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

OBJECTIVETo evaluate the efficacy and safety of the parenteral administration of various quantities of amino acid in preterm infants.

METHODSPreterm infants (birth weight 1000-2000 g) recruited into the study were randomized into three groups. High amino acid group (HP): 2.4 g/(kg.d) of amino acid IV within 24 hours after birth increasing by increments of 1.2 g/(kg.d) to a maximum of 3.6 g/(kg. d); medium amino acid group (MP): 1.0 g/(kg.d) of amino acid IV 24 hours after birth, increasing by increments of 0.5 g/(kg.d) until a maximum of 3.0 g/(kg.d); and low amino acid group (LP): 0.5 g/(kg.d) of amino acid on D3, increasing by increments of 0.5 g/(kg.d) until a maximum of 3.0 g/(kg.d) as the final dose.

RESULTSTotally 96 preterm infants were recruited: HP 34, MP 32 and LP 30. There were no significant differences in demographic or clinical characteristics among the 3 groups. HP group showed lower postnatal weight loss (43.4 g, 95% CI 74.3, 12.6) and weight loss% (2.84%, 95% CI 4.79%, 0.71%) than LP group. HP group showed shorter length of stay in NICU (5.25 d), days to reach 2000 g (7.03 d) and days to tolerate 100 kcal/(kg.d) enteral nutrition (4.52 d) than LP group. Cost of hospitalization was significantly lower in HP group than in LP group (-6275 RMB, 1 US$=8 RMB) and MP group (-5715 RMB). Mean serum RBP (D4), threonine and tyrosine levels were significantly higher in HP group than in LP group. Serum insulin levels were similar; mean serum glucose level was lower in HP group than in LP group. HP infants had lower incidence of sepsis than LP infants (21.9% vs 40.0%). There were no significant differences in the levels of blood ammonia, acid-base balance (as determined by pH and NaHCO3-), BUN, Cr, AST, and ALT.

CONCLUSIONSIntensive and early administration of intravenous amino acid [2.4 g/(kg.d)] improves preterm infants' growth and the tolerance of enteral feeding. It also reduces the cost of hospitalization, and the incidence of sepsis.

Amino Acids ; administration & dosage ; adverse effects ; Humans ; Infant, Newborn ; Infant, Premature ; Parenteral Nutrition

OBJECTIVETo investigate the high-risk factors for parenteral nutrition-associated cholestasis (PNAC), which is the most common complication of parenteral nutrition for infants, in very low birth weight infants (VLBWIs).

METHODSRetrospective analysis was performed on the clinical and laboratory data of 204 VLBWIs who received parenteral nutrition for over 2 weeks in the neonatal intensive care unit from August 2006 to December 2011. The infants'liver function was evaluated periodically before and after Parenteral nutrition. Univariate analysis and multivariate analysis were performed in the observation (PNAC) and control (without PNAC) groups.

RESULTSPNAC occurred in 46 (22.5%) of the 204 VLBWIs. Univariate analysis showed that continuous positive airway pressure (CPAP) ventilation, respiration failure, respiratory distress syndrome (RDS), bronchopulmonary dysplasia (BPD) and retinopathy of prematurity (ROP) were significantly increased in the observation group compared with the control group. The observation group had lower birth weights, longer duration of ventilation, later breast feeding beginning, longer duration of fasting, longer duration of parenteral nutrition, and higher cumulated amino acid and lipid emulsion intake. Logistic regression analysis revealed that duration of fasting was a high-risk factor for PNAC (OR=1.115, 95%CI: 1.031-1.207).

CONCLUSIONSMany risk factors are associated with PNAC. Early enteral nutrition and short duration of parenteral nutrition are helpful in preventing the incidence of PNAC in VLBWIs.

