Consenso colombiano de Falla Intestinal Crónica en Síndrome de Intestino Corto / Colombian Consensus on Chronic Intestinal Failure in Short Bowel Syndrome

Introducción. Los términos falla intestinal crónica, síndrome de intestino corto (SIC) y nutrición parenteral total son muy frecuentes en la práctica clínica cotidiana.El objetivo de esta guía fue establecer un marco de referencia de práctica clínica basado en el mejor de nivel de evidencia en pacientes con falla intestinal crónica secundaria a síndrome de intestino corto. Métodos. Se estableció un grupo de expertos interdisciplinarios en el manejo de la falla intestinal crónica quienes, previa revisión de la literatura escogida, se reunieron de manera virtual acogiendo el método Delphi para discutir una serie de preguntas seleccionadas, enfocadas en el contexto terapéutico de la falla intestinal crónica asociada al síndrome de intestino corto. Resultados. La recomendación del grupo de expertos colombianos es que se aconseje a los pacientes con SIC consumir dietas regulares de alimentos integrales que genere hiperfagia para compensar la malabsorción. Las necesidades proteicas y energéticas dependen de las características individuales de cada paciente; la adecuación del régimen debe ser evaluada a través de pruebas clínicas, antropométricas y parámetros bioquímicos. Se sugiere, especialmente a corto plazo después de la resección intestinal, el uso de análogos de somatostatina para pacientes con yeyunostomía de alto gasto en quienes el manejo de líquidos y electrolitos es problemático. En pacientes con SIC, que son candidatos a tratamiento con enterohormonas, Teduglutida es la primera opción. Conclusión. Existen recomendaciones en el manejo integral de la rehabilitación intestinal respaldadas ampliamente por este consenso y es importante el reconocimiento de alternativas terapéuticos enmarcadas en el principio de buenas prácticas clínicas.

Introduction. The terms chronic intestinal failure, short bowel syndrome (SBS), and total parenteral nutrition are very common in daily clinical practice. The objective of this guideline was to establish a reference framework for clinical practice based on the best level of evidence in patients with chronic intestinal failure secondary to short bowel syndrome. Methods. A group of interdisciplinary experts in the management of chronic intestinal failure was established who, after reviewing the selected literature, met virtually using the Delphi method to discuss a series of selected questions, focused on the therapeutic context of chronic intestinal failure associated with short bowel syndrome. Results. The recommendation of the Colombian expert group is that patients with SBS be advised to consume regular diets of whole foods that generate hyperphagia to compensate malabsorption. Protein and energy needs depend on the individual characteristics of each patient; the adequacy of the regimen must be evaluated through clinical, anthropometric tests and biochemical parameters. The use of somatostatin analogue is suggested, especially in the short term after bowel resection, for patients with high-output jejunostomy in whom fluid and electrolyte management is problematic. In SBS, who are candidates for enterohormonal therapy, Teduglutide is the first choice. Conclusion. There are recommendations on the comprehensive management of intestinal rehabilitation that are widely supported by this consensus and it is important to recognize therapeutic alternatives framed in the principle of good clinical practice.

Diagnosis and treatment strategy of intestinal flora imbalance after liver transplantation / 器官移植

Multiple short-term and long-term complications might occur after liver transplantation. In the early stage after liver transplantation, the incidence of multidrug-resistant bacteria is likely to cause different types of infection, one of which is intestinal flora imbalance. In the recent decade, a series of studies have demonstrated that intestinal flora plays an important role in maintaining intestinal homeostasis. Intestinal flora may interact with other organs via multiple patterns. Among which, gut-liver axis is one of the most critical channels for regulating microenvironment of the host. Changes in the quantity and composition of intestinal flora could lead to intestinal flora imbalance. In both local and systemic systems, extensive interaction exists between intestinal flora and immune system. In this article, the risk factors of intestinal flora imbalance after liver transplantation, influence of intestinal flora imbalance on liver transplant recipients and relevant treatment strategies were reviewed.

