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Intravenous Feeding in Infants and Children

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A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Pediatric Nutrition".

Deadline for manuscript submissions: closed (20 April 2023) | Viewed by 28648

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Dr. Miguel Saenz de Pipaon

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Guest Editor

Department of Neonatology, Hospital Universitario La Paz, Department of Pediatrics, Universidad Autonoma de Madrid, 28046 Madrid, Spain
Interests: preterm and term infant parenteral and enteral nutrition; feeding
Special Issues, Collections and Topics in MDPI journals

Dr. Walter A. Mihatsch

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Guest Editor

Department of Pediatrics, Ulm University, 89075 Ulm, Germany；Department of Health Management, Neu-Ulm University of Applied Sciences, 89231 Neu-Ulm, Germany
Interests: parenteral nutrition of infants
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Infants and children who cannot sufficiently be fed by the enteral route depend on parenteral nutrition. In 2005, evidence-based guidelines on pediatric parenteral nutrition were published by the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and the European Society for Clinical Nutrition and Metabolism (ESPEN), supported by the European Society of Paediatric Research (ESPR). To provide up-to-date clear guidance, in 2018, these guidelines were revised by the same three organizations (ESPEN, ESPGHAN, ESPR) together with the Chinese Society of Parenteral and Enteral Nutrition (CSPEN). During the guideline developing process, research gaps and priorities where more studies are required in order to refine recommendations were defined by the ESPEN, ESPGHAN, ESPR, and CSPEN working group on pediatric parenteral nutrition. Recently, a consensus paper was published to share these research gaps and priorities with the scientific community to focus resources and attract scientists and scholars into collaborative work around these research goals. The highest research priority was given to the effects of parenteral macro- and micronutrient intakes on long-term metabolic function and neurocognitive outcomes.

The aim of the of the present Special Issue of Nutrients is to share up-to-date research and developments in pediatric parenteral nutrition in order to further promote research within this most important field.

Dr. Miguel Saenz de Pipaon
Dr. Walter A. Mihatsch
Guest Editors

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Keywords

pediatric
parenteral nutrition
intravenous feeding
macronutrients
micronutrients
organisation

Published Papers (12 papers)

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15 pages, 3520 KiB

Open AccessArticle

Assessment of the Adherence to ESPGHAN 2018 Guidelines in the Neonatal Intensive Care Unit of the Ghent University Hospital: A Retrospective Study

by Joeri De Cloet, Ine Simal, Karel Benoot and Linde Goossens

Nutrients 2023, 15(10), 2324; https://0-doi-org.brum.beds.ac.uk/10.3390/nu15102324 - 16 May 2023

Cited by 1 | Viewed by 1196

Abstract

Parenteral nutrition (PN) is a standard of care for preterm infants in the first postnatal days. The European Society of Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) has updated their guideline recommendations on PN in 2018. However, data on actual 2018 guideline adherence in clinical practice are sparse. In this retrospective study, conducted at the neonatal intensive care unit (NICU) of Ghent University Hospital, we analyzed the ESPGHAN 2018 PN guideline adherence and growth for 86 neonates admitted to the NICU. Analyses were stratified by birth weight (<1000 g, 1000 to <1500 g, ≥1500 g). We documented the provisions for enteral nutrition (EN) and PN, and we tested the combined EN and PN provisions for ESPGHAN 2018 adherence. The nutrition protocols showed a high adherence to PN guidelines in terms of carbohydrate provisions, yet lipid provisions for EN and PN often exceeded the recommended maximum of 4 g/kg/d; although, PN lipid intakes maxed out at 3.6 g/kg/d. Protein provisions tended to fall below the recommended minimum of 2.5 g/kg/d for preterm infants and 1.5 g/kg/d for term neonates. The energy provisions also tended to fall below the minimum recommendations, especially for neonates with a birth weight (BW) < 1000 g. Over a mean PN duration of 17.1 ± 11.4 d, the median weekly Fenton Z-scores changes for length, weight, and head circumference were positive for all BW groups. Future studies have to assess how protocols adapt to current guidelines, and how this affects short- and long-term growth across different BW groups. In conclusion, the reported findings provide real-world evidence regarding the effect of ESPGHAN 2018 PN guideline adherence, and they demonstrate how standardized neonatal PN solutions can safeguard stable growth during NICU stays. Full article

