Nutritional follow-up of critically ill infants receiving short term parenteral nutrition

Abstract

SUMMARY: Few studies have tried to characterize the efficacy of parenteral support of critically ill infants during short period of intensive care. We studied seventeen infants during five days of total parenteral hyperalimentation. Subsequently, according to the clinical conditions, the patients received nutritional support by parenteral, enteral route or both up to the 10 th day. Evaluations were performed on the 1 st , 5 th , and 10 th days. These included: clinical data (food intake and anthropometric measurements), haematological data (lymphocyte count), biochemical tests (albumin, transferrin, fibronectin, prealbumin, retinol-binding protein) and hormone assays (cortisol, insulin, glucagon).Anthropometric measurements revealed no significant difference between the first and second evaluations. Serum albumin and transferrin did not change significantly, but mean values of fibronectin (8.9 to 16 mg/dL), prealbumin (7.7 to 18 mg/dL), and retinol-binding protein (2.4 to 3.7 mg/dL) increased significantly (p < 0.05) from the 1 st to the 10 th day. The hormonal study showed no difference for insulin, glucagon, and cortisol when the three evaluations were compared. The mean value of the glucose/insulin ratio was of 25.7 in the 1 st day and 15.5 in the 5 th day, revealing a transitory supression of this hormone. Cortisol showed values above normal in the beginning of the study.We conclude that the anthropometric parameters were not useful due to the short time of the study; serum proteins, fibronectin, prealbumin, and retinol-binding protein were very sensitive indicators of nutritional status, and an elevated glucose/insulin ratio, associated with a slight tendency for increased cortisol levels suggest hypercatabolic state. The critically ill patient can benefit from an early metabolic support.

Clinical Presentation of Malnourished Patients With Pneumonia Requiring Prolonged Ventilatory Support

“…Merritt et al (1985) [38] suggested that hypoalbuminemia is associated with inflammation, as in pneumonia, rather than being a common marker of protein [22] or caloric deficiencies [39]. Our data on plasma albumin during the acute phase are comparable to those obtained by many authors [22,25,36,43] as they indicated a negative linear correlation between plasma albumin and the length of oxygen therapy in G1. Hypoalbuminemia during inflammation [44] and during the edematous phase of PEM (i.e., Kwashiorkor and marasmic Kwashiorkor) [45] is due to reduced synthesis.…”

“…G2 patients exhibited a milder underweight status compared to G1. The observed low ZWA on admission agreed with the findings of others [22][23][24][25]. From a review of studies from developing countries, Victora et al [26] concluded that underweight infants have a higher risk of mortality, case fatality and morbidity from pneumonia or ALRI.…”

“…2016;5(2): [19][20][21][22][23][24][25][26][27][28] tion are predictors, along with age, temperature, respiratory rate and increased respiratory effort, of the outcome of serious bacterial infections [11]. According to WHO [12], more than 30% of children under 5 years of age worldwide are malnourished.…”

Parenteral Beslenen Yoğun Bakım Hastalarında Soya Yağı, Zeytinyağı ve Mct-Lct Bazlı Nutrisyon Solüsyonlarının Etkilerinin Karşılaştırılması

“…Nitrojen dengesi, vücut proteinlerinin kaybı veya kazanılmasının bir göstergesi olabilir, ancak tek başına bir hedef değildir. Bu nedenle malnutrisyonda değişiklik gösteren dört plazma protein düzeyiyle ilgili olarak albüminin düşük, transferrinin orta derecede, prealbümin ve retinol bağlayıcı proteininse yüksek derecede duyarlı olduğu gösterilmiştir (24).Yoğun bakım ünitelerinde nutrisyon takibi yapılan malnutrisyonlu geriyatrik hastaların %42,9'u kombine enteral-parenteral, %3,1'i enteral, %18,5'i parenteral ve %7,6'sı oral yollarla beslenmiştir. Hastaların serum protein değerleri, hastanede kalış süresi ve mortalite açısından fark görülmemiş, ayrıca hastaneye yatış ve nutrisyonel destek sonrası biyokimyasal parametreler arasında herhangi bir farklılık saptanmadığı bildirilmiştir.…”

Resposta inflamatória sistêmica e alterações no metabolismo lipídico em crianças e adolescentes gravemente doentes

“…Estas mudanças levam a subnutrição energético-proteica caracterizada pela perda de proteína corpórea e do depósito de gordura (Thibault e Pichard, 2010;Prieto e Cid, 2011 internação hospitalar e duração da antibioticoterapia mais prolongada (Briassoulis et al, 2001;de Souza Menezes et al,2011;Tappenden et al, 2013). Estes eventos levam a um aumento na taxa de mortalidade, tornando prioritária a introdução precoce da terapia nutricional (Delgado et al, 2000(Delgado et al, e 2008Calder et al, 2010;Tappenden et al, 2013).…”