JPEN. Journal of Parenteral and Enteral Nutrition

BACKGROUND: Use of dextrose-containing maintenance fluids prior to parenteral nutrition initiation is speculated to reduce the risk for refeeding syndrome. We aimed to assess if the use of dextrose vs. non-dextrose maintenance fluids before parenteral nutrition initiation changes electrolyte supplementation requirements and shifts during initiation. METHODS: This retrospective cohort study included nothing by mouth patients who received maintenance fluids ≥ 72 hours before parenteral nutrition...

BACKGROUND: Enteral drug therapy is challenging in short bowel syndrome with intestinal failure (SBS-IF) due to unpredictable absorption. SEFA-6179 is an enterally-administered medium chain fatty acid analogue under development for intestinal failure-associated liver disease. We investigate the pharmacokinetics of two SEFA-6179 formulations in two large animal models of SBS-IF, including a new pseudojejunostomy model. METHODS: Twenty Yucatan minipigs were obtained...

BACKGROUND: Current standards for assessing body composition can be costly and technically challenging. There is a need for a predictive equation that combines multiple clinical and anthropometric factors to predict body composition outcomes at 36 weeks of postmenstrual age (PMA) or discharge. METHODS: To develop a widely applicable equation that predicts body fat percentage in preterm infants, we analyzed anthropometric data collected prospectively from a cohort of infants born very preterm between 2017 and 2018...

BACKGROUND: Patients in the intensive care unit (ICU) are at high risk for refeeding syndrome (RFS), yet there is uncertainty regarding how RFS should be operationalized in the ICU. We evaluated different definitions for RFS and tested how they associated with patient-centered outcomes in the ICU. METHODS: This was a retrospective comparison study. Patients age ≥ 18 were eligible if they were newly initiated on enteral feeding while hospitalized in the ICU...

From the time of their initial surgery, children with short bowel syndrome (SBS) begin rehabilitating their remaining bowel in a quest towards reaching enteral autonomy. Even in the earliest experiences from 1987, nearly 98% of children with intestinal failure (IF) attend school during this process and 50% of children were shown to adapt defined as achieving independence from parenteral nutrition (PN) This article is protected by copyright. All rights reserved.

BACKGROUND: Parenteral nutrition (PN) is prescribed for preterm infants until nutrition needs are met via the enteral route, but unanswered questions remain regarding PN best practices in this population. METHODS: An interdisciplinary committee was assembled to answer 12 questions concerning the provision of PN to preterm infants. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) process was used. Questions addressed parenteral macronutrient doses, lipid injectable emulsion (ILE) composition, and clinically relevant outcomes, including PNALD, early childhood growth, and neurodevelopment...

BACKGROUND: To quantify the osmolality of human milk fortified with human milk fortifiers (HMFs), powder infant formulas, and protein additives. METHODS: Commercial liquid HMFs and powder infant formulas were added to pasteurized pooled donor human milk in triplicate and stirred. The osmolality of unfortified and fortified human milk at 22, 24, 26, 27, 28, and 30 kilocalories/ounce was determined using freezing point depression. RESULTS: The osmolality of fortified human milk associated with caloric density in a linear relationship regardless of the fortification strategies...

INTRODUCTION: The International Intestinal Failure registry (IIFR) is an international consortium to study intestinal failure (IF) outcomes in a large contemporary pediatric cohort. We aimed to identify predictors of early (1-year) enteral autonomy. METHODS: We included IIFR pilot phase patients. IF was defined by parenteral nutrition need for at least 60 days due to a primary gastrointestinal etiology. The primary outcome was time to enteral autonomy achievement...

BACKGROUND: Critically ill patients frequently accrue substantial nutritional deficits due to multiple episodes of prolonged fasting prior to procedures. Existing literature suggests that for most patients receiving tube feeding the aspiration risk is low. Yet, national and international guidelines do not address fasting times for tube feeding, promoting uncertainty regarding optimal pre-procedural fasting practice. We aimed to characterize current institutional fasting practices in the United States for patients with and without a secure airway, with variable types of enteral access, for representative surgical procedures...

rom a technical perspective, the term "inflammatory bowel disease" (IBD) encompasses any intestinal disorder in which there is a component of inflammation. However, IBD usually refers to one of two diseases, ulcerative colitis (UC) or Crohn's disease (CD). Both are believed to reflect disorders in the immune system, although the specific etiology (or etiologies) have not been clearly delineated. As is true for many chronic inflammatory disorders, weight loss and other manifestations of protein-calorie malnutrition (PCM) are frequently seen...

