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Senterre T, van den Akker CHP, Domellof M, Saenz de Pipaon M, Arnell H, Tabbers M, Valla FV, Tomlin S, Paulsson M, Wackernagel D, Haiden N, Luukkainen P, Orfeo L, Carnielli VP, Rigo J. Safe and efficient practice of parenteral nutrition in neonates and children aged 0-18 years - The role of licensed multi-chamber bags. Clin Nutr 2024; 43:1696-1705. [PMID: 38823267 DOI: 10.1016/j.clnu.2024.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 04/11/2024] [Accepted: 05/12/2024] [Indexed: 06/03/2024]
Abstract
Parenteral nutrition (PN) is recognized as a complex high-risk therapy. Its practice is highly variable and frequently suboptimal in pediatric patients. Optimizing care requires evidence, consensus-based guidelines, audits of practice, and standardized strategies. Several pediatric scientific organizations, expert panels, and authorities have recently recommended that standardized PN should generally be used over individualized PN in the majority of pediatric patients including very low birth weight premature infants. In addition, PN admixtures produced and validated by a suitably qualified institution are recommended over locally produced PN. Licensed multi chamber bags are standardized PN bags that comply with Good Manufacturing Practice and high-quality standards for the finished product in the frame of their full manufacturing license. The purpose of this article is to review the practical aspects of PN and the evidence for using such multi-chamber bags in pediatric patients. It highlights the safety characteristics and the limitations of the different PN practices and provides some guidance for ensuring safe and efficient therapy in pediatric patients.
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Affiliation(s)
- Thibault Senterre
- Baxter R&D Europe, Braine-l'Alleud, Belgium; University of Liège, Liège, Belgium.
| | - Chris H P van den Akker
- Department of Pediatrics - Neonatology, Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Amsterdam, the Netherlands; Amsterdam Reproduction and Development and Amsterdam Gastroenterology Endocrinology Metabolism Research Institutes, Amsterdam, the Netherlands.
| | - Magnus Domellof
- Department of Clinical Sciences, Umeå University, Umea, Sweden.
| | - Miguel Saenz de Pipaon
- Instituto de Investigación Sanitaria del Hospital Universitario La Paz - IdiPAZ, (Hospital Universitario La Paz - Universidad Autónoma de Madrid), Madrid, Spain.
| | - Henrik Arnell
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Astrid Lindgren Children's Karolinska University Hospital, Stockholm, Sweden; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
| | - Merit Tabbers
- Amsterdam Reproduction and Development and Amsterdam Gastroenterology Endocrinology Metabolism Research Institutes, Amsterdam, the Netherlands; Department of Pediatric Gastroenterology, Hepatology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - Frederic V Valla
- Transversal dietetics and Nutrition Unit and Nutrition Unit (UTDN), Intensive Care Nutrition, Hospices Civils de Lyon, Lyon-Bron, France.
| | - Stephen Tomlin
- Pharmacy Department, Children's Medicines Centre, Great Ormond Street Hospital for Sick Children, London, UK.
| | - Mattias Paulsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
| | - Dirk Wackernagel
- Department of Neonatology, Gutenberg University, Mainz, Germany; CLINTEC, Karolinska Institutet, Stockholm, Sweden.
| | - Nadja Haiden
- Department of Neonatology, Kepler University Hospital, Linz, Austria.
| | | | - Luigi Orfeo
- Neonatal Intensive Care Unit, Isola Tiberina Hospital Gemelli Isola, Rome, Italy.
| | - Virgilio P Carnielli
- Department of Mother and Child Health, Division of Neonatology, G. Salesi Children's Hospital - Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona, Ancona, Italy; Department of Odontostomatologic and Specialized Clinical Sciences, Polytechnic University of Marche, Ancona, Italy.
