Effects of prophylactic use of taurolidine-citrate lock on the number of catheter-related infections in children under 2 years of age undergoing surgery.

Central venous access poses a risk for the development of catheter-related infections (CRIs). The aim of this study was to evaluate prophylactic use of taurolidine-citrate (T-C) solution on the number of CRIs. Ninety-seven catheters, used in 86 children, were divided at random into two groups: Group T(-) (N=49) underwent standard aseptic procedures, and Group T(+) (N=48) received additional filling of the lines with T-C solution during intervals in cycles of parenteral nutrition or drug supply. Sixteen CRIs occurred in Group T(-) and one CRI occurred in Group T(+); this difference was significant (P<0.05). Use of T-C appears to be a safe and effective method for the prevention of CRIs.

Aluminum contamination of parenteral nutrition additives, amino acid solutions, and lipid emulsions.

Contamination of parenteral nutrition solutions with aluminum may result in accumulation of this element in bones and, in premature infants, may inhibit bone calcium uptake and induce cholestasis. We measured the aluminum concentration of small-volume parenterals, amino acid solutions, lipid emulsions, and special solutions containing glucose, amino acids, electrolytes, and trace elements (standard I for children with a body weight of 3-5 kg, standard II for children with a body weight of 5-10 kg). The method used was graphite furnace atomic absorption spectrometry GTA-AAS (SpectrAA-400 Plus, Varian, PtY Ltd., Mulgrave, Australia). Quality control was run with the use of control serum (Seronorm, Nycomed, Oslo, Norway). The aluminum contents of parenterally administered solutions were: pediatric trace elements, 130 micrograms/L, and pediatric trace elements, 3000 micrograms/L; phosphorus salts: K-phosphates, 9800 micrograms/L, and Na/K phosphates, 13,000 micrograms/L; 10% calcium gluconate, 4400 micrograms/L; 6.5% amino acids, 30 micrograms/L; 10% amino acids, 120 micrograms/L; 12.5% amino acids, 121 micrograms/L; 20% lipid emulsion, 30 micrograms/L; 20% lipid emulsion, 180 micrograms/L; water-soluble vitamins, 12 micrograms/L; lipid soluble vitamins, 360 micrograms/L; standard I, 55 micrograms/L; standard II, 90 micrograms/L; The aluminum intake from parenteral nutrition was 6.6-10.8 micrograms.kg-1.d-1--a dose exceeding the safety limit of 2 micrograms.kg-1.d-1. The possible association of aluminum not only with metabolic bone disease, but also with encephalopathy, dictates caution when dealing with the pediatric population on long-term parenteral nutrition. In the absence of reliable label information, it seems proper to monitor the aluminum concentration in parenteral nutrition products and to report it in professional journals.

Home parenteral nutrition in children: the Polish experience.

BACKGROUND: Home parenteral nutrition has become routine for management of intestinal failure in patients. In Poland the main obstacle to widespread use of home parenteral nutrition is the lack of interest of commercial companies in delivering feedings and ancillaries to patients. METHODS: Twenty-five home parenteral nutrition patients aged from 4 months to more than 13 years were reviewed. The mother or both parents were trained in home parenteral nutrition techniques for 4 to 6 weeks and compounded the nutrients themselves at home. RESULTS: The mean duration of home parenteral nutrition was 10,117 patient days. Hospital stays of patients receiving parenteral feedings were significantly shorter than the duration of administration of home parenteral nutrition (p < 0.001). Eleven children are continuing the home parenteral nutrition program. Eighty-three catheters were used in these patients. The rate of catheter occlusion decreased within the observation period, and in 1997 not one case of occlusion was observed. In 1997 only three catheters were removed during 7.8 patient years, and the overall incidence of catheter-related complications was 0.38 per patient year. The overall occurrence of septicemia was one case in 516 days and of catheter infection was one in 459 days. In 1997 a catheter was infected on average of once every 1419 days. There was significant improvement in the z score for weight during therapy. The average monthly cost of nutrients and ancillary items was approximately $1200 (4200 Polish zlotys [PLN]). These costs are 1.6 to 3 times lower than those recorded in other studies. CONCLUSION: Home parenteral nutrition in children with nutrients mixed by caregivers in the home setting is a safe and appropriate method of treatment that can be used in countries where home parenteral nutrition solutions are not manufactured or where commercial home parenteral nutrition is not economically feasible.

Is growth hormone a feasible adjuvant in the treatment of children after small bowel resection?

