Parenteral Provision of Micronutrients to Pediatric Patients: An International Expert Consensus Paper

Abstract

Introduction Micronutrients (vitamins and trace elements) are essential to all nutrition. For children and neonates who are dependent upon nutrition support therapies for growth and development, the prescribed regimen must supply all essential components. This paper aims to facilitate interpretation of existing clinical guidelines into practical approaches for the provision of micronutrients in pediatric parenteral nutrition. Methods An international, interdisciplinary expert panel was convened to review recent evidence‐based guidelines and published literature to develop consensus‐based recommendations on practical micronutrient provision in pediatric parenteral nutrition. Results The guidelines and evidence have been interpreted as answers to 10 commonly asked questions around the practical principles for provision and monitoring of micronutrients in pediatric patients. Conclusion Micronutrients are an essential part of all parenteral nutrition and should be included in the pediatric nutrition therapy care plan.

Significant Published Articles in 2020 for Pharmacy Nutrition Support Practice

“…Seventeen articles comprising guidelines, consensus, recommendation, and position papers were excluded from the ranking process. [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] An average of 27 articles (range: 15-53) of the 152 from the primary literature were denoted as most important by individual members of the author group. Five papers from the primary literature were collectively identified (receiving 5 or more votes) as most important by the authors.…”

“…Alhazzani et al 8 Surviving Sepsis Campaign: Guidelines on the management of critically ill adults with coronavirus disease 2019 (