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Otero-Millán L, Bea-Mascato B, Legido Soto JL, Martínez-López-De-Castro N, Lago Rivero N. Electron Microscopy for the Stability Assessment of Parenteral Nutrition Admixtures: Focus on Precipitation. Nutrients 2024; 16:1390. [PMID: 38732636 PMCID: PMC11085670 DOI: 10.3390/nu16091390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 04/30/2024] [Accepted: 05/01/2024] [Indexed: 05/13/2024] Open
Abstract
(1) Background: parenteral nutrition (PN) is indispensable for patients unable to receive oral or enteral feeding. However, the complexity of PN solutions presents challenges regarding stability and compatibility. Precipitation reactions may occur. The most frequent is the formation of calcium phosphate (Ca-P). The different factors influencing these reactions must be considered to ensure patient safety. (2) Methods: eight paediatric PN solutions were prepared, following standard protocols. Samples were stored at room temperature and in a refrigerator. Electron microscopy, coupled with energy dispersive X-ray spectroscopy (EDS), was employed. Precipitates were analysed for composition and morphology. (3) Results: precipitates were observed in all samples, even at day 0. Crystalline structures, predominantly composed of calcium or magnesium, sometimes associated with chlorine or phosphorus, were detected. Additionally, amorphous precipitates, contained heterogeneous compositions, including unexpected elements, were identified. (4) Conclusions: various precipitates, primarily calcium- or magnesium-based, can form in PN solutions, although it is not expected that they can form under the real conditions of use. Calcium oxalate precipitation has been characterised, but the use of organic calcium and phosphate salts appears to mitigate calcium phosphate precipitation. Electron microscopy provides interesting results on NP precipitation, but sample preparation may present technical limitations that affect the interpretation of the results.
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Affiliation(s)
- Luis Otero-Millán
- Pharmacy Department, University Hospital Complex of Vigo, 36312 Vigo, Spain;
- NeumoVigo I+i Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur) SERGAS-UVIGO, 36312 Vigo, Spain
| | - Brais Bea-Mascato
- Innovation in Clinical Pharmacy Research Group (i-FARMA-Vigo), Galicia Sur Health Research Institute (IIS Galicia Sur) SERGAS-UVIGO, 36312 Vigo, Spain;
| | - Jose Luis Legido Soto
- Applied Physic Department, Faculty of Sciences, University of Vigo, 36310 Vigo, Spain;
| | - Noemi Martínez-López-De-Castro
- Pharmacy Department, University Hospital Complex of Vigo, 36312 Vigo, Spain;
- Innovation in Clinical Pharmacy Research Group (i-FARMA-Vigo), Galicia Sur Health Research Institute (IIS Galicia Sur) SERGAS-UVIGO, 36312 Vigo, Spain;
| | - Natividad Lago Rivero
- Pharmacy Department, University Hospital Complex of Vigo, 36312 Vigo, Spain;
- Innovation in Clinical Pharmacy Research Group (i-FARMA-Vigo), Galicia Sur Health Research Institute (IIS Galicia Sur) SERGAS-UVIGO, 36312 Vigo, Spain;
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Clauss C, Tack V, Macchiarulo M, Akerman M, El-Chaar G, Hanna N, Tiozzo C. Light protection of parenteral nutrition, cholestasis, and other prematurity-related morbidities in premature infants. Front Pediatr 2022; 10:900068. [PMID: 35989991 PMCID: PMC9381878 DOI: 10.3389/fped.2022.900068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Parenteral Nutrition (PN) can lead to intestinal failure associated liver disease (IFALD). There are no human studies to date studying specifically the benefits of light-protection on neonatal IFALD. Recently, the European Medicines Agency and the American Society for Parenteral and Enteral Nutrition (ASPEN) both recommended full light protection of PN to reduce the risk of adverse clinical outcomes. OBJECTIVE The primary objective of this study was to evaluate the impact of light-protecting PN on the incidence of cholestasis and peak direct bilirubin levels in premature infants. STUDY DESIGN Retrospective chart review of preterm infants requiring PN for a minimum of 2 weeks with or without light-protection. After light protection of the PN solution, primary outcomes (including cholestasis and direct bilirubin levels) of both groups were compared. Secondary outcomes include evaluation of bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP), sepsis and mortality. RESULTS A total of 50 preterm infants <37 weeks gestation were included, 25 infants in each group. There was a statistically significant decrease in the rate of cholestasis (12 vs. 3, p = 0.005), median peak direct bilirubin levels (1.7 vs. 0.9 mg/dL, p = 0.02) and total bilirubin levels (4.1 vs. 3.4, p = 0.05) in the light-protection group compared to no light-protection group. There was a decrease in the incidence of severe BPD (with an increase of mild BPD, resulting in the same overall BPD rate) in the light-protection compared to no light-protection group (7 vs. 15, p = 0.0223). There was no difference in NEC, ROP, sepsis or mortality. CONCLUSION Our study supports that the practice of light-protecting PN may reduce the incidence of IFALD in premature infants. Moreover, there was a trend toward decreased incidence of severe BPD in the light-protection group. Further light protection studies are needed to confirm these findings.