Effects of total parenteral nutrition on postnatal growth in very low birth weight and extremely low birth weight newborns

Background: Prematurity is the most important cause of mortality in Under-5 children responsible for one million deaths/ year. Premature babies are not able to store enough nutrients for their optimal survival; it is essential to provide them total parenteral nutrition. Intravenous lipid infusion in neonates is linked with high risk of sepsis and thrombocytopenia. PN with amino acids and glucose can be imparted to achieve nutritional goal. This trial was intended to assess the effects of various components of amino acid PN on postnatal growth in VLBW and ELBW newborns.Methods: A prospective observational study was conducted from January 2018 - May 2019 in NICU of TMMC and RC which included preterm newborns with birth weight of less than 1500gms who received aminoven infusion. Anthropometric measurements, incidence of hypo/hypercalcaemia, hypo/hyperglycaemia, direct hyperbilirubinemia, incidence of sepsis were evaluated.Results: Out of 22 patients, 12 neonates received high dose aminoven therapy whereas 10 neonates received low dose aminoven therapy. It was seen that rapid rate of increment of amino acids had adequate weight on discharge, 72.72% have adequate growth among the rapid group compared to 36.36% among slower group. No significant changes in calcium metabolism or glucose metabolism were seen in both the groups.Conclusions: In resource limited settings, parenteral nutrition with intravenous amino acids have a better effect on the weight of preterm newborns at discharge when high doses of amino acids infusion started early with rapid increment in the dose.

The Clinical Outcomes of Pharmacist Interventions in Total Parenteral Nutrition services in Riyadh City, Saudi Arabia

Objectives: Total parenteral nutrition (TPN) is the perilous component of nutritional care for neonatal, pediatric and adult patients. TPN is designated for someone who cannot or should not consume nutrients through their regular oral pathway. In this study, we explored the clinical outcomes of pharmacist intervention in Parenteral Nutrition at the public hospital in Riyadh city, Saudi Arabia. Methods: In prospective cohort studies, we simulated the data of 12 months of 2015 related to TPN services for neonatal, pediatric and adult patients. Most of the TPN units at hospitals works eight hours per day and seven days per a week. The hospital in Riyadh, Saudi Arabia has 300 beds. The pharmacist intervention consisted of an International Study Model, measure level of activity, rational of clinical intervention, recommendation, and patient with outcome impact. The data were analyzed through Survey Monkey system. Results: The total number of pharmacist interventions were 402 of recognized TPN-related problems. The total number of TPN orders was 394 prescribed to 82 patients. The majority of patients were neonates 303 (75.56%) followed by Pediatrics 97 (24.19%). The highest number of critical care interventions were found to be potentially serious 108 (28.8%) and potentially significant 174 (46.4%). The documented rationale of clinical intervention activities was inappropriate dose 93 (24.8%) drug therapy omission 50 (13.3%) and inappropriate route of administration 41 (10.9%). Most of the patient outcomes were laboratory value improved 170 (45.33%) and patient condition improved 137 (36.53%). Conclusion: TPN clinical pharmacist had an essential vital role of preventing a TPN-related problem, improve patient outcome, and avoid the unnecessary supplementary cost. Increasing TPN clinical pharmacist assigned for all TPN services at all health care system in Saudi Arabia.

Cost of Total Parenteral Nutrition Services at the Ministry of Health, Saudi Arabia

