Management of Central Venous Access in Children With Intestinal Failure

Wendel, Danielle; Mezoff, Ethan A.; Raghu, Vikram K.; Kinberg, Sivan; Soden, Jason; Avitzur, Yaron; Rudolph, Jeffrey A.; Gniadek, Michelle; Cohran, Valeria C.; Venick, Robert S.; Cole, Conrad R.

doi:10.1097/mpg.0000000000003036

Cited by 36 publications

(72 citation statements)

References 97 publications

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“…Their insertion is an invasive method and is used in both adult and pediatric patients [23]. Additionally, long-term intestinal problems in children also require the insertion of a CVC to provide parenteral nutrition, but this is frequently accompanied by infections resulting in an increased rate of morbidity and mortality [24].…”

Section: Hais Associated With Administration Of Temporary Indwelling Devicesmentioning

confidence: 99%

Impact of Healthcare-Associated Infections Connected to Medical Devices—An Update

et al. 2021

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Healthcare-associated infections (HAIs) are caused by nosocomial pathogens. HAIs have an immense impact not only on developing countries but also on highly developed parts of world. They are predominantly device-associated infections that are caused by the planktonic form of microorganisms as well as those organized in biofilms. This review elucidates the impact of HAIs, focusing on device-associated infections such as central line-associated bloodstream infection including catheter infection, catheter-associated urinary tract infection, ventilator-associated pneumonia, and surgical site infections. The most relevant microorganisms are mentioned in terms of their frequency of infection on medical devices. Standard care bundles, conventional therapy, and novel approaches against device-associated infections are briefly mentioned as well. This review concisely summarizes relevant and up-to-date information on HAIs and HAI-associated microorganisms and also provides a description of several useful approaches for tackling HAIs.

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Section: Hais Associated With Administration Of Temporary Indwelling Devicesmentioning

confidence: 99%

Impact of Healthcare-Associated Infections Connected to Medical Devices—An Update

et al. 2021

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“…Once a condition with a high mortality, pediatric intestinal failure is now considered a complex but survivable disorder 3 . The introduction of multidisciplinary teams and novel therapies has resulted in improved outcomes, 4 but children with intestinal failure remain at risk for multiple comorbidities and significant complications 5–10 …”

Section: Introductionmentioning

confidence: 99%

Normal anthropometry does not equal normal body composition in pediatric intestinal failure

Yanchis

Belza

Harrison

et al. 2021

J Parenter Enteral Nutr

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Background Published reports on abnormal body composition in pediatric patients with intestinal failure have been in patients with poor growth. The goal of the current study is to report the body composition of normally growing patients with intestinal failure. Methods Children 8–18 years old with a dual‐energy x‐ray absorptiometry (DXA) between January 1, 2013, and July 15, 2018, were included in the study. Data were retrospectively collected from the medical charts and included demographics, residual bowel anatomy, nutrition support, height, and weight. DXA data, including total body less head bone mineral density (BMD), fat mass (FM), and fat‐free mass (FFM), were collected and compared with published literature controls matched for age and sex. Results Thirty‐four children met inclusion criteria. Mean age at the time of DXA was 9.6 ± 1.8 years. Weight‐ and height‐for‐age z‐scores were −0.4 ± 0.9 and −0.5 ± 1.0, respectively. Mean BMD z‐score was −1.0 ± 1.3. Twenty‐six percent of patients (n = 9) had reduced BMD. Patients with intestinal failure had higher FM (P = .02) and lower FFM (P = .02) compared with controls. Conclusions These data show that, despite reference range z‐scores for height and weight, children with intestinal failure are at risk for abnormal body composition. Body composition should be routinely measured in children with intestinal failure to direct nutrition interventions.

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“…The presence of cholestasis was defined as a serum conjugated bilirubin concentration of ≥40 µmol/L for ≥2 wk with the necessity of a clinical intervention (defined as reduction in lipid dose, discontinuation of lipids, switch to a fish-oil-based lipid emulsion [Omegaven ® ], or prescription of ursodeoxycholic acid), derived from the definition used by Belza et al ( 22 ). An episode of a central-line associated blood stream infection was defined as the presence of a blood culture proven bacteremia (not being contamination) obtained from the catheter lumen ( 23 ). IF was defined as a duration of PN dependency of >60 d, calculated from the date of surgery onwards ( 20 ).…”

Section: Methodsmentioning

confidence: 99%

Anthropometrics and fat mass, but not fat-free mass, are compromised in infants requiring parenteral nutrition after neonatal intestinal surgery

Vlug

Neelis

Wells

et al. 2022

The American Journal of Clinical Nutrition

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Background Children with intestinal failure (IF) receiving long-term parenteral nutrition (PN) have altered body composition (BC), but data on BC changes from start of PN onwards are lacking. Objective We aimed to assess growth and BC in infants after neonatal intestinal surgery necessitating PN and at risk for IF, and to explore associations with clinical parameters. Design Prospective cohort study in infants after intestinal surgery. IF was defined as PN-dependency for > 60 days. Standard deviation scores (SDS) for anthropometry were calculated until 6 months corrected age. In a subgroup, fat mass (FM) and fat-free mass (FFM) were measured with air-displacement plethysmography at 2- and 6-months corrected age. SDS for length-adjusted FM index and FFM index were calculated. Associations between cumulative amount of PN and BC parameters were analyzed with linear mixed-effect models. Results Ninety-five neonates were included (54% male, 35% born < 32 weeks). Thirty-nine infants (41%) had IF. Studied infants had compromised anthropometric parameters during follow-up. At 6 months corrected age, they remained smaller (median weight-for-age SDS –0.9 [interquartile range –1.5, 0.1], P < 0.001) than the normal population. In 57 infants, 93 BC measurements were performed. FM index SDS was lower than in healthy infants at 2- and 6-months corrected age (–0.9 [–1.6, –0.3], P < 0.001 and –0.7 [–1.3, 0.1], P = 0.001, respectively), but FFM index SDS did not differ. A higher cumulative amount of PN predicted higher FM index in female infants but lower FM index in male infants. Conclusions In this cohort of infants receiving PN after intestinal surgery, compromised anthropometrics, decreased FM and adequate FFM were observed during the first 6 months. Male and female infants seemed to respond differently to PN when it comes to FM index. Continuing growth monitoring after 6 months of age is strongly recommended, while further research should explore the benefit of incorporating ongoing BC monitoring during follow-up. Clinical Trial Registration: Dutch Trial Register NTR6080, https://www.trialregister.nl/trial/5892.

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Management of Central Venous Access in Children With Intestinal Failure

Cited by 36 publications

References 97 publications

Impact of Healthcare-Associated Infections Connected to Medical Devices—An Update

Impact of Healthcare-Associated Infections Connected to Medical Devices—An Update

Normal anthropometry does not equal normal body composition in pediatric intestinal failure

Anthropometrics and fat mass, but not fat-free mass, are compromised in infants requiring parenteral nutrition after neonatal intestinal surgery

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