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Affiliation(s)
- Christie Clauss
- Department of Pharmacy, NYU Langone Hospital-Long Island, Mineola, NY, United States
| | - Valentyna Tack
- Department of Neonatology, Children's National Hospital, Washington, DC, United States
| | - Maria Macchiarulo
- Department of Pharmacy, Hassenfeld Children's Hospital at NYU Langone, New York, NY, United States
| | - Meredith Akerman
- Department of Foundations of Medicine, NYU Langone Hospital-Long Island, Mineola, NY, United States
| | - Gladys El-Chaar
- Department of Pharmacy, NYU Langone Hospital-Long Island, Mineola, NY, United States.,Department of Pharmacy, St. John's University College of Pharmacy and Health Sciences, Queens, NY, United States
| | - Nazeeh Hanna
- Division of Neonatology, Department of Pediatrics, New York University Long Island School of Medicine, Mineola, NY, United States
| | - Caterina Tiozzo
- Division of Neonatology, Department of Pediatrics, New York University Long Island School of Medicine, Mineola, NY, United States
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Robinson DT, Ayers P, Fleming B, Gura KM, Gutsul L, Michalski A, Holcombe B, Sacks GS. Recommendations for photoprotection of parenteral nutrition for premature infants: An ASPEN position paper. Nutr Clin Pract 2021; 36:927-941. [PMID: 34472142 DOI: 10.1002/ncp.10747] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Although crucial in improving health outcomes in the preterm infants, parenteral nutrition (PN) is not without risk, especially if handled improperly. A growing body of evidence suggests that components of PN admixtures, including lipid injectable emulsions (ILEs), are susceptible to degradation, including oxidation when exposed to light (ie, photo-oxidation), resulting in the production of reactive oxygen species. Infants, especially those born preterm, are considered more susceptible to consequences of oxidative stress than children and adults. Oxidative stress is associated with bronchopulmonary dysplasia, retinopathy of prematurity, necrotizing enterocolitis, and intestinal failure-associated liver disease. The American Society for Parenteral and Enteral Nutrition (ASPEN) assembled a working group to provide recommendations on clinical practice surrounding photoprotection of PN.This Position Paper reviews the scientific literature on the formation of quantifiable peroxides and other degradation products when PN admixtures and ILEs are exposed to light and reports adverse clinical outcomes in premature infants exposed to PN. Recommendations for photoprotection of PN admixtures and ILEs are provided, as well as the challenges in achieving complete photoprotection with the equipment, supplies, and materials currently available in the US. ASPEN and the authors understand that the full implementation of complete photoprotection may not currently be feasible given current product availability; recommendations provided in this paper serve to represent the goal to which to strive as well as to highlight the importance of product availability to achieve these practices. This paper has been approved by the ASPEN Board of Directors.