Objectives: The estimation of cost of total parenteral nutrition (TPN) is a part of the pharmacoeconomic program at the Ministry of Health (MOH), Saudi Arabia. In this study, we explored the cost analysis of TPN services by using American Model with local cost. Methods: Simulation was performed for all 6 months of TPN services for neonate, pediatric and adult patients. King Salman Hospital in Riyadh, Saudi Arabia was chosen as the study site; it has 300 beds. The physician or the pharmacist prescribed TPN to their patients. The pharmacist reviews and prepares TPN. The nurse administers TPN and follows up with the doctor or the pharmacist. TPN was prepared through sterile 797 standards and automated compounding facilities. The costing was derived from MOH information database. The cost was calculated based on the variable expenses including personal cost, material cost and supply cost. Fixed costs included direct cost, non-salary cost and overhead cost. All costs were estimated in US dollar currency and local prices. Results: A total number of 112 patients were prescribed with (1631) TPN orders; the total volume of TPN was 619,161.90 mL. Of these, 103 (91.96%), 6 (5.36%) and 3 (2.68%) were prescribed for neonatal, adult and pediatric patients, respectively. Of those with TPN orders, 1484 (90.99%), 108 (6.62%) and 39 (2.39%) were prescribed for neonatal, adult and pediatric patients, respectively. The total average number of orders per day was 4.47. Of those, 4.07, 0.3 and 0.11 was for neonatal, adult and pediatric patients, respectively. The average duration of TPN for adults, neonatal and pediatric patients was 18, 14.4 and 13 days, respectively. The total average direct cost for active ingredient in the TPN was 61.81 USD. Of those, 38.54 USD (62.35%), 16.63 USD (26.91%) and 6.64 USD (10.74%) was for pediatric, adult and neonatal patients. The estimated cost of TPN services for neonatal, adult and pediatric patients was 863.74 USD, 691.3 USD and 618.16 USD per day, respectively. The total annual and daily estimated expenditures of TPN orders were 629,865.02 USD and 212.22 USD; 44,795.24 USD and 207.39 USD; and 5,303.77 USD and 68.00 USD respectively for neonatal, adult and pediatric patients. The total annual and daily estimated cost were 314,764.70 USD and 3,055.97 USD; 22,398.12 USD and 3,733.02 USD; and 2,652.00 USD and 884.00 USD respectively for neonatal, adult and pediatric patients. Conclusion: In this study, we performed cost-estimation of the TPN in Saudi Arabia. This is the first study at MOH in Saudi Arabia. It is an essential basic element of pharmacoeconomic program and cost analysis of TPN-related healthcare services.

Multimídia interativa em saúde: capacitação de enfermeiros sobre cuidados dos pacientes em nutrição parenteral total / Interactive health multimedia: nursing training on patient care in nutrition total parenteral

A multimídia interativa é uma medida no âmbito da tecnologia de informação e comunicação adotada atualmente de forma ampla, com a proposta de difundir conhecimentos de forma muito mais acessível e uniforme a toda comunidade, interligada pela aplicação prática do conhecimento científico. Utilizando-se desse mecanismo de ampliação de conhecimentos, a ciência da saúde vêm empregando esses avanços tecnológicos na capacitação de profissionais, especialmente enfermeiros, no caso da presente pesquisa, na temática da Nutrição Parenteral Total. O objetivo do estudo foi estruturar e testar uma multimídia interativa construída no site Fábrica de Aplicativos, como estratégia de capacitação de enfermeiros que cuidam de clientes submetidos à nutrição parenteral. Metodologia: estudo intervencional, em instituição federal do Rio de Janeiro. Os participantes foram avaliados sobre a temática, em pré teste, foi aplicado a multimídia interativa, realizada no site Fábrica de aplicativos, após isso, um pós teste, onde foi analisado as competências adquiridas após a implementação da multimídia interativa

Interactive multimedia is a measure in the field of information technology and communication currently widely adopted, with the proposal of disseminating knowledge in a much more accessible and uniform way to the whole community, interlinked by the practical application of scientific knowledge. Using this mechanism of knowledge enhancement, health science has been employing these technological advances in the training of professionals, especially nurses, in the case of the present research, in the theme of Total Parenteral Nutrition. The objective of the study is to structure and test an interactive multimedia built on the Application Factory site, as a training strategy for nurses who care for clients submitted to parenteral nutrition. Methodology: interventional study, in a federal institution of Rio de Janeiro. Participants Will be evaluated on the subject, in pre-test, will be applied to interactive multimedia, held in the Application Factory site, in a new moment, a post test, where will be analyzed the skills acquired after the implementation of interactive multimedia

Thiamine Deficiency in a Child with Short Bowel Syndrome and Review / 대한소아소화기영양학회지