(This article belongs to the Special Issue Intravenous Feeding in Infants and Children)

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9 pages, 384 KiB

Open AccessArticle

Exclusive Fish Oil Lipid Emulsion Rescue Strategy Improves Cholestasis in Neonates on Partially Fish Oil-Based Lipid Emulsion: A Pilot Study

by David Ramiro-Cortijo, Sonia Del Pozo Arribas, Lidia Inisterra Viu, Natalia García Vázquez and Miguel Saenz de Pipaon

Nutrients 2023, 15(3), 509; https://0-doi-org.brum.beds.ac.uk/10.3390/nu15030509 - 18 Jan 2023

Viewed by 1715

Abstract

Resolution of parenteral nutrition-associated liver disease has been identified in infants receiving SMOFlipid™ or a 100% fish oil lipid emulsion (FOLE). However, the effect of FOLE is unknown when the previous emulsion received is a mixed lipid emulsion containing fish oil. This observational pilot study reports data regarding the use of Omegaven™ after the diagnosis of cholestasis while receiving SMOFlipid™. We conducted a retrospective review of medical charts of neonates in which a partially fish oil-based lipid emulsion was replaced by a fish oil lipid emulsion at 1 g/kg/day due to cholestasis. Thirty-eight infants (92.1% preterm, being 44.7% born below 28 weeks’ gestation), received FOLE. Birth weight was 1390 (743.0; 2298) grams. The age that cholestasis diagnosed was 15.0 (10.0; 24.8) days. The fish oil emulsion was administered for 38.5 (11.2; 51.8) days. In 73.7% (28/38) of the neonates, the cholestasis was resolved. In 34.2% (13/38), resolution happened before FOLE discontinuation. In addition, in the rest of the neonates (15) in whom cholestasis resolved, resolution occurred after FOLE discontinuation. Nine of the neonates died. In conclusion, the use of a 100% fish oil-based emulsion in neonates afflicted with cholestasis developed while on a partially fish oil-based emulsion is associated with a bilirubin decrease. Full article

(This article belongs to the Special Issue Intravenous Feeding in Infants and Children)

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15 pages, 658 KiB

Open AccessArticle

Association between Adherence to the Healthy Food Pyramid and Breast Milk Fatty Acids in the First Month of Lactation

by David Ramiro-Cortijo, Gloria Herranz Carrillo, Andrea Gila-Diaz, Santiago Ruvira, Pratibha Singh, Cheyenne Braojos, Camilia R. Martin and Silvia M. Arribas

Nutrients 2022, 14(24), 5280; https://0-doi-org.brum.beds.ac.uk/10.3390/nu14245280 - 11 Dec 2022

Cited by 1 | Viewed by 2161

Abstract

In lactating women, breast milk (BM) fatty acids may come from the diet or stored adipose tissue. Our objective was to evaluate the influence of the adherence to the healthy food pyramid (HFP), the dietary pattern in the Mediterranean region, and the maternal body composition on the BM fatty acids pattern. Fifty breastfeeding women answered a socioeconomic survey and the adherence to the HFP questionnaire (AP-Q). In addition, they provided a BM sample at 7 ± 1, 14 ± 1, and 28 ± 1 days postpartum. The body’s composition was analyzed at days 7 and 28 by bioimpedance. The BM fatty acids were analyzed by gas chromatography–mass spectroscopy. We found a negative association between the consumption of olive oil and the BM palmitic acid levels (β = −3.19 ± 1.40; p = 0.030), and the intake of cereals and legumes was positively associated with the BM saturated fatty acids (β = 11.48 ± 3.87; p = 0.005). The intake of proteins and vegetables was positively associated with the omega-3 fatty acids and negatively with the omega-6:omega-3 ratio in BM. A negative association between the maternal age (β = −0.43 ± 0.11; p = 0.001) and the α-linolenic acid (ALA) levels was observed, being overall AP-Q positively associated with the ALA levels (β = 0.39 ± 0.15; p = 0.016). Physical activity reduced both the omega-3 and omega-6 fatty acids in BM. Diet had a larger influence than the maternal body’s composition on BM fatty acids during the first month of lactation, demonstrating a better adherence to the HFP and positively impacting on the omega-3 content in BM, a fact that is modulated by one’s maternal age. Full article

