients received SAMe because of cholestasis after prolonged TPN.

RESULTSBile flow, serum levels of total bile acid and gamma-glutamyl transpeptidase were elevated markedly in hypercalorie and sepsis groups. Hepatocellular fatty degeneration, dilatation of cholangiole, and bile sludge could be seen microscopically, while SAMe administration in hypercalorie adds SAMe and sepsis adds SAMe groups could increase bile flow, decrease serum total bile acid and gamma-glutamyl transpeptidase levels. Microscopic findings were normal, no dilated cholangiole or bile sludge could be found. Cholestasis and abnormal results of liver function test were the main clinical manifestations of 16 patients before SAMe administration. Three weeks after SAMe administration, their serum levels of total bilirubin, alkaline phosphotase, gamma-glutamyl transpeptidase, alanine aminotransferase(ALT), and aspartate aminotransferase(AST) were decreased markedly; they became normal in the 4 th week.

CONCLUSIONSAMe could prevent and treat cholestasis without discontinuation of TPN.

Adult ; Animals ; Cholestasis ; drug therapy ; metabolism ; pathology ; Female ; Humans ; Liver ; pathology ; Male ; Middle Aged ; Parenteral Nutrition, Total ; adverse effects ; Rats ; Rats, Sprague-Dawley ; S-Adenosylmethionine ; therapeutic use

Cholestasis ; etiology ; physiopathology ; therapy ; Female ; Humans ; Liver Diseases ; drug therapy ; etiology ; physiopathology ; Male ; Neonatology ; Parenteral Nutrition, Total ; adverse effects ; S-Adenosylmethionine ; therapeutic use ; Ursodeoxycholic Acid ; therapeutic use

OBJECTIVEPeripherally inserted central catheter (PICC) is widely used to provide a long-term access for the administration of total parenteral nutrition and medications. Catheter-related infections (CRI) are common complications of PICC. The purpose of this retrospective study was to investigate the role of low-dose heparin added to the total nutrient admixture (CTNA) in the prevention of CRI.

METHODSEighty-three neonates who underwent PICC received TNA with (heparin group, n=43) or without heparin (0.5 U/mL) (control group, n=40). The incidence of CRI was compared between the two groups.

RESULTSThe incidences of catheter obstruction (5% vs 20%) and the catheter-tip colonization (2% vs 18%) in the heparin group were significantly lower than those in the control group (p<0.05). None of the neonates in the heparin group had clinical evidence of catheter-related bloodstream infection, but 5 cases in the control group (p<0.05).

CONCLUSIONSThe administration of low-dose heparin in TNA may decrease the incidences of catheter obstruction and CRI.

Catheter-Related Infections ; epidemiology ; prevention & control ; Catheterization, Central Venous ; adverse effects ; Female ; Heparin ; administration & dosage ; Humans ; Incidence ; Infant, Newborn ; Male ; Parenteral Nutrition, Total ; Retrospective Studies

BACKGROUNDEarly enteral feeding (EF) may result in fever, elevated white blood cell count, increased serum levels of liver enzymes, and diarrhea. We name the complications "enteral refeeding syndrome", as a subtype of refeeding syndrome, because they are likely to result from long-term lack of lumen nutrition. The aim of this study was to investigate the characteristics of enteral refeeding syndrome after long-term total parenteral nutrition (TPN), and the solution for the disease.

METHODSWe collected the clinical data of 100 patients with gastrointestinal fistula, who were cured from Apirl 2001 to July 2002. Their fasting time, daily stool frequency, body temperature, heart rate, respiratory rate, levels of transaminases, alkaline phosphatase (AKP), and gamma-glutamylcyclotransferase (gamma-GT), white blood cell count, and systemic inflammatory reaction syndrome (SIRS) score were recorded before and 1, 3, 5, 10, and 15 days after EF. Student's t test and analysis of variance were used to analyze the data.

RESULTSOf the 100 patients, 56 were cured after selective resection of intestinal fistula, 15 were cured by emergency operation, and 29 recovered spontaneously. The levels of AKP and gamma-GT increased significantly on the 3rd day after EF [On the 3rd day after EF, (243.0 +/- 121.6) U/L and (177.2 +/- 109.9) U/L vs. before EF (181.5 +/- 127.5) U/L and (118.4 +/- 94.2) U/L, P < 0.05], and decreased gradually afterwards. The SIRS scores on the 1st day (1.05 +/- 1.08) and 3rd day (0.96 +/- 1.11) after EF were significantly higher than that before EF (0.72 +/- 0.84), then decreased to 0.83 +/- 0.91, 0.49 +/- 0.73 and 0.32 +/- 0.60 on the 5th, 10th and 15th days after EF. The number of patients with diarrhea at 1, 3, 5, 10 and 15 days post-EF were 31, 26, 12, 13, and 7, respectively.

