A.S.P.E.N. Clinical Guidelines

Arsenault, Danielle; Brenn, Megan; Kim, Sendia; Gura, Kathleen M.; Compher, Charlene; Simpser, Edwin; Puder, Mark

doi:10.1177/0148607111418980

Cited by 38 publications

(11 citation statements)

References 57 publications

(88 reference statements)

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“…Board of Directors has been publishing Clinical Guidelines since 1986. [3][4][5][6][7][8][9][10][11][12][13][14] A.S.P.E.N. evaluates in an ongoing process when individual Clinical Guidelines should be updated.…”

Section: Strongmentioning

confidence: 99%

A.S.P.E.N. Clinical Guidelines

McMahon

Nystrom

Braunschweig

et al. 2012

J Parenter Enteral Nutr

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135

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Background: Hyperglycemia is a frequent occurrence in adult hospitalized patients who receive nutrition support. Both hyperglycemia and hypoglycemia (resulting from attempts to correct hyperglycemia) are associated with adverse outcomes in diabetic as well as nondiabetic patients. This American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Clinical Guideline summarizes the most current evidence and provides guidelines for the desired blood glucose goal range in hospitalized patients receiving nutrition support, the definition of hypoglycemia, and the rationale for use of diabetes‐specific enteral formulas in hospitalized patients. Method: A systematic review of the best available evidence to answer a series of questions regarding glucose control in adults receiving parenteral or enteral nutrition was undertaken and evaluated using concepts adopted from the Grading of Recommendations, Assessment, Development and Evaluation working group. A consensus process was used to develop the clinical guideline recommendations prior to external and internal review and approval by the A.S.P.E.N. Board of Directors. Results/Conclusions: 1. What is the desired blood glucose goal range in adult hospitalized patients receiving nutrition support? We recommend a target blood glucose goal range of 140–180 mg/dL (7.8–10 mmol/L). (Strong) 2. How is hypoglycemia defined in adult hospitalized patients receiving nutrition support? We recommend that hypoglycemia be defined as a blood glucose concentration of <70 mg/dL (<3.9 mmol/L). (Strong) 3. Should diabetes‐specific enteral formulas be used for adult hospitalized patients with hyperglycemia? We cannot make a recommendation at this time.

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Section: Strongmentioning

confidence: 99%

A.S.P.E.N. Clinical Guidelines

McMahon

Nystrom

Braunschweig

et al. 2012

J Parenter Enteral Nutr

Self Cite

135

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“…Patients were monitored for hypophospathemia throughout the duration of PN, which was considered a marker of refeeding syndrome (RS) in the first 10 days of PN in malnourished children or those who had lost a significant amount of weight prior to the start of PN [ 13 ]. Hypoglycaemia was defined as a blood glucose level of less than 3.6 mmol/l (40 mg/dl) both in newborns and in children [ 14 , 15 ]. Children were considered hyperglycaemic if their blood sugare rose above 7 mmol/L (126 mg/dl) [ 14 ].…”

Section: Methodsmentioning

confidence: 99%

“… Hypoglycaemia was defined as a blood glucose level of less than 3.6 mmol/l (40 mg/dl) both in newborns and in children [ 14 , 15 ]. Children were considered hyperglycaemic if their blood sugare rose above 7 mmol/L (126 mg/dl) [ 14 ]. In newborns plasma glucose concentrations above 8 mmol/l (150 mg/dL) were considered pathological in accordance with the guidelines of the American Society for Parenteral and Enteral Nutrition [ 14 ].…”

Section: Methodsmentioning

confidence: 99%

“…Children were considered hyperglycaemic if their blood sugare rose above 7 mmol/L (126 mg/dl) [ 14 ]. In newborns plasma glucose concentrations above 8 mmol/l (150 mg/dL) were considered pathological in accordance with the guidelines of the American Society for Parenteral and Enteral Nutrition [ 14 ]. Blood triglyceride concentrations were checked on a weekly basis 4 h after stopping the lipid infusion; levels > 200 mg/dl in newborns, > 250 mg/dl in infants and > 400 mg/dl in children were considered pathological [ 16 ].…”