Thiamine (vitamin B₁) is a water-soluble vitamin that is not endogenously synthesized in humans. It is absorbed by the small intestine, where it is activated. Its active form acts as a coenzyme in many energy pathways. We report a rare case of thiamine deficiency in a 3.5-year old boy with short bowel syndrome secondary to extensive bowel resection due to necrotizing enterocolitis during his neonatal age. The patient was parenteral nutrition-dependent since birth and had suffered from recurrent central catheter-related bloodstream infections. He developed confusion with disorientation and unsteady gait as well as profound strabismus due to bilateral paresis of the abductor muscle. Based on these and a very low thiamine level he was diagnosed and treated for Wernicke encephalopathy due to incomplete thiamine acquisition despite adequate administration. He fully recovered after thiamine administration. After 1999 eight more cases have been reported in the PubMed mostly of iatrogenic origin.

Ascitis quilosa postraumática tratada con nutrición parenteral total y octreótido / Post-trauma Chylous Ascites Treated with Total Parenteral Nutrition and Octreotide

La ascitis quilosa es la acumulación de quilo en la cavidad peritoneal por ruptura u obstrucción de los conductos linfáticos abdominales. Aunque es infrecuente, se describe mayor probabilidad de aparición después de traumas abdominales. Se presenta un paciente masculino de 46 años que sufre herida por arma blanca tóracoabdominal por lo que requirió tratamiento quirúrgico de urgencia. Luego de varias cirugías se constató la presencia de líquido abdominal blanquecino, con triglicéridos elevados. Se confirmó la ascitis quilosa, que se reabsorbió en 45 días con nutrición parenteral y octreótido(AU)

Chylous ascites is the accumulation of lipid-rich lymph in the peritoneal cavity due to rupture or obstruction of the abdominal lymph ducts. Although it is rare, greater probability is described for its onset after abdominal traumas. The case is presented of a 46-year-old male patient who suffers from a thorax-abdomen knife wound and therefore required emergency surgical treatment. After several surgeries, the presence of whitish abdominal liquid was detected, with elevated triglycerides. Chylous ascites was confirmed, which was reabsorbed in 45 days with parenteral nutrition and octreotide(AU)

Umbilical Venous Catheter Complication Presenting as Chylous Ascites in a Newborn: Intraperitoneal Extravasation of Total Parenteral Nutrition Infusate

Umbilical venous catheterization (UVC) is a common practice in intensive neonatal care. However, a malpositioned UVC and its prolonged use may lead to various problems, including mechanical, infectious, and thrombotic complications in various organs such as the liver, lungs, and heart. Congenital chylous ascites is characterized by abnormally high levels of triglycerides in the peritoneal fluid of newborns, which originate from refluxed lymph within the abdominal cavity. Herein, we report a case of an UVC complication presenting as chyloperitoneum simulating congenital chylous ascites in a preterm neonate that resulted from total parenteral nutrition (TPN) extravasation from a malpositioned UVC. Biochemical analysis of intraperitoneal chylous fluid and TPN infusate could help confirm the origin of chyloperitoneum. This case suggests that TPN extravasation from UVC should be considered when chyloperitoneum develops in newborns with an indwelling catheter. UVC positions must also be carefully monitored at regular intervals to recognize associated complications early, particularly in cases with an inevitably malpositioned catheter related to the anatomy of the vessel course.

Three dimensions in auditing the prescription of parenteral nutrition: from the perspective of clinical pharmacists of nutrition / 中华临床营养杂志

Objective A discussion of practical models for auditing the prescription of parenteral nutrition by clinical pharmacists of nutrition.Methods A three-dimensional approach to prescription audit of parenteral nutrition by clinical pharmacists,focusing on the stability of the nutritional solution,its pharmacological rationality and the patient's individual need.Results Establishment of this three-dimensional approach.Conclusion This three-dimensional approach ensures the safety and rationality of parenteral nutrition and gives play to clinical pharmacists.