BACKGROUND: Prevention of enteral feeding interruption (EFI) improves clinical outcomes of the critically ill in intensive care unit (ICU). This leads to shorter ICU stay and thereby lowering healthcare costs. This study compared the total cost of intensive care with early use of semi-elemental formula (SEF) vs. standard polymeric formula (SPF) under the Ministry of Health (MOH) system in Malaysia. METHODS: A decision tree model was developed based on literature and expert inputs...

BACKGROUND: To quantify the displacement of human milk by commercial human milk fortifiers (HMF) and infant formulas. METHODS: Commercial liquid HMFs and powder infant formulas were added to pasteurized pooled donor human milk in triplicate, stirred, and weighed. The difference in weight between unfortified and fortified human milk at 22, 24, 26, 27, 28, and 30 kilocalories/ounce was calculated. RESULTS: The displacement of human milk by liquid HMFs and powder infant formulas and powder HMF was highly associated with caloric density...

Over the past few decades, the advancements in home parenteral nutrition (HPN) management mean that patients receiving intravenous nutrition can live independently in the community but so much is still left to be desired. Once only a hypothetical concept, the ability to nourish patients while bypassing their digestive tract was brought to reality in the 1960s to turn what was once a terminal illness into a chronic one [1,2]. This article is protected by copyright. All rights reserved.

BACKGROUND: Central line-associated bloodstream infections (CLABSI) are a serious complication in children with intestinal failure. This study assessed the incremental costs of 4% Tetrasodium Ethylenediaminetetraacetic Acid (EDTA) compared to Taurolidine lock and heparin lock per quality-adjusted life-year (QALY) gained in children with intestinal failure from the healthcare payer and societal perspective. METHODS: A Markov cohort model of a 1-year-old child with intestinal failure was simulated until the age of 17 years (time horizon), with a cycle length of one month...

BACKGROUND: Patients with intestinal failure (IF) often present with abnormal body composition characterized by high fat mass. However, the distribution of fat and its association with the development of intestinal failure-associated liver disease (IFALD) remain unclear. This study aims to investigate the body composition and its relationship with IFALD in older children and adolescents with IF. METHODS: This retrospective case-control study enrolled patients with IF receiving parenteral nutrition (PN) at Keio University Hospital, who initiated PN before the age of 20 (cases)...

BACKGROUND: Teduglutide is a synthetic glucagon-like peptide-2 analogue approved for the treatment of short bowel syndrome associated with chronic intestinal failure (SBS-IF) in adult patients. Clinical trials have demonstrated its ability to reduce parenteral support (PS) requirement. This study aimed to describe the effect of 18-month treatment with teduglutide, evaluating PS and factors associated with PS volume reduction of ≥20% from baseline and weaning. Two-year clinical outcomes were also assessed...

BACKGROUND: Children with intestinal failure without liver disease, may be given soy-based lipid emulsion (SLE) or mixed lipid emulsion (MLE containing soy/medium chain triglyceride/olive/fish oils). Both differ in essential fatty acid content, while MLE has added arachidonic acid (AA) and docosahexaenoic acid (DHA). The aim of this study in neonatal piglets, was to compare serum and tissue fatty acid composition when the emulsions were given at unrestricted doses. METHODS: We compared SLE (n=15) and MLE (n=15) at doses of 10-15g/kg/d in total parenteral nutrition (TPN)...

My primary goal of Editor in Chief of JPEN is to increase quality of original research publications. As 64% of original research publications in JPEN over the last 10 years were on clinical research, the focus of our efforts is on increasing the quality of clinical research manuscripts. A more rigorous review process was implemented a year ago which included adding Deputy Editors and Associate Editors specifically chosen with advanced clinical research training as well as content expertise. This article is protected by copyright...

BACKGROUND: Reports of essential fatty acid deficiency (EFAD) in patients on parenteral nutrition (PN) receiving a composite lipid (mixed-oil intravenous lipid emulsion (MO ILE)) are predominantly in children managed by lipid dose restriction. The objective of the current study was to determine the prevalence of EFAD in patients with intestinal failure (IF) who are PN dependent and not lipid restricted. METHODS: We retrospectively evaluated patients, ages 0-17y followed by our intestinal rehabilitation program between November 2020 and June 2021 with PN dependency index (PNDI) of > 80% on a MO ILE, SMOFlipid®...

BACKGROUND: Measuring energy expenditure (EE) by indirect calorimetry (IC) has become the gold standard tool for critically ill patients in order to define energy targets and tailor nutrition. Debate remains as to the optimal duration of measurements, or the optimal time of day in which to perform IC. METHODS: In this retrospective observational study, we analyzed results of daily continuous IC in 270 mechanically ventilated, critically ill patients, admitted to the surgical intensive care unit in a tertiary medical center, and compared measurements performed at different hours of the day...