Cholestasis ; etiology ; prevention & control ; Humans ; Infant, Newborn ; Infant, Very Low Birth Weight ; Logistic Models ; Parenteral Nutrition ; adverse effects ; Risk Factors

Parenteral nutrition (PN) is a life saving and support therapy for critical newborn infants. Parenteral nutrition-associated cholestasis (PNAC) is one of its common complications. This article focuses on the risk factors for PNAC in newborn infants in both non-nutrient and nutrient associated risk factors. The main risk factors include prematurity, small for gestational age, prolonged PN, diseases (especially sepsis and necrotizing enterocolitis), delayed or less proportional enteral nutrition, non cyclic PN, amino acids/lipids composition and dosage, energy supply and trace elements contents.
Cholestasis ; etiology ; Humans ; Infant, Newborn ; Infant, Premature ; Infant, Small for Gestational Age ; Parenteral Nutrition ; adverse effects ; Risk Factors

OBJECTIVETo analyze the clinical features and influential factors of parenteral nutrition associated cholestasis (PNAC) in preterm infants.

METHODA total of 159 infants with birth weight less than 2000 grams and/or gestational age less than 34 weeks were exposed to parenteral nutrition for longer than 14 days in NICU during the period from July 2007 to June 2009. Of these infants, 40 cases who had PNAC were aligned into the PNAC group, and the other 119 cases without PNAC were aligned into the non-PNAC group. PNAC occurring time, duration, the degree of PNAC and hepatic injury were observed. Logistic regression analysis was performed to evaluate the correlative factors of PNAC.

RESULTPNAC occurred about (3.3 ± 1.6) weeks after beginning PN, usually lasted for (13.3 ± 5.4) weeks. The maximum direct bilirubin was (135.2 ± 65.5) µmol/L. Of the PNAC patients, 73.7% suffered from hepatic injury. Hepatic injury usually occurred (6.6 ± 3.0) weeks after beginning PN, and lasted for (9.5 ± 5.4) weeks. The highest alanine aminotransferase (ALT) was (121.5 ± 48.4) U/L. The logistic regression of the possible correlative factors showed that time to start enteric feeding, persistence time of PN, asphyxia, small for gestational age, intracranial hemorrhage, were related to PNAC.

CONCLUSIONThe prognosis of PNAC was good. Early enteral feeding, shorter time of PN, avoidance of the complications such as asphyxia and sepsis, were the important measures to lower PNAC.

Cholestasis ; diagnosis ; etiology ; Humans ; Infant, Newborn ; Infant, Premature ; Infant, Very Low Birth Weight ; Parenteral Nutrition ; adverse effects

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

The efficacy and safety of using umbilical venous catheters vs. peripheral venous catheters for the delivery of parenteral nutrition was studied in 129 critically ill premature infants who were treated in a neonatal intensive care unit for the first 3 weeks of life. Infants who received parenteral nutrition by umbilical venous catheter had greater parenteral caloric intake, lower physiologic weight loss and greater weight gain during the study as compared to infants who received parenteral nutrition by peripheral vein. While the overall incidence of sepsis was comparable in both groups (19% vs 19.7%), benign and transient episodes of hyperglycemia were seen more commonly in infants receiving parenteral nutrition by umbilical catheters. None of the hyperglycemic infants, however, required insulin therapy. The incidence of other metabolic complication was comparable in both groups. At follow up, no evidence of portal hypertension was detected in any of the infants up to 66 months of age treated with umbilical venous catheters. We conclude that the use of umbilical venous catheter allows for a comparably safe and a more appropriate parenteral nutrition support than peripheral catheters in critically ill premature neonates.
*Catheterization, Peripheral ; Comparative Study ; Female ; Human ; Infant, Newborn ; *Infant, Premature ; Male ; Parenteral Nutrition/adverse effects/*methods ; Respiratory Distress Syndrome/*therapy ; Retrospective Studies ; *Umbilical Veins