(This article belongs to the Special Issue Intravenous Feeding in Infants and Children)

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12 pages, 977 KiB

Open AccessArticle

Effects of Early versus Standard Central Line Removal on the Growth of Preterm Infants with Very Low Birth Weight: A Non-Inferiority, Randomized Clinical Trial

by Justyna Romańska, Tomasz Wawrzoniak, Paweł Krajewski, Joanna Seliga-Siwecka, Natalia Brunets, Izabela Lehman, Renata Bokiniec, Ewa Adamska, Barbara Królak-Olejnik, Jan Modzelewski and Tomasz Szczapa

Nutrients 2022, 14(22), 4766; https://0-doi-org.brum.beds.ac.uk/10.3390/nu14224766 - 11 Nov 2022

Viewed by 1360

Abstract

Very preterm infants are usually supported by parenteral nutrition delivered through central lines (CLs) while progressing with enteral intake, although the optimal time point for their removal is unclear. This study evaluated the impact of the CL discontinuation time on the short-term growth outcomes of preterm infants. A non-inferiority, parallel-group, randomized controlled trial was conducted in four neonatal intensive care units in Poland. Preterm infants with very low birth weight (VLBW) without congenital abnormalities were eligible. Patients were allocated to discontinue central access at an enteral feeding volume of 100 mL/kg/day (intervention group) or 140 mL/kg/day (control group). The study’s primary outcome was weight at 36 weeks’ postmenstrual age, with a non-inferiority margin of −210 g. Overall, 211 patients were allocated to the intervention or control groups between January 2019 and February 2021, of which 101 and 100 were eligible for intention-to-treat analysis, respectively. The mean weight was 2232 g and 2200 g at 36 weeks’ postmenstrual age in the intervention and control groups, respectively. The mean between-group difference was 32 g (95% confidence interval, −68 to 132; p = 0.531), which did not cross the specified margin of non-inferiority. No intervention-related adverse events were observed. Early CL removal was non-inferior to the standard type for short-term growth outcomes in VLBW infants. Full article

(This article belongs to the Special Issue Intravenous Feeding in Infants and Children)

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11 pages, 291 KiB

Open AccessArticle

Management of Central Venous Catheters in Children and Adults on Home Parenteral Nutrition: A French Survey of Current Practice

by Julien Gotchac, Florian Poullenot, Dominique Guimber, Emmanuelle Ecochard-Dugelay, Stéphane Schneider, Noël Peretti, Lore Billiauws, Corinne Borderon, Anne Breton, Emilie Chaillou Legault, Cécile Chambrier, Aurélie Comte, Marie-Edith Coste, Djamal Djeddi, Béatrice Dubern, Claire Dupont, Lucile Espeso, Philippe Fayemendy, Nicolas Flori, Ginette Fotsing, Swellen Gastineau, Olivier Goulet, Emeline Guiot, Adam Jirka, Jeanne Languepin, Sabrina Layec, Didier Quilliot, Laurent Rebouissoux, David Seguy, Isabelle Talon, Anne Turquet, Marjolaine Vallee, Stéphanie Willot, Thierry Lamireau and Raphael Enaud Show full author list Hide full author list

Nutrients 2022, 14(12), 2532; https://0-doi-org.brum.beds.ac.uk/10.3390/nu14122532 - 18 Jun 2022

Cited by 3 | Viewed by 1939

Abstract

Although central venous catheter (CVC)-related thrombosis (CRT) is a severe complication of home parenteral nutrition (HPN), the amount and quality of data in the diagnosis and management of CRT remain low. We aimed to describe current practices regarding CVC management in French adult and pediatric HPN centers, with a focus on CVC obstruction and CRT. Current practices regarding CVC management in patients on HPN were collected by an online-based cross-sectional survey sent to expert physicians of French HPN centers. We compared these practices to published guidelines and searched for differences between pediatric and adult HPN centers’ practices. Finally, we examined the heterogeneity of practices in both pediatric and adult HPN centers. The survey was completed by 34 centers, including 21 pediatric and 13 adult centers. We found a considerable heterogeneity, especially in the responses of pediatric centers. On some points, the centers’ responses differed from the current guidelines. We also found significant differences between practices in adult and pediatric centers. We conclude that the management of CVC and CRT in patients on HPN is a serious and complex situation for which there is significant heterogeneity between HPN centers. These findings highlight the need for more well-designed clinical trials in this field. Full article

