Should pediatric parenteral nutrition be individualized?

Abstract

Introduction: Parenteral nutrition (PN) formulations are commonly individualized, since their standardization appears inadequate for the pediatric population. This study aimed to evaluate the nutritional state and the reasons for PN individualization in pediatric patients using PN, hospitalized in a tertiary hospital in Campinas, São Paulo. Methods: This longitudinal study comprised patients using PN followed by up to 67 days. Nutritional status was classified according to the criteria established by the World Health Organization (WHO) (2006) and WHO (2007). The levels of the following elements in blood were analyzed: sodium, potassium, ionized calcium, chloride, magnesium, inorganic phosphorus, and triglycerides (TGL). Among the criteria for individualization, the following were considered undeniable: significant reduction in blood levels of potassium (<3mEq/L), sodium (<125mEq/L), magnesium (<1mEq/L), phosphorus (<1.5mEq/L), ionic calcium (<1mmol), and chloride (<90mEq/L), or any value above the references. Results: Twelve pediatric patients aged 1 month to 15 years were studied (49 individualizations). most patients were classified as malnourished. It was observed that 74/254 (29.2%) of examinations demanded individualized PN for indubitable reasons. Conclusion: The nutritional state of patients was considered critical in most cases. Thus, the individualization performed in the beginning of PN for energy protein adequacy was indispensable. In addition, the individualized PN was indispensable in at least 29.2% of PN for correction of alterations found in biochemical parameters.

Diseño y adecuación de una solución gluco-proteica con calcio a las necesidades de recién nacidos pre-término

“…La estandarización de la NP permite cubrir las necesidades diarias de un grupo de pacientes con características similares entre sí 9 . A diferencia de los adultos, la mayoría de las NP en la población pediátrica son individualizadas ya que el RNPT y el recién nacido a término presentan grandes diferencias y precisan un aporte nutricional distinto, por lo que es difícil diseñar una NP ideal que cubra las necesidades de la mayoría de recién nacidos 10,11 .…”