CONCLUSIONSThe longer the TPN lasts, the more severe the enteral refeeding syndrome becomes. Continuous EF is effective for the syndrome. Early enteral nutrition is useful in preventing it.

Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Diarrhea ; etiology ; Enteral Nutrition ; adverse effects ; Female ; Humans ; Infant ; Jaundice ; etiology ; Leukocyte Count ; Male ; Middle Aged ; Parenteral Nutrition, Total ; adverse effects ; Syndrome ; Systemic Inflammatory Response Syndrome ; etiology ; gamma-Glutamyltransferase ; blood

Anti-Bacterial Agents ; administration & dosage ; Catheterization, Central Venous ; adverse effects ; Catheters, Indwelling ; adverse effects ; Female ; Humans ; Hydrothorax ; diagnosis ; etiology ; Jugular Veins ; Middle Aged ; Parenteral Nutrition, Total ; Pleural Effusion ; diagnosis ; etiology

BACKGROUNDDamage to the gut barrier often occurs during critical illnesses. In such cases, it is very important to alleviate impairment of the intestinal barrier and protect intestinal barrier function. This study investigated the protective effect of growth hormone on intestinal barrier function in rats under stress.

METHODSThis study consisted of prospective, randomized, and controlled animal experiments. Twenty-five Sprague-Dawley rats served as total parenteral nutrition (TPN) models and were divided into three groups: TPN group, sepsis (Sep) group, and growth hormone (GH) group. Another 8 rats served as normal controls. Each group received different stress stimuli. Rats were fed for 7 days, and samples were taken for examination 24 hours after gavaging with dual saccharides.

RESULTSThe architecture of the small intestinal mucosa in the Sep group showed the most severe damage among all groups. Nitric oxide levels in blood plasma and immunoglobulin A levels in the intestinal mucosa of the GH group were significantly lower than in the Sep group (P < 0.02). There were no significant changes in CD3 counts and in the CD4/CD8 ratio between the four groups. Dual sugar tests and bacteriological examinations revealed that intestinal permeability and rate of bacterial translocation in the GH group were lower than in the Sep group (P < 0.01, respectively).

CONCLUSIONProphylactic treatment with growth hormone can alleviate damage to intestinal barrier function caused by trauma and endotoxemia in rats under stress.

Animals ; Bacterial Translocation ; drug effects ; Growth Hormone ; therapeutic use ; Intestinal Mucosa ; drug effects ; physiology ; Parenteral Nutrition, Total ; adverse effects ; Prospective Studies ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Stress, Physiological ; physiopathology

PURPOSE: Little research has been conducted on adverse drug reactions in neonates, particularly in Korea, where no studies have been reported. METHODS: We conducted a retrospectively study using medical records in a neonatal intensive care unit from August 1, 2013 to July 31, 2014. The adverse drug reactions were evaluated according to the Naranjo algorithm, World Health Organization-Uppsala Monitoring Centre, and the Korean adverse drug reaction algorithm. RESULTS: Of the 410 infants hospitalized during the study period, 57 cases of adverse drug reactions were reported in 40 infants (9.8%). The average gestational age was 28.4+/-4.3 weeks, the average birth weight was 1,184.1+/-622.0 g, and the adverse drug reactions were reported at an average of 21.0+/-29.7 days after birth. Causative agents were identified as electrolytes (36.8%), respiratory medication (14.0%), total parenteral nutrition (12.3%), lipid emulsion (10.5%), antibiotics (7.0%), non-steroidal anti-inflammatory drugs (NSAIDs, 7.0%), sedatives (7.0%), vaccine (3.5%), and an antiviral medication (1.8%). Of the 57 cases, 55 (96.5%) cases demonstrated meaningful adverse drug reactions, defined as those given a score of "possible or above" in all 3 adverse drug reaction algorithms. CONCLUSION: More emphasis is warranted in the field of neonatal adverse drug reactions.
Anti-Bacterial Agents ; Birth Weight ; Drug-Related Side Effects and Adverse Reactions* ; Electrolytes ; Gestational Age ; Humans ; Hypnotics and Sedatives ; Infant ; Infant, Newborn ; Intensive Care, Neonatal* ; Korea ; Medical Records ; Parenteral Nutrition, Total ; Parturition ; Retrospective Studies ; World Health