ABSTRACT
BACKGROUND: The primary hypothesis of this article is that a team approach in creating a protocolized laboratory monitoring schedule for home parenteral nutrition (PN) patients improves patient safety by decreasing the occurrence of nutrition deficiencies and is cost-effective. METHODS: In this prospective cohort study of home PN patients, each patient followed an established protocol of laboratory monitoring and weekly review by an interdisciplinary team of dietitians, nurses, and physicians. Data collected included anthropometric measurements, laboratory results, deviations from laboratory protocols, laboratory charges, PN shortage information, and means of ameliorating such shortages. Cost-effectiveness analysis was only performed for nonmicronutrient laboratory tests. RESULTS: Fifteen children (male, n = 6) with a median age of 59 months (range, 19-216) were included in this study. Primary diagnoses included short bowel syndrome (47%) and intestinal pseudo-obstruction (40%). Patients received PN mixtures from 6 different infusion companies and experienced 60 different shortages in the PN formulation requiring adjustments or substitutions (mean, 4 shortages per patient). All patients had appropriate growth and complete micronutrient monitoring. No patient experienced any clinical symptoms due to shortages. The median number of laboratory draws/patient per month was 2.9 preprotocol compared with 1.14 postprotocol (P = .003). The median per patient per month charges were $2014 (interquartile range [IQR], 1471-2780) preprotocol compared with $792 (IQR, 435-1140) postprotocol (P = .002). CONCLUSIONS: A structured team approach to laboratory monitoring of home PN patients can simplify PN management, significantly decrease monthly laboratory costs, and lead to fewer laboratory draws while improving micronutrient monitoring and preventing deficiencies.
Subject(s)
Hematologic Tests/statistics & numerical data , Malnutrition/diagnosis , Malnutrition/prevention & control , Parenteral Nutrition, Home/methods , Adolescent , Child , Child, Preschool , Clinical Protocols , Cohort Studies , Cost-Benefit Analysis/economics , Female , Hematologic Tests/economics , Humans , Infant , Male , Parenteral Nutrition, Home/economics , Patient Care Team , Patient Safety , Prospective StudiesABSTRACT
A gluten-free diet (GFD) is commonly recognized as the treatment for celiac disease. It also has been investigated as a treatment option for other medical conditions, including dermatitis herpetiformis, irritable bowel syndrome, neurologic disorders, rheumatoid arthritis, diabetes mellitus, and HIV-associated enteropathy. The strength of the evidence for the use of a GFD in these nonceliac diseases varies, and future research may better define the benefits of a GFD for those conditions with weak existing evidence.
Subject(s)
Celiac Disease/diet therapy , Diet, Gluten-Free , Arthritis, Rheumatoid/diet therapy , Autistic Disorder/diet therapy , Dermatitis Herpetiformis/diet therapy , Diabetes Mellitus/diet therapy , HIV Enteropathy/diet therapy , Humans , Irritable Bowel Syndrome/diet therapy , Nervous System Diseases/diet therapyABSTRACT
Pediatric nutritional deficiencies are associated not only with poverty and developing countries, but also in children in the developed world who adhere to restricted diets. At times, these diets are medically necessary, such as the gluten-free diet for management of celiac disease or exclusion diets in children with food allergies. At other times, the diets are self-selected by children with behavioral disorders, or parent-selected because of nutrition misinformation, cultural preferences, alternative nutrition therapies, or misconceptions regarding food tolerance. Health care providers must be vigilant in monitoring both growth and feeding patterns to identify inappropriate dietary changes that may result in nutritional deficiencies.
Subject(s)
Diet/adverse effects , Dietary Supplements , Malnutrition/diet therapy , Malnutrition/etiology , Micronutrients/administration & dosage , Adolescent , Celiac Disease/diet therapy , Child , Child, Preschool , Developmental Disabilities/etiology , Diet, Gluten-Free/adverse effects , Diet, Ketogenic/adverse effects , Diet, Macrobiotic/adverse effects , Diet, Reducing/adverse effects , Diet, Vegetarian/adverse effects , Enteral Nutrition/adverse effects , Food Hypersensitivity/diet therapy , Humans , Malnutrition/complications , Malnutrition/diagnosis , Malnutrition/metabolism , Milk Hypersensitivity/diet therapy , Minerals/administration & dosage , Nutrition Assessment , Nutritional Requirements , Nutritional Status , Trace Elements/administration & dosage , Vitamins/administration & dosageABSTRACT
Growth velocity assessment is a means for tracking growth in infants and children over time. With the revision of the Centers for Disease Control and Prevention (CDC) growth charts in 2000 and the introduction of the World Health Organization (WHO) growth charts in 2006, there is a need for an updated growth velocity reference to provide data that better align with these current charts. In this article, the authors provide data on weight velocity for males and females from birth through 20 years using the WHO data and the revised CDC data. Weight velocity charts can be especially useful when patients are seen within short time intervals and can be used to set weight goals for children requiring nutrition support and for children who are chronically ill.