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Affiliation(s)
- Daniel T Robinson
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Phil Ayers
- Clinical Pharmacy Services, Department of Pharmacy, Baptist Medical Center, Jackson, Mississippi, USA
| | - Barbara Fleming
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Kathleen M Gura
- Department of Pharmacy, Boston Children's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Liliia Gutsul
- Central Admixture Pharmacy Services, Inc, Chicago, Illinois, USA
| | - Austin Michalski
- Patient Food and Nutrition Services, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Beverly Holcombe
- American Society for Parenteral and Enteral Nutrition, Silver Spring, Maryland, USA
| | - Gordon S Sacks
- Fresenius Kabi USA, LLC, Lake Zurich, Illinois, USA.,Auburn University Harrison School of Pharmacy, Auburn, Alabama, USA
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Lichtschutz für Lösungen zur parenteralen Ernährung von Säuglingen und Kindern bis zum Alter von 2 Jahren. Monatsschr Kinderheilkd 2021. [DOI: 10.1007/s00112-020-01111-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
ZusammenfassungDas Bundesinstitut für Arzneimittel und Medizinprodukte (BfArM) empfahl im Rote-Hand-Brief vom 02.09.2019: „Während der Verabreichung an Neugeborene und Kinder unter 2 Jahren sollen entsprechend zugelassene Arzneimittel zur parenteralen Ernährung (PE), die Aminosäuren und/oder Fettemulsionen enthalten, vor Licht geschützt werden (Behältnisse und Infusionsbestecke)“.Ziel dieser Stellungnahme ist es, evidenzbasierte Empfehlungen zum Lichtschutz für Lösungen zu parenteraler und heimparenteraler Ernährung bei Säuglingen und Kindern bis zum Alter von 2 Jahren zu geben.Der Bundesverband Deutscher Krankenhausapotheker, die Ernährungskommission der Deutschen Gesellschaft für Kinder- und Jugendmedizin, die Ernährungskommission der Österreichischen Gesellschaft für Kinder und Jugendheilkunde und die Arbeitsgemeinschaft Chronisches Darmversagen der Gesellschaft für Pädiatrische Gastroenterologie und Ernährung empfehlen in Übereinstimmung mit den internationalen Empfehlungen zur pädiatrischen parenteralen Ernährung der Fachgesellschaften ESPGHAN, ESPEN, ESPR und CSPEN: 1. Parenterale Nährlösungen, die Fette und/oder Vitamine enthalten, sind während der Applikation durch geeignete Maßnahmen vor Licht zu schützen. 2. Parenterale Nährlösungen, die keine Fette und/oder Vitamine enthalten (z. B. Lösungen mit Aminosäuren, Glucose, Elektrolyten oder Spurenelementen) bedürfen keines speziellen Lichtschutzes. 3. Bei heimparenteraler Ernährung können im Hinblick auf die kindlichen Bedürfnisse normale Spiralleitungen verwendet werden, solange lichtschützende Spiralleitungen nicht verfügbar sind.
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Pavlek LR, Rivera BK, Smith CV, Randle J, Hanlon C, Small K, Bell EF, Rysavy MA, Conroy S, Backes CH. Eligibility Criteria and Representativeness of Randomized Clinical Trials That Include Infants Born Extremely Premature: A Systematic Review. J Pediatr 2021; 235:63-74.e12. [PMID: 33894262 PMCID: PMC9348995 DOI: 10.1016/j.jpeds.2021.04.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/23/2021] [Accepted: 04/15/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To assess the eligibility criteria and trial characteristics among contemporary (2010-2019) randomized clinical trials (RCTs) that included infants born extremely preterm (<28 weeks of gestation) and to evaluate whether eligibility criteria result in underrepresentation of high-risk subgroups (eg, infants born at <24 weeks of gestation). STUDY DESIGN PubMed and Scopus were searched January 1, 2010, to December 31, 2019, with no language restrictions. RCTs with mean or median gestational ages at birth of <28 weeks of gestation were included. The study followed the PRISMA guidelines; outcomes were registered prospectively. Data extraction was performed independently by multiple observers. Study quality was evaluated using a modified Jadad scale. RESULTS Among RCTs (n = 201), 32 552 infants were included. Study participant characteristics, interventions, and outcomes were highly variable. A total of 1603 eligibility criteria were identified; rationales were provided for 18.8% (n = 301) of criteria. Fifty-five RCTs (27.4%) included infants <24 weeks of gestation; 454 (1.4%) infants were identified as <24 weeks of gestation. CONCLUSIONS The present study identifies sources of variability across RCTs that included infants born extremely preterm and reinforces the critical need for consistent and transparent policies governing eligibility criteria.