Impact of a low-to-middle dosage of glutamine-supplemented total parenteral nutrition on inflammatory markers in patients with inflammatory bowel disease / 中华临床营养杂志

Objective To evaluate the impact of total parenteral nutrition(TPN)on nutrition status and inflammatory markers in hospitalized fasted patients with inflammatory bowel disease(IBD).Methods A retrospective study was performed and 82 hospitalized fasted IBD patients [male/female=58/24,(39.4±14.5)years] who received TPN entered the study.Among them,38 patients had ulcerative colitis(UC)and 44 patients suffered from Crohn`s disease(CD).Clinical data(gender,age,duration of disease,history of disease,prednisone,immuno-suppressor,and antibiotics)were obtained from medical records.Nutritional parameters,C-creative protein(CRP),and erythrocyte sedimentation rate(ESR)before and after TPN were also obtained.Average caloric supplementation by TPN was(4 437.3±1 199.1)kJ/d and the nitrogen amount was(9.9±1.7)g/d.Median PN length was 15 days(7-54 days).67 IBD patients received a TPN formula with glutamine(≥14 d,25 patients vs.0-14 d,42 patients)and 15 IBD subjects received TPN without glutamine.Malnutrition was diagnosed by body mass index(BMI)and serum albumin level.Results The prevalence of undernutrition was 90.2％(74/82)in the study population.CD patients had a significantly longer history of disease [84(3-288)months vs.24(1-324)months,P<0.001] and a significantly lower BMI [(15.6±1.8)kg/m2 vs.(19.1±3.5)kg/m2,P<0.001] compared with those in UC patients.TPN improved nutritional parameters [serum albumin:(28.7±6.6)g/L before TPN vs.(31.7±5.8)g/L after TPN,P<0.001;pre-albumin:(174.1±85.5)mg/L before TPN vs.(227.2±82.8)mg/L after TPN,P<0.001].Conclusions TPN improves nutritional status in hospitalized fasted IBD patients.However,prospective randomized controlled trials are required to estimate the role of low-to-middle dosage of glutamine in IBD patients.

Clinical study of nutritional support in patients with acute peritonitis caused by colonic perforation / 肠外与肠内营养

Objective:To investigate the effect of different postoperative nutritional support on the gastrointestinal function and nutritional status in acute colon peforation patients.Methods:60 cases of acute emergency operation patients with perforation of the colon,according to the given nutritional support treatment of the different ways,were divided into enteral parenteral joint nutrition (EN + PN) group and total parenteral nutrition (TPN) group.Clinical therapeutic effects of two groups were compared.Results:The results of EN + PN group were significantly better than the those in TPN group (P ＜ 0.05).Conclusion:EN + PN model can improve the postoperative nutritional status and accelerate the recovery of patients with acute colonic perforation.

Intestinal Hypoganglionosis Leading to Intestinal Failure and the Compassionate Use of Omegaven™ / 대한소아소화기영양학회지

Intestinal hypoganglionosis is a rare innervation disorder that provides numerous nutritional, medical and surgical challenges. In this case report, we present a case of a newborn with intestinal hypoganglionosis leading to intestinal failure and intestinal failure-associated liver disease who responded to Omegaven™, a fat emulsion comprised of omega-3 fatty acids. Omegaven™ has been shown to be beneficial in the management of cholestatic liver injury. Clinical success with Omegaven™ was seen in this patient with a clear decrease in aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase and complete resolution of cholestasis with a direct bilirubin of zero within two weeks of initiation of Omegaven™. No current guidelines for the diagnosis and management of hypoganglionosis are available. We recommend a multidisciplinary approach and the use of novel therapies such as fat emulsions composed of omega-3 fatty acids for improved patient outcomes. Appropriate compassionate use protocols should be obtained from the Food and Drug Administration prior to initiation of Omegaven™.