The aim of our study was to assess the metabolic consequences of short-term administration of growth hormone in children after gut resection and influence on polyamine production in red blood cells (RBC). Twelve children aged 4-60 months were studied. All children remained on parenteral nutrition and 11 also received oral feeding. Total non-protein energy intake was 429 +/- 86 kJ/kg body weight (BW)/day. Recombinant growth hormone (GH) was administered subcutaneously at a dose of 0.3 IU/kg BW/day for 10 days. Resting energy expenditure (REE; kJ/kg BW/day) was: 316.07 +/- 54.08 before and 346.04 +/- 54.40 during GH administration (P < 0.02), but daily weight gain before GH administration was significantly lower than during treatment. A significant increase of polyamine concentrations was observed in the RBC (spermidine: 30.1 +/- 15.1 and 43.8 +/- 24.9 nmol/ml packed RBC, P < 0.003; spermine: 15.6 +/- 5.1 and 19.6 +/- 10.6 nmol/ml packed RBC, P < 0.02) and in jejunal mucosa (spermidine: 172.10 +/- 142.35 nmol/g tissue and 193.92 +/- 108.15 nmol/g tissue). The authors concluded that increased polyamine concentrations in the RBC and jejunal mucosa reflect a cellular response to GH administration. The anabolic effect of GH results in higher weight gain, although increased REE may indicate increased energy requirements during GH treatment.

Energy metabolism in portal hypertension in children.

This study was designed to assess resting energy expenditure (REE) and nutritional status in children with hepatic and prehepatic portal hypertension in comparison with healthy controls. Twenty-five patients with portal hypertension (PHT) and a history of variceal bleeding were compared with 14 healthy volunteers selected after matching for age and sex. PHT patients were allocated to one of two groups: 11 children with liver cirrhosis and/or chronic hepatitis, aged 14.0 +/- 3.3 y (means +/- SD) or 14 children with extrahepatic portal vein obstruction, aged 12.3 +/- 2.8 y. The control group consisted of 14 healthy children, aged 14.0 +/- 1.8 y. REE (indirect calorimetry) assessed after an overnight fast was significantly higher in PHT patients than in controls when related to body mass (143.7 +/- 29.5 and 116.1 +/- 5.9 kJ/kg, respectively; p < 0.004), lean body mass (168.0 +/- 28.9 and 146.4 +/- 14.1 kJ/kg, respectively; p < 0.02), and body surface area (7480 +/- 736 and 6590 +/- 567 kJ/1.73 m2, respectively; p < 0.001). The ratios of measured REE to basal energy expenditure calculated from standard equations (Schofield equations) indicated higher REE in PHT patients (102.24 +/- 6.90% and 93.54 +/- 4.47%, respectively; p < 0.001). Fat was the predominant source of energy in both PHT patients and controls; the percentage of nonprotein energy derived from carbohydrate oxidation was equaled: 36.04 +/- 18.84% and 37.15 +/- 15.71%, respectively. Analysis of percentage of undernutrition in PHT patients and controls revealed significant differences (44% and 21%, respectively; p < 0.001). Children with PHT are susceptible to malnutrition and have elevated REE compared with healthy controls. Fat is the principal basal state oxidative substrate for patients with PHT and healthy children.

[Thermogenesis during parenteral nutrition and after oral meal]. / Termogeneza podczas zywienia pozajelitowego i po posilku doustnym.

The aim of the study was to assess thermogenesis during parenteral feeding (group A) and after an oral test meal of a polymeric diet (group B). Carbohydrates, fat and protein ratios in the oral meal and parenteral mixture were: 51:34:15 and 76:11:13, resp. In both situations 20% of resting energy expenditure (REE) was administered-as a bolus oral meal or during 120 min. of intravenous infusion. Mean results of respiratory gas exchange of 15 min. periods were used for calculations. Basal respiratory quotient (RQ) in group A and B was 0.841 and 0.806 resp (difference not significant; NS); peak RQ was 0.910 and 0.924 resp. (NS). Peak RQ in group B was significantly higher than basal (p < 0.006). REE in group A and B was 1,416 +/- 0,231 kj/kg/15 min. and 1,322 +/- 0,226 kj/kg/15 min. resp. (NS). Peak thermic effect (expressed as the rise of REE in percent of the energy content of the nutrients) was: 4.778% and 5.135% resp. (NS). Postprandial thermogenesis is not dependent on the route of administration of nutrients (parenteral or oral). The proportion of substrate utilisation depends on the content of the meal or parenteral mixture.

[Autoimmune enteropathy--difficulties in diagnosis and treatment]. / Biegunka autoimmunologiczna--trudnosci w diagnostyce i leczeniu.

We describe a 42-month-old child with protracted diarrhoea that began at 6 months of age. Severe secretory diarrhoea persisted despite therapy with exclusion diets, total parenteral nutrition, chemotherapeutics, antisecretory drugs. The diagnosis of autoimmune enteropathy with total villous atrophy and anti-enterocyte antibodies was established at 16 months of age. Prednisone therapy induced a clinical remission. After dose reduction, clinical relapse occurred, complicated with HCV infection with elevated serum alanine aminotransferase activity. Increasing the prednisone dose did not result in clinical improvement. Treatment with cyclosporine induced clinical remission. After 10 months cyclosporine therapy is still continued and the boy is doing well.

[Familial diarrhea exemplified by two children]. / Biegunka rodzinna na przykladzie dwojga dzieci.

Two cases (siblings) are presented of children with diarrhoea since neonatal period and early infancy, of secretory character. The aetiological factor could not have been established and effective treatment could not have been instituted.