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

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

OBJECTIVESome neonates especially premature infants, low birth weight infants and extremely low birth weight infants have limited endogenous energy stores. It is necessary to establish continuous administration of postnatal nutrition. The use of parenteral nutrition (PN) in neonates with immaturity of digestive system and intentionally delayed feedings has gained widespread acceptance. PN has been shown to provide sufficient nutrients to maintain growth in newborn infants. The major complication of PN in neonates is PN-associated cholestasis (PNAC). It remains a significant and frequent clinical problem for neonatal practitioners. In some cases, progressive liver damage, liver failure and death may become inevitable. In order to analyze the risk factors of the PNAC in neonates and to provide the evidence of safety and efficiency in clinical nutrition support, the clinical data of 612 neonates who had received PN for more than 5 days during the past 20 years were reviewed.

METHODSRetrospective analysis on data collected from April 1985 to March 2005 was performed. The records of 612 neonates were divided into two groups according to the established Nutrition Support Team (NST) in our hospital. Each group included two sub-groups. Seventy neonates of the first group were divided into PNAC group (n = 6) and non-PNAC group (n = 64); these patients were seen between 1st April 1985 and 31st March 1995. The remaining 542 neonates of the second group who were also divided into 2 groups, i.e. PNAC group (n = 12) and non-PNAC group (n = 530) who were seen from 1st April 1995 through 31st March 2005. The incidence of PNAC between the first group and the second group was compared and the associated factors were analyzed. The PNAC was defined when serum level of direct-bilirubin exceeded 1.5 mg/dl or direct-bilirubin greater than 50% of the bilirubin and excluding cholestasis resulted from other diseases.

RESULTSThe total incidence of PNAC in neonates who had received TPN for more than 5 days was 2.94%. The incidence of PNAC of the first and the second decade was 8.57% and 2.21%, respectively (OR = 0.242, 95% CI = 0.088 approximately 0.666). The average gestational age (GA) and birth weight (BW) of PNAC group were less than those of the non-PNAC group (GA: (33 +/- 5) w vs. (36 +/- 4) w, P = 0.009; OR = 0.827, 95% CI = 0.698 approximately 0.980. BW: (2003 +/- 743) g vs. (2393 +/- 764) g, P = 0.045; OR = 1.001, 95% CI = 0.999 approximately 1.002). The PN duration and calorie intake of PNAC group was longer than that of the non-PNAC group (PN duration: 32 +/- 30 d vs. (13 +/- 10) d, P = 0.000; OR = 1.072, 95% CI = 1.032 approximately 1.112. Calorie intake: [(272 +/- 46) kJ/(kg.d)] [(65.0 +/- 10.9) kcal/(kg.d)] (1 kcal = 4.184 kJ) vs. [(232 +/- 55) kJ/(kg.d) (55.5 +/- 13.1) kcal/(kg.d)], (P = 0.002; OR = 1.066, 95% CI = 1.012 approximately 1.122), but the weight gain in the non-PNAC group had a tendency to increase as compared to that of the PNAC group [(20 +/- 27) g/d vs. (9 +/- 19) g/d, P = 0.175].

CONCLUSIONSThe incidence of PNAC was associated with the longer duration of PN, the smaller age at initiation of PN, the higher calorie intake, prematurity and lower birth weight. Establishment of the nutrition support team can normalize the practice of the PN administration and decrease the incidence of the complication with nutrition support. It is a favorable mode and it can provide a safer, more effective and reasonable means in clinical nutrition support. To avoid PNAC, it is suggested that the administration of enteric feeding should start as soon as possible, which may enhance effective contraction of gallbladder and secretion of gastrointestinal hormones, and it is best to avoid high calorie of PN and control the calorie intake under 251.04 approximately 334.72 kJ/(kg.d) [60 approximately 80 kcal/(kg.d)].

Cholestasis ; complications ; epidemiology ; etiology ; Female ; Gestational Age ; Humans ; Incidence ; Infant ; Infant, Low Birth Weight ; physiology ; Infant, Newborn ; Infant, Premature ; growth & development ; Male ; Parenteral Nutrition ; adverse effects