Los días de exposición a nutrición parenteral aumentan el riesgo de bacteriemia asociada a catéter venoso central / Exposition to total parenteral nutrition increases the risk of catheter-related bloodstream infection

Background: Infectious complications associated to central venous catheter (CVC) increase morbidity, mortality and costs. Total parenteral nutrition (TPN) is one of the risk factors described for catheter-related bloodstream infection (CR-BSI). The aim of this study was explore if TPN and time of exposition, are risk factors for CR-BSI among patient exposed to this therapy. Patients and Methods: Cohort study of patients with CVC exposed and not exposed to TPN with calculation of the relative risk (RR) for CR-BSI and percentage of CR-BSI according to different times of exposition to TPN. Study encompassed years 2010-2015 and only adult patients were included. Results: During the study period 51 events of CR-BSI were identified, with 27 occurring among those exposed to TPN and 24 among those not exposed. CR-BSI incidence rate was 6.3 in the group with TPN and 1.2 in those without this therapy (RR 5.4; IC 95 3.6-8.2). The percentage of patients with CR-BSI increased in parallel to exposition time (Pearson coefficient +0.91) and the OR increased for expositions ≥ 7 days (OR 2.8; IC 95 1.047.4; p < 0.05). Conclusions: Exposition to TPN increases the risk to CR-BSI in adult patients with CVC and this risk raise with exposition time.

Antecedentes: Las complicaciones infecciosas asociadas a dispositivos vasculares centrales tienen impacto en morbi-mortalidad y costos. Diferentes factores de riesgo han sido identificados en las ITS/CVC, incluyendo la nutrición parenteral total (NPT). Objetivo: Determinar si la NPT y el tiempo de exposición constituyen factores de riesgo para desarrollar ITS/CVC. Pacientes y Método: Estudio de cohortes de diseño prospectivo, de pacientes adultos con catéter venoso central (CVC) convencional, internados en el Hospital Militar entre los años 2010 y 2015 y que estuvieron expuestos o no expuestos a NPT, calculando el riesgo relativo (RR) y la distribución porcentual de las ITS/CVC a diferentes intervalos de exposición de NPT con análisis de coeficiente de correlación y cálculo de Odds Ratio (OR). Resultados: Durante el período de estudio se registraron 51 eventos de ITS/CVC en pacientes adultos con CVC, de los cuales 27 estuvieron expuestos a NPT y 24 no. Incidencia de 6,3 por 1.000 días en expuestos a NPT vs 1,2 en no expuestos (RR de 5,4; IC 95 3,6 a 8,2). La proporción de pacientes con ITS/CVC aumentó a medida que aumentaba la exposición a NPT (coeficiente correlación r = +0,91), siendo significativa para exposiciones ≥ 7 días (OR 2,8; IC 95 1,04-7,4; p < 0,05). Conclusiones: La exposición a NPT aumenta el riesgo de ITS/CVC en pacientes adultos hospitalizados respecto a aquellos pacientes que no reciben NPT, además este riesgo aumenta con el tiempo de exposición.

Stability Investigation of Total Parenteral Nutrition Solution of Different Prescriptions / 中国药房

OBJECTIVE:To investigate the number of insoluble particle in total parenteral nutrition(TPN)solutions and to pro-vide reference for clinical application. METHODS:6 kinds of commonly used TPN prescriptions were selected. After prepared ac-cording to sterile operation procedure,TPN at 25℃was investigated at 0,1,4,8 and 24 h in terms of appearance,pH value,os-motic pressure and the numbers of insoluble particles. RESULTS:The appearance and pH value of TPN had no significant change within 24 h after preparation,and osmotic pressures were all lower than 900 mOsm/L. Study results showed that the numbers of in-soluble particles quickly increased,and ≥10 μm and ≥25 μm insoluble particles exceeded the limitation of Chinese Pharmacopoe-ia after Lipid-soluble vitamin for injection were injected into TPN. Medium/long chain fat emulsion injection,water-soluble vita-min,electrolytes and trace elements also increased the numbers of insoluble particles. CONCLUSIONS:Medium/long chain fat emulsion injection,lipid-soluble/water-soluble vitamin,vitamin C,electrolytes and trace elements have certain influence on the number of insoluble particle of TPN. To analyze the reason for the forming of insoluble particles has great meaning both for improv-ing the TPN quality and reducing the harm of particles for patients.