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Indications and complications of inpatient parenteral nutrition prescribed to children in a large tertiary referral hospital

Mantegazza¹,

Landy²,

Zuccotti³

et al. 2018

Ital J Pediatr

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BackgroundParenteral Nutrition (PN) is prescribed to children with intestinal failure. Although life saving, complications are common. Recommendations for indications and constituents of PN are made in the 2005 guidelines by the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN). The aim of this study was to establish if the indications for prescribing PN in a tertiary children’s hospital were appropriate, and to identify complications encountered. Data were compared to those published by the National Confidential Enquiry into patient outcome and death (NCEPOD) carried out in the United Kingdom in 2010.MethodsChildren and newborns receiving inpatient PN over a 6 months period were entered into the study and data was collected prospectively. The appropriate indications for the use of PN were based on the ESPGHAN guidelines. Recorded complications were divided into metabolic, central venous catheter (CVC) related, hepatobiliary and nutritional.ResultsA total of 303 children (67 newborns) were entered into the study. The main indications for the start of PN were critical illness (66/303), surgery (63/303) and bone marrow transplantation (28/303). The ESPGHAN recommendations were followed in 91.7% (278/303) of cases (95.5% of newborns, 90.7% of children). PN was considered inappropriate in 12/303 patients and equivocal in 13. The mean PN duration was 18 days (1–160) and the incidence of complications correlated to the length of PN prescribed. Metabolic, hepatobiliary and CVC related complications affected 74.6, 24.4, 16.4% of newborns and 76.7, 37.7 and 24.6% of children respectively.In relation to the appropriate indications for the start of PN our results mirrored those reported by the NCEPOD audit (92.4% of newborns and 88.6% children). However, the incidence of metabolic disturbances was higher in our cohort (74.6% vs 30.4% in children, 76.7% vs 14.3% in newborns) but CVC related complications lower amongst our newborns (16,4% vs 25%).ConclusionsAlthough the indications for inpatient PN in children is mostly justified, there is still a proportion who is receiving PN unnecessarily. PN related complications remain common. There is a need for better education amongst health professionals prescribing PN and access to nutritional support teams to reduce unwanted side effects.

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Guidelines for parenteral nutrition in preterm infants: The American Society for Parenteral and Enteral Nutrition

Robinson,

Calkins,

Chen

et al. 2023

J Parenter Enteral Nutr

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BackgroundParenteral 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.MethodsAn 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. Preterm infants with congenital gastrointestinal disorders or infants already diagnosed with necrotizing enterocolitis or PN‐associated liver disease (PNALD) at study entry were excluded.ResultsThe committee reviewed 2460 citations published between 2001 and 2023 and evaluated 57 clinical trials. For most questions, quality of evidence was very low. Most analyses yielded no significant differences between comparison groups. A multicomponent oil ILE was associated with a reduction in stage 3 or higher retinopathy of prematurity (ROP) compared to an ILE containing 100% soybean oil. For all other questions, expert opinion was provided.ConclusionMost clinical outcomes were not significantly different between comparison groups when evaluating timing of PN initiation, amino acid dose, and ILE composition. Future clinical trials should standardize outcome definitions to permit statistical conflation of data, thereby permitting more evidence based recommendations in future guidelines. This guideline has been approved by the ASPEN 2022‐2023 Board of Directors.

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A.S.P.E.N. Clinical Guidelines

Cited by 38 publications

References 57 publications

A.S.P.E.N. Clinical Guidelines

A.S.P.E.N. Clinical Guidelines

Indications and complications of inpatient parenteral nutrition prescribed to children in a large tertiary referral hospital

Guidelines for parenteral nutrition in preterm infants: The American Society for Parenteral and Enteral Nutrition

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