ABSTRACT
Objective:To analyze the paradigm and changes of enteral nutrition support for hospitalized children in Shanghai Children's Medical Center affiliated to School of Medicine of Shanghai, Jiao Tong University in last ten years, so as to provide guidance for nutritionists and dietitians on the application and management of enteral nutrition.Method:Relevant data were collected and analyzed from 2011 to 2020 in the Clinical Nutrition Department of Shanghai Children's Medical Center, including the implementation status of parenteral and enteral nutrition as well as the types and distribution of different enteral nutrition formulas and diet.Results:The Clinical Nutrition Department of our hospital provided seventy-five types of diet for hospitalized children. The utilization of ordinary diets and specialized diets has been stable at about 76,000 cases per year. In the past decade, twenty-one ordinary formulas and special formulas were provided every year by the Clinical Nutrition Department in our hospital and the utilization has been stable at 46,000 cases per year. The total consumption of ordinary formulas and the proportion of ordinary formulas users showed a descending trend. The proportion of specialized formulas users among discharged patients remained at 10%, with an upward trend in the proportion of high-calorie formulas and extensively-hydrolyzed formulas.Conclusions:The enteral nutrition formulas and inpatient diets are important components of nutritional treatment. The evolution of its clinical application to some extent reflects the changes of disease spectrum and the development of clinical disciplines. In short, the dietitians play a significant role in the nutrition support team.
ABSTRACT
Objective:To investigate the effects of multiple trace elements in neonatal parenteral nutrition (PN) on the stability of fat emulsion, and to assess the changes of stability indexes after filtration.Methods:With the standard body weight of 1.5 kg, seven groups of neonatal PN solutions with different concentrations of multiple trace elements were designed, including blank group (without multiple trace elements), normal dose group (1 ml/kg, i.e., 0.75 ml per 100 ml PN) and five experimental groups (i.e., 1.5 ml, 3 ml, 4.5 ml, 6 ml, and 7.5 ml per 100 ml PN respectively). Macroscopic observation was performed 0 h and 24 h after preparation. The mean droplet diameter (MDD) of lipid emulsion was determined with dynamic light scattering before and after filtration. The percentage of fat residing in globules larger than 5 μm (PFAT5) and the globule size distribution before and after filtration were determined with light blockage method.Results:Macroscopic examination of the 7 groups of PN solutions identified neither changes in color nor stratification within 24 hours after solution preparation. Within 24 hours after solution preparation, the MDDs of all PN solutions before filtration were between (338.67±6.11) nm and (370.00±15.13) nm, and the PFAT5 values before filtration ranged from (32.00±1.00) ×10 -3% to (85.67±6.81) ×10 -3%. The MDDs of all PN solutions after filtration were between (310.67±8.62) nm and (362.33±19.86) nm, and the PFAT5 values after filtration ranged from (4.67±1.15) ×10 -3% to (17.33±0.58) ×10 -3%. The concentration of multiple trace elements was positively correlated with PFAT5 ( P<0.05). There was statistically significant difference in PFAT5 values at 0 h and 24 h after preparation ( P=0.004). The difference of PFAT5 values before and after filtration was also statistically significant ( P=0.000). Conclusions:Within 24 hours after solution preparation at room temperature, the appearance of neonatal PN solutions with different concentrations of trace elements supplementation was unchanged, and the MDDs of fat emulsions were all within the safe range. However, when the concentration of monovalent cations (Na +, K +) was 38.9 mmol/L, the concentration of divalent cation (Ca 2+) was 5 mmol/L, and the concentration of trace elements (Zn 2+, Cu 2+, Mn 2+, and Se 4+) was higher than 0.063 mmol/L, the PFAT5 value was higher than 0.05%. In this case, filtration with a 1.2 μm filter was necessary, which could significantly reduce the PFAT5 value and the globule size distribution, and improve the safety and standardization of the clinical application of PN solutions. It is suggested that the neonatal PN solutions supplemented with multiple trace elements injection (I) may be administered through a terminal filter.