Risk factors and prevention of chylous leakage after pancreaticoduodenectomy / 中华肝胆外科杂志

Objective To investigate the risk factors of chylous leakage after pancreatioduodenectomy so as to find effective measures to prevent this complication.Methods A retrospective analysis was conducted on 230 patients who underwent pancreatioduodenectomy at the First Affiliated Hospital of Zhejiang University from Jun.2012 to Jun.2014.Patients with chylous leakage were identified and a 1 ∶ 2 patients in the study and the control groups were selected.The parameters for matching included tumor volume,vascular invasion,and extent of lymph node dissection.A logistic analysis was performed to identify independent risk factors of chylous leakage.Results 15 (6.5％) patients developed chylous leakage after pancreatioduodenectomy.The average hospital stay after surgery of the study group was 20.8 days,compared to 13.5 days in the control-group (P =0.004).In the study group,chylous leakage rate increased in patients with 14th and 16th group of lymph nodes dissection (80％ vs 36.7％,P =0.006).Logistic analysis showed that 14th and 16th lymph nodes dissection was an independent risk factor of chylous leakage after pancreatioduodenectomy (P ＜ 0.05,OR =6.909,95％ CI 1.593 ～ 29.958).Conclusions Chylous leakage prolonged hospitalization after pancreatioduodenectomy.Dissection of the 14th and 16th lymph node groups was an independent risk factor of chylous leakage after pancreatioduodenectomy.Careful ligation of the gastrocolic vein near the lymphatic trunk and dissection of 14th and 16th group of lymph nodes were effective interventions to reduce postoperative chylous leakage.

Investigation on Stability of TPN Solution Containing Vitamin C / 中国药师

Objective:To study the stability of total parenteral nutrition ( TPN) solution used in our hospital .Methods:The ap-pearance and pH of the compatibility solution were observed and the content of vitamin C was determined in 8 h after the compatibility . Results:The content of vitamin C in compound amino acid solution was decreased with the time , and the solution turned yellow in 4 h and the content of vitamin C was decreased by 10%, while no notable change in pH value was shown .The solution without compound amino acid was stable in 6 h.Conclusion:Vitamin C injection mixed with TNP solution containing compound amino acid is not recom-mended, and vitamin C should be used alone .

Effects of Calcium Ion on the Stability of Total Parenteral Nutrition Solution / 中国药房

OBJECTIVE:To study the effects of calcium ion(Ca2+)on the stability of total parenteral nutrition(TPN),and to provide reference for clinical use. METHODS:4 kinds of TPN containing different contents of Ca2+were prepared according to ster-ile operation procedure,and at room temperature,their microbial limit,appearance,pH value,osmotic pressure molar concentra-tion,the number of insoluble particle and emulsion particle size were investigated at 0,2,4,6,8 and 24 h. RESULTS:Within 24 h,no bacterial colony was found in TPN,and its appearance had no obvious change;pH value of TPN were all higher than 5 at different time points,without statistical significance(P>0.05);osmotic pressure molar concentration of TPN were all within the range of normal human blood(280-310 mOsmol/kg),without statistical significance(P>0.05). As the increase of Ca2+,the num-ber of insoluble particle ≥10 μm in TPN showed increasing tendency,with statistical significance (P0.05). There was statistical significance in emulsion partial size of TPN at different time points(P<0.05). CONCLUSIONS:Ca2+ can influence the stability of TPN,manifesting as the number of insolu-ble particle ≥10 μm and emulsion partial size increase. To garantee the safety of TPN use in the clinic,the concentration of biva-lent cation in TPN prescrption should be kept in reasonable range,and TPN should be used as soon as possible after preparation.

Cardiac tamponade: a rare but preventable complication of central venous catheter in neonates

Pericardial effusion with cardiac tamponade is a rare and life-threatening complication of peripherally inserted central catheter (PICC) in a neonate. We report a 33-week preterm neonate who had sudden clinical deterioration at day seven of total parenteral nutrition regime via PICC. Recognition of pericardial effusion with cardiac tamponade in neonates with a PICC requires a high index of suspicion and steps in prevention include proper catheter tip placement and continuous monitoring of line position and function.