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Affiliation(s)
- Leeann R. Pavlek
- Center for Perinatal Research, The Abigail Wexner Research Institute at Nationwide Children’s Hospital,Department of Pediatrics and The Ohio State University Wexner Medical Center, Columbus, OH
| | - Brian K. Rivera
- Center for Perinatal Research, The Abigail Wexner Research Institute at Nationwide Children’s Hospital
| | - Charles V. Smith
- Center for Integrated Brain Research, Seattle Children’s Research Institute, Seattle, WA
| | - Joanie Randle
- Ohio Perinatal Research Network at Nationwide Children’s Hospital, Columbus, OH
| | - Cory Hanlon
- Ohio Perinatal Research Network at Nationwide Children’s Hospital, Columbus, OH
| | - Kristi Small
- Ohio Perinatal Research Network at Nationwide Children’s Hospital, Columbus, OH
| | - Edward F. Bell
- Stead Family Department of Pediatrics, University of Iowa, Iowa City, IA
| | - Matthew A. Rysavy
- Stead Family Department of Pediatrics, University of Iowa, Iowa City, IA
| | - Sara Conroy
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University,Biostatistics Resource at Nationwide Children’s Hospital
| | - Carl H. Backes
- Center for Perinatal Research, The Abigail Wexner Research Institute at Nationwide Children’s Hospital,Department of Pediatrics and The Ohio State University Wexner Medical Center, Columbus, OH,Ohio Perinatal Research Network at Nationwide Children’s Hospital, Columbus, OH,Obstetrics and Gynecology, The Ohio State University Wexner Medical Center,The Heart Center, Nationwide Children’s Hospital, Columbus, OH
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7
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[Neonatal parenteral nutrition formulation: where are we?]. NUTR HOSP 2020; 38:11-15. [PMID: 33155472 DOI: 10.20960/nh.02903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Introduction Introduction: the introduction of parenteral nutrition in preterm infants has meant a major advance in their prognosis, being the last few years very fruitful in terms of publication of guidelines in this area. Objectives: to know the formulation and preparation procedures of neonatal parenteral nutrition (NPN) in Spanish hospitals. Methods: a multi-centre survey was conducted in Pharmacy Services on the aforementioned processes. Results: fifty-five hospitals met inclusion criteria. Electronic prescription systems were use by 51 %, 65.5 % always formulated individually, while 34.4 % had predesigned formulas. Tricameral preparations were used by 13.0 %. In 52.7 % of cases, first day nutrition was prepared on demand, starting before 8 hours of life in 88.1 % of cases. Inorganic phosphate was the first option in 10.4 %, vitamins, trace elements and zinc were added daily in 92.7 %, 90.9 % and 70.9 % of cases, respectively. NPN including lipids in the same bag was formulated by 45.4 % of the hospitals, compared to 34.5 % where it was administered separately in all cases. In 50.9 % of hospitals they never added heparin to their NPN. The 89.1 % used photoprotected bags. The stability of the admixture varied from 24 hours to 15 days. Conclusion: the elaboration of the PPN in Spain is subject to great variability. There is controversy regarding the use of heparin and ternary mixtures, which is reflected in the variability of clinical practice.
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Lavoie JC, Chessex P. Parenteral nutrition and oxidant stress in the newborn: A narrative review. Free Radic Biol Med 2019; 142:155-167. [PMID: 30807828 DOI: 10.1016/j.freeradbiomed.2019.02.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 02/06/2019] [Accepted: 02/18/2019] [Indexed: 01/27/2023]
Abstract
There is strong evidence that oxidant molecules from various sources contaminate solutions of parenteral nutrition following interactions between the mixture of nutrients and some of the environmental conditions encountered in clinical practice. The continuous infusion of these organic and nonorganic peroxides provided us with a unique opportunity to study in cells, in vascular and animal models, the mechanisms involved in the deleterious reactions of oxidation in premature infants. Potential clinical impacts of peroxides infused with TPN include: a redox imbalance, vasoactive responses, thrombosis of intravenous catheters, TPN-related hepatobiliary complications, bronchopulmonary dysplasia and mortality. This is a narrative review of published data.