(This article belongs to the Special Issue Intravenous Feeding in Infants and Children)

7 pages, 1077 KiB

Open AccessArticle

The Impact of Restricted versus Liberal Early Fluid Volumes on Plasma Sodium, Weight Change, and Short-Term Outcomes in Extremely Preterm Infants

by Barbro Diderholm, Erik Normann, Fredrik Ahlsson, Richard Sindelar and Johan Ågren

Nutrients 2022, 14(4), 795; https://0-doi-org.brum.beds.ac.uk/10.3390/nu14040795 - 14 Feb 2022

Cited by 3 | Viewed by 2569

Abstract

The optimal fluid requirements for extremely preterm infants are not fully known. We examined retrospectively the fluid intakes during the first week of life in two cohorts of extremely preterm infants born at 22–26 weeks of gestation before (n = 63) and after a change from a restrictive to a more liberal (n = 112) fluid volume allowance to improve nutrient provision. The cohorts were similar in gestational age and birth weight, but antenatal steroid exposure was more frequent in the second era. Although fluid management resulted in a cumulative difference in the total fluid intake over the first week of 87 mL/kg (p < 0.001), this was not reflected in a mean weight loss (14 ± 5% at a postnatal age of 4 days in both groups) or mean peak plasma sodium (142 ± 5 and 143 ± 5 mmol/L in the restrictive and liberal groups, respectively). The incidences of hypernatremia (>145 and >150 mmol/L), PDA ligation, bronchopulmonary dysplasia, and IVH were also similar. We conclude that in this cohort of extremely preterm infants a more liberal vs. a restricted fluid allowance during the first week had no clinically important influence on early changes in body weight, sodium homeostasis, or hospital morbidities. Full article

(This article belongs to the Special Issue Intravenous Feeding in Infants and Children)

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10 pages, 606 KiB

Open AccessArticle

Children with Intestinal Failure Maintain Their Renal Function on Long-Term Parenteral Nutrition

by Anat Guz Mark, Shelly Levi, Miriam Davidovits, Luba Marderfeld and Raanan Shamir

Nutrients 2021, 13(10), 3647; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13103647 - 18 Oct 2021

Cited by 4 | Viewed by 2098

Abstract

Background: Long-term parenteral nutrition (PN) has been associated with renal complications, including hypercalciuria, nephrocalcinosis, proteinuria and reduced glomerular filtration rate (GFR). Pediatric data are scarce and mostly short-term. Our study aimed to evaluate renal complications in children with intestinal failure (IF) receiving long-term PN. Methods: A cross-sectional study was performed in a tertiary pediatric IF clinic of patients receiving home-PN treatment for more than 1 year. Data regarding medical background, anthropometrics, laboratory investigations and abdominal sonography were retrieved. Results: Complete data were available for 15 children (67% males), with a median age of 6 (range 1.5–15) years and a median (IQR) PN duration of 4 (1.5–6) years. Low-grade proteinuria was identified in 61% and microalbuminuria in 30% of the cohort. Hypercalciuria and hyperoxaluria were present in 50% and 46%, respectively. One patient had nephrocalcinosis. The estimated GFR was normal in all but one patient who had pre-existing kidney disease. Conclusions: Pediatric IF patients can present with preserved kidney function after years of PN treatment. Despite the high prevalence of hypercalciuria, nephrocalcinosis was not common. Base line and long-term monitoring of various aspects of renal function would be essential to characterize the effects of prolonged PN on kidney functions in pediatric patients. Full article

(This article belongs to the Special Issue Intravenous Feeding in Infants and Children)

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15 pages, 1656 KiB

Open AccessArticle

Monitored Supplementation of Vitamin D in Preterm Infants: A Randomized Controlled Trial

by Alicja Kołodziejczyk-Nowotarska, Renata Bokiniec and Joanna Seliga-Siwecka

Nutrients 2021, 13(10), 3442; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13103442 - 28 Sep 2021