Caracterização da evolução clínica dos recém-nascidos com gastrosquise em uma unidade de terapia intensiva neonatal de referência da américa latina / Characteristics of the clinical development of a newborn with gastroschisis in an intensive care unit in latin america

INTRODUCTION: Congenital malformations are major diseases observed at birth. They are the second most common cause of death in the neonatal population, the first one being prematurity. OBJECTIVE: To characterise the clinical outcome of newborns with gastroschisis (GS) in a neonatal intensive care unit. METHODS: A retrospective observational clinical study in 50 infants with GS using the association of intestinal abnormalities, impossibility of primary closure of the abdominal defect and reoperation necessity as classification criteria for the disease. The significance level was p < 0.05. RESULTS: The hospitalisation to primary surgery occurred with a median age of 2 hours. Fourteen percent of children were subjected to a primary silo interposition and 24% had associated intestinal malformation. Nineteen newborns (NB) required more than one surgery. The median length of stay was 33 days, higher in patients with complex GS (56 days). All NB recovered from urine output 48 hours after surgery and 40% had hyponatraemia and oligoanuria in this period. There was no difference between the natraemia and fasting time (p = 0.79). Weight gain was similar in both groups with total parenteral nutrition and became significantly higher in patients with simple GS after enteral feeding (p = 0.0046). These NB evolved 2.4 times less cholestasis. Late-onset sepsis occurred in 58% of patients and was related to the infection of the central venous catheter in 37.9% of cases. Mortality was higher in infants infected with complex GS and the overall mortality rate was 14%. CONCLUSION: Clinical characterisation of newborns with gastroschisis depends on the complexity and the knowledge and conduct of morbidities to reduce mortality.

INTRODUÇÃO: As malformações congênitas fazem parte das principais doenças observadas ao nascimento. Entre as causas de óbito no período neonatal as malformações foram a segunda causa, sendo ainda a primeira, a prematuridade. OBJETIVOS: Caracterizar a evolução clínica dos recém-nascidos (RN) com gastrosquise (GTQ) em uma unidade de terapia intensiva neonatal e descrever as morbidades renal, nutricional e infecciosa relacionados ao manejo clínico pós-natal na unidade de terapia intensiva neonatal MÉTODO: Foi realizado estudo observacional retrospectivo em 50 RN com GTQ, utilizando a associação de anormalidades intestinais, impossibilidade de fechamento primário do defeito abdominal e necesidade de reoperação como critérios de classificação para a doença. O nível de significância foi p < 0,05. RESULTADOS: A admissão hospitalar para cirurgia primária ocorreu com mediana de idade de 2 horas. O total de 14% das crianças foram submetidas a uma interposição de silo primária e 24% apresentaram malformação intestinal associada. Dezenove RN necessitaram mais de uma intervenção cirúrgica. A mediana do tempo de estadia foi de 33 dias, sendo maior nos pacientes com GTQ complexa (56 dias). Todos os RN recuperaram o débito urinário a partir de 48 horas do pós-operatório e 40% apresentaram hiponatremia e oligoanúria nesse período. Não houve diferença entre a natremia e o tempo de jejum (p = 0,79). O ganho ponderal foi similar em ambos os grupos com nutrição parenteral total e tornou-se significativamente maior nos pacientes com GTQ simples após a alimentação enteral (p = 0,0046). Esses RN evoluíram 2,4 vezes com menos colestase. Sepse tardia ocorreu em 58% dos pacientes e foi relacionada à infecção do CVC em 37,9% dos casos. A mortalidade foi maior nos RN infectados com GTQ complexa e a taxa global de mortalidade foi de 14%. CONCLUSÃO: A caracterização clínica dos RN com GTG depende da complexidade e do conhecimento e condução das morbidades para diminuir a mortalidade.