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Affiliation(s)
- Jean-Claude Lavoie
- Centre de Recherche Hôpital Ste-Justine, Department of Nutrition, University of Montreal, Montreal, QC, Canada
| | - Philippe Chessex
- Division of Neonatology, Department of Pediatrics, Children's and Women's Health Center of British Columbia, University of British Columbia, Vancouver, BC, Canada.
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ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Lipids. Clin Nutr 2018; 37:2324-2336. [DOI: 10.1016/j.clnu.2018.06.946] [Citation(s) in RCA: 107] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 05/29/2018] [Indexed: 12/24/2022]
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Nuyt AM, Lavoie JC, Mohamed I, Paquette K, Luu TM. Adult Consequences of Extremely Preterm Birth: Cardiovascular and Metabolic Diseases Risk Factors, Mechanisms, and Prevention Avenues. Clin Perinatol 2017; 44:315-332. [PMID: 28477663 DOI: 10.1016/j.clp.2017.01.010] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Extremely preterm babies are exposed to various sources of injury during critical stages of development. The extremely preterm infant faces premature transition to ex utero physiology and undergoes adaptive mechanisms that may be deleterious in the long term because of permanent alterations in organ structure and function. Perinatal events can also directly cause structural injury. These disturbances induce morphologic and functional changes in their organ systems that might heighten their risks for later adult chronic diseases. This review examines the pathophysiology of programming of long-term health and diseases after preterm birth and associated perinatal risk factors.
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Affiliation(s)
- Anne Monique Nuyt
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Research Center, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, 3175 chemin de la Côte-Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada.
| | - Jean-Claude Lavoie
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Research Center, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, 3175 chemin de la Côte-Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada; Department of Nutrition, Faculty of Medicine, Research Center, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, 3175 chemin de la Côte-Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada
| | - Ibrahim Mohamed
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Research Center, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, 3175 chemin de la Côte-Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada
| | - Katryn Paquette
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Research Center, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, 3175 chemin de la Côte-Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada
| | - Thuy Mai Luu
- Division of General Pediatrics, Department of Pediatrics, Faculty of Medicine, Research Center, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, 3175 chemin de la Côte-Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada
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Chessex P, Laborie S, Nasef N, Masse B, Lavoie JC. Shielding Parenteral Nutrition From Light Improves Survival Rate in Premature Infants. JPEN J Parenter Enteral Nutr 2016; 41:378-383. [DOI: 10.1177/0148607115606407] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Philippe Chessex
- Division of Neonatology, Department of Pediatrics, Children’s and Women’s Health Centre of BC, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sophie Laborie
- Division of Neonatology, Department of Pediatrics, Hospices Civils de Lyon, Centre Hospitalier Pierre Bénite, Lyon, France
| | - Nehad Nasef
- Mansoura University Children’s Hospital, Faculty of Medicine, University of Mansoura, Mansoura, Egypt
| | - Benoit Masse
- Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Quebec, Canada
| | - Jean-Claude Lavoie
- Departments of Pediatrics and Nutrition, University of Montreal, Montreal, Quebec, Canada
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de Souza RJ, Eisen RB, Perera S, Bantoto B, Bawor M, Dennis BB, Samaan Z, Thabane L. Best (but oft-forgotten) practices: sensitivity analyses in randomized controlled trials. Am J Clin Nutr 2016; 103:5-17. [PMID: 26675766 DOI: 10.3945/ajcn.115.121848] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 11/04/2015] [Indexed: 01/15/2023] Open
Abstract
A randomized controlled clinical trial is the best way to minimize bias in ascertaining treatment effects, but the credibility of the results of a trial depends on the validity of the methods used to analyze the data, and the conditions under which such methods produce valid answers. A sensitivity analysis is a method to determine the robustness of trial findings by examining the extent to which results are affected by changes in methods, models, values of unmeasured variables, or assumptions. The goal of a sensitivity analysis is to identify results that are most dependent on questionable or unsupported assumptions. In this article, we briefly review the current use of sensitivity analyses in a random sample of published nutrition literature and provide a guide on the use of sensitivity analyses in randomized trials as to when to consider them, what to consider when planning them, and different methods of implementing them. We propose an 8-step strategy for improving the approach to conducting and reporting sensitivity analyses in nutrition-based trials.
