Parenteral nutrition for preterm infants: Issues and strategy

Lapillonne, Alexandre; Simeoni, Umberto; Picaud, Jean Charles; Rozé, Jean‐Christophe; Saliba, Élie; Bocquet, A.; Chouraqui, J.-P.; Dupont, Claire; Feillet, François; Frelut, M.-L.; Girardet, Jean-Philippe; Turck, Dominique; Briend, André

doi:10.1016/j.arcped.2018.02.005

Cited by 45 publications

(36 citation statements)

References 112 publications

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“…Currently, more than 90% of preterm newborns survive the neonatal period, but many exhibit long-lasting negative neurological outcomes such as sensory, motor, and cognitive deficits [37][38][39][40]. Recent findings demonstrate that some neurological deficits appear because of impaired cerebellar development, resulting in a cerebellum reduced in size in both human patients and animals delivered preterm [4,16,[41][42][43].…”

Section: Discussionmentioning

confidence: 99%

Effects of Phosphatidylserine Source of Docosahexaenoic Acid on Cerebellar Development in Preterm Pigs

2020

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Preterm birth, a major contributor to infant mortality and morbidity, impairs development of the cerebellum, the brain region involved in cognitive processing and motor function. Previously, we showed that at term-equivalent age, preterm pigs that received formula supplemented with docosahexaenoic acid (DHA) esterified to phosphatidylserine (PS) had cerebellar weights similar to those of newborn term pigs and were heavier than control preterm pigs. However, whether PS-DHA promotes the development of specific cerebellar cell populations or enhances key developmental processes remains unknown. Here we investigated the effects of the PS-DHA on development of the cerebellum in preterm pigs delivered via caesarean section and reared for ten days on a milk replacer with either PS-DHA (experimental group) or sunflower oil (control group). Upon necropsy, key cerebellar populations were analyzed using immunohistochemistry. Consumption of PS-DHA was associated with the expansion of undifferentiated granule cell precursors and increased proliferation in the external granule cell layer (EGL). Preterm pigs that received PS-DHA also had significantly fewer apoptotic cells in the internal granule cell layer (IGL) that contains differentiated granule neurons. PS-DHA did not affect the number of differentiating granule cells in the inner EGL, thickness of the inner EGL, density of Purkinje cells, or Bergmann glial fibers, or diameter of Purkinje cells. Thus, PS-DHA may support cerebellar development in preterm subjects by enhancing proliferation of granule cells, a process specifically inhibited by preterm birth, and increasing the survival of granule cells in the IGL. These findings suggest that PS-DHA is a promising candidate for clinical studies directed at enhancing brain development.

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Section: Discussionmentioning

confidence: 99%

Effects of Phosphatidylserine Source of Docosahexaenoic Acid on Cerebellar Development in Preterm Pigs

2020

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“…Furthermore, taurine should also be added. From the chemical point of view, taurine is not an amino acid but rather an amino-sulphonic acid; it is deficient in premature infants lacking the enzyme converting cystathionine into cysteine [15]. The body can produce some AAs (alanine, asparagine, aspartic acid, glutamic acid), which are therefore considered non-essential AAs (NEAAs).…”

Section: Amino Acids: Physiologymentioning

confidence: 99%

Macronutrients in Parenteral Nutrition: Amino Acids

et al. 2020

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The right amount and quality of amino acids (AAs) supplied to patients on parenteral nutrition (PN) reduces muscle mass loss, may preserve or even increase it, with significant clinical benefits. Several industrial PN mixtures are available so that nutrition specialists can choose the product closest to the patient’s needs. In selected cases, there is the possibility of personalizing compounded mixtures in a hospital pharmacy that completely meets the individual nutritional needs of PN patients. This narrative review deals with the AA solutions used in PN mixtures. The physiology, the methods to calculate the AA needs, and the AA and energy requirements suggested by scientific guidelines for each patient type are also reported.

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“…In premature neonates, particularly very premature babies with small weight for gestational age, gut immaturity and clinical instability often do not allow rapid full enteral feeding, leading to insufficient nutritional intake and poor growth [ 12 , 13 , 14 ]. Parenteral nutrition (PN) is an essential therapy for meeting the high nutritional requirements of such neonates, and to reduce growth restriction, especially during the first weeks of life [ 12 , 14 , 15 ]. Unfortunately, the timing, quality, and quantity of nutritional intake are not consistently achieved.…”

Section: Introductionmentioning

confidence: 99%

Cost-Consequences Analysis of Increased Utilization of Triple-Chamber-Bag Parenteral Nutrition in Preterm Neonates in Seven European Countries

Kriz¹,

Wright²,

Paulsson

et al. 2020

Nutrients

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The safety of parenteral nutrition (PN) remains a concern in preterm neonates, impacting clinical outcomes and health-care-resource use and costs. This cost-consequence analysis assessed national-level impacts of a 10-percentage point increase in use of industry-prepared three-chamber bags (3CBs) on clinical outcomes, healthcare resources, and hospital budgets across seven European countries. A ten-percentage-point 3CB use-increase model was developed for Belgium, France, Germany, Italy, Portugal, Spain, and the UK. The cost-consequence analysis estimated the impact on compounding error harm and bloodstream infection (BSI) rates, staff time, and annual hospital budget. Of 265,000 (52%) preterm neonates, 133,000 (52%) were estimated to require PN. Baseline compounding methods were estimated as 43% pharmacy manual, 16% pharmacy automated, 22% ward, 9% outsourced, 3% industry provided non-3CBs, and 7% 3CBs. A modeled increased 3CB use would change these values to 39%, 15%, 18%, 9%, 3%, and 17%, respectively. Modeled consequences included −11.6% for harm due to compounding errors and −2.7% for BSIs. Labor time saved would equate to 41 specialized nurses, 29 senior pharmacists, 26 pharmacy assistants, and 22 senior pediatricians working full time. Budget impact would be a €8,960,601 (3.4%) fall from €260,329,814 to €251,369,212. Even a small increase in the use of 3CBs in preterm neonates could substantially improve neonatal clinical outcomes, and provide notable resource and cost savings to hospitals.

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Parenteral nutrition for preterm infants: Issues and strategy

Cited by 45 publications

References 112 publications

Effects of Phosphatidylserine Source of Docosahexaenoic Acid on Cerebellar Development in Preterm Pigs

Effects of Phosphatidylserine Source of Docosahexaenoic Acid on Cerebellar Development in Preterm Pigs

Macronutrients in Parenteral Nutrition: Amino Acids

Cost-Consequences Analysis of Increased Utilization of Triple-Chamber-Bag Parenteral Nutrition in Preterm Neonates in Seven European Countries

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