Cited by 8 | Viewed by 3423

Abstract

Appropriate supplementation of vitamin D can affect infections, allergy, and mental and behavioral development. This study aimed to assess the effectiveness of monitored vitamin D supplementation in a population of preterm infants. 109 preterm infants (24 0/7–32 6/7 weeks of gestation) were randomized to receive 500 IU vitamin D standard therapy (n = 55; approximately 800–1000 IU from combined sources) or monitored therapy (n = 54; with an option of dose modification). 25-hydroxyvitamin D [25(OH)D] concentrations were measured at birth, 4 weeks of age, and 35, 40, and 52 ± 2 weeks of post-conceptional age (PCA). Vitamin D supplementation was discontinued in 23% of infants subjected to standard treatment due to increased potentially toxic 25(OH)D concentrations (>90 ng/mL) at 40 weeks of PCA. A significantly higher infants’ percentage in the monitored group had safe vitamin D levels (20–80 ng/mL) at 52 weeks of PCA (p = 0.017). We observed increased vitamin D levels and abnormal ultrasound findings in five infants. Biochemical markers of vitamin D toxicity were observed in two patients at 52 weeks of PCA in the control group. Inadequate and excessive amounts of vitamin D can lead to serious health problems. Supplementation with 800–1000 IU of vitamin D prevents deficiency and should be monitored to avoid overdose. Full article

(This article belongs to the Special Issue Intravenous Feeding in Infants and Children)

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Review

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14 pages, 2662 KiB

Open AccessReview

Systematic Review on Individualized Versus Standardized Parenteral Nutrition in Preterm Infants

by Walter Mihatsch, Miguel Ángel Jiménez Varas, Lucia Lorenzino Diehl, Virgilio Carnielli, Rahel Schuler, Corinna Gebauer and Miguel Sáenz de Pipaón Marcos

Nutrients 2023, 15(5), 1224; https://0-doi-org.brum.beds.ac.uk/10.3390/nu15051224 - 28 Feb 2023

Cited by 2 | Viewed by 2100

Abstract

The need for high quality evidence is recognized for optimizing practices of parenteral nutrition (PN). The purpose of the present systematic review is to update the available evidence and investigate the effect of standardized PN (SPN) vs. individualized PN (IPN) on protein intake, immediate morbidities, growth, and long-term outcome in preterm infants. A literature search was performed on articles published in the period from 1/2015 to 11/2022 in PubMed and Cochrane database for trials on parenteral nutrition in preterm infants. Three new studies were identified. All new identified trials were nonrandomized observational trials using historical controls. SPN may increase weight and occipital frontal circumference gain and lower the value of maximum weight loss. More recent trials suggest that SPN may easily increase early protein intake. SPN may reduce the sepsis incidence, but overall, no significant effect was found. There was no significant effect of standardization of PN on mortality or stage ≥2 necrotizing enterocolite (NEC) incidence. In conclusion SPN may improve growth through higher nutrient (especially protein) intake and has no effect on sepsis, NEC, mortality, or days of PN. Full article

(This article belongs to the Special Issue Intravenous Feeding in Infants and Children)

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25 pages, 485 KiB

Open AccessFeature PaperReview

Impact of Total Parenteral Nutrition on Gut Microbiota in Pediatric Population Suffering Intestinal Disorders

by Tomás Cerdó, José Antonio García-Santos, Anna Rodríguez-Pöhnlein, María García-Ricobaraza, Ana Nieto-Ruíz, Mercedes G. Bermúdez and Cristina Campoy

Nutrients 2022, 14(21), 4691; https://0-doi-org.brum.beds.ac.uk/10.3390/nu14214691 - 06 Nov 2022