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Affiliation(s)
- Russell J de Souza
- Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences, Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Rebecca B Eisen
- Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences
| | - Stefan Perera
- Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences
| | - Bianca Bantoto
- Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences
| | - Monica Bawor
- Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences
| | - Brittany B Dennis
- Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences
| | - Zainab Samaan
- Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences, Department of Psychiatry and Behavioral Neurosciences, St. Joseph's Healthcare Hamilton and Hamilton Health Sciences Mood Disorders Program, Hamilton, Canada
| | - Lehana Thabane
- Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences, Center for Evaluation of Medicine, Population Health Research Institute, Hamilton Health Sciences, and System-Linked Research Unit, McMaster University, Hamilton, Canada; and
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Elremaly W, Mohamed I, Rouleau T, Lavoie JC. Adding glutathione to parenteral nutrition prevents alveolar loss in newborn Guinea pig. Free Radic Biol Med 2015; 87:274-81. [PMID: 26164632 DOI: 10.1016/j.freeradbiomed.2015.06.040] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 03/08/2015] [Accepted: 06/28/2015] [Indexed: 10/23/2022]
Abstract
UNLABELLED Bronchopulmonary dysplasia, a main complication of prematurity, is characterized by an alveolar hypoplasia. Oxidative stress is suspected to be a trigger event in this population who has a low level of glutathione, a main endogenous antioxidant, and who receives high oxidative load, particularly ascorbylperoxide from their parenteral nutrition. HYPOTHESIS the addition of glutathione (GSSG) in parenteral nutrition improves detoxification of ascorbylperoxide by glutathione peroxidase and therefore prevents exaggerated apoptosis and loss of alveoli. METHODS Ascorbylperoxide is assessed as substrate for glutathione peroxidase in Michaelis-Menten kinetics. Three-days old guinea pig pups were divided in 6 groups to receive, through a catheter in jugular vein, the following solutions: 1) Sham (no infusion); 2) PN(-L): parenteral nutrition protected against light (low ascorbylperoxide); 3) PN(+L): PN without photo-protection (high ascorbylperoxide); 4) 180 μM ascorbylperoxide; 5) PN(+L)+10 μM GSSG; 6) ascorbylperoxyde+10 μM GSSG. After 4 days, lungs were sampled and prepared for histology and biochemical determinations. Data were analysed by ANOVA, p < 0.05 RESULTS: The Km of ascorbylperoxide for glutathione peroxidase was 126 ± 6 μM and Vmax was 38.4 ± 2.5 nmol/min/ U. The presence of GSSG in intravenous solution has prevented the high GSSG, oxidized redox potential of glutathione, activation of caspase-3 (apoptosis marker) and loss of alveoli induced by PN(+L) or ascorbylperoxide. CONCLUSION A correction of the low glutathione levels observed in newborn animal on parenteral nutrition, protects lungs from toxic effect of ascorbylperoxide. Premature infants having a low level of glutathione, this finding is of high importance because it provides hope in a possible prevention of bronchopulmonary dysplasia.
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Affiliation(s)
- Wesam Elremaly
- Department of Nutrition, CHU Sainte-Justine, University of Montréal, Montréal, Qc, Canada H3T 1C5
| | - Ibrahim Mohamed
- Department of Pediatrics, CHU Sainte-Justine, University of Montréal, Montréal, Qc, Canada H3T 1C5
| | - Thérèse Rouleau
- Department of Nutrition, CHU Sainte-Justine, University of Montréal, Montréal, Qc, Canada H3T 1C5; Department of Pediatrics, CHU Sainte-Justine, University of Montréal, Montréal, Qc, Canada H3T 1C5
| | - Jean-Claude Lavoie
- Department of Nutrition, CHU Sainte-Justine, University of Montréal, Montréal, Qc, Canada H3T 1C5; Department of Pediatrics, CHU Sainte-Justine, University of Montréal, Montréal, Qc, Canada H3T 1C5.
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