Cited by 7 | Viewed by 3184

Abstract

Parenteral nutrition (PN) is a life-saving therapy providing nutritional support in patients with digestive tract complications, particularly in preterm neonates due to their gut immaturity during the first postnatal weeks. Despite this, PN can also result in several gastrointestinal complications that are the cause or consequence of gut mucosal atrophy and gut microbiota dysbiosis, which may further aggravate gastrointestinal disorders. Consequently, the use of PN presents many unique challenges, notably in terms of the potential role of the gut microbiota on the functional and clinical outcomes associated with the long-term use of PN. In this review, we synthesize the current evidence on the effects of PN on gut microbiome in infants and children suffering from diverse gastrointestinal diseases, including necrotizing enterocolitis (NEC), short bowel syndrome (SBS) and subsequent intestinal failure, liver disease and inflammatory bowel disease (IBD). Moreover, we discuss the potential use of pre-, pro- and/or synbiotics as promising therapeutic strategies to reduce the risk of severe gastrointestinal disorders and mortality. The findings discussed here highlight the need for more well-designed studies, and harmonize the methods and its interpretation, which are critical to better understand the role of the gut microbiota in PN-related diseases and the development of efficient and personalized approaches based on pro- and/or prebiotics. Full article

(This article belongs to the Special Issue Intravenous Feeding in Infants and Children)

12 pages, 993 KiB

Open AccessReview

PN Administration in Critically Ill Children in Different Phases of the Stress Response

by Koen Joosten and Sascha Verbruggen

Nutrients 2022, 14(9), 1819; https://0-doi-org.brum.beds.ac.uk/10.3390/nu14091819 - 27 Apr 2022

Cited by 4 | Viewed by 2329

Abstract

Nutritional support is an important part of the treatment of critical ill children and the phase of disease has to be taken into account. The metabolic stress response during acute critical illness is characterized by severe catabolism. So far, there is no evidence that the acute catabolic state can be prevented with nutritional support. The Pediatric ’Early versus Late Parenteral Nutrition’ (PEPaNIC) trial showed that withholding supplemental parenteral nutrition (PN) during the first week in critically ill children, when enteral nutrition was not sufficient, prevented infections and shortened the stay in the pediatric intensive care unit (PICU) and the hospital. A follow-up performed 2 and 4 years later showed that withholding parenteral nutrition (PN) also improved several domains of the neurocognitive outcome of the children. Current international guidelines recommend considering withholding parenteral macronutrients during the first week of pediatric critical illness, while providing micronutrients. These guidelines also recommend upper and lower levels of intake of macronutrients and micronutrients if PN is administered. Full article

(This article belongs to the Special Issue Intravenous Feeding in Infants and Children)

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Other

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12 pages, 2915 KiB

Open AccessSystematic Review

Continuous versus Intermittent Enteral Feeding in Critically Ill Children: A Systematic Review

by Xenophon Theodoridis, Lydia Chrysoula, Kleo Evripidou, Ioustini Kalaitzopoulou and Michail Chourdakis

Nutrients 2023, 15(2), 288; https://0-doi-org.brum.beds.ac.uk/10.3390/nu15020288 - 06 Jan 2023

Cited by 2 | Viewed by 3229

Abstract

Administration of enteral nutrition (EN) in critically ill pediatric patients admitted to the pediatric intensive care unit (PICU) constitutes a major challenge due to the increased risk of complications, as well as the lack of well-trained healthcare professionals. EN is usually delivered via cyclic, continuous, or intermittent feeding; however, a number of potential barriers have been reported in the literature regarding different feeding regimens. The purpose of this review was to assess the effectiveness of continuous and intermittent bolus feeding on critically ill children. A systematic search was conducted in PubMed, Scopus Cochrane Central Register of Controlled Trials (CENTRAL) and a clinical trial registry up to September 2022, including randomized controlled trials (RCTs) published in the English language. Four studies met the inclusion criteria with a total population of 288 patients admitted to the PICU. Three studies were rated with a high risk of bias and one with some concerns. There was high heterogeneity between the studies in regard to the reporting of outcomes. Three studies measured the total time needed to reach prescribed caloric intake with conflicting results, while two studies evaluated the length of stay (LOS) in PICU with no difference between the two arms. One study assessed the time weaning from mechanical ventilation, favoring the bolus group. No data were provided for gastric residual volume (GRV), anthropometric measurements, and biochemical markers. Additional randomized trials with better methodology are needed to assess the efficacy of the two enteral feeding regimens in critically ill PICU patients. Full article

(This article belongs to the Special Issue Intravenous Feeding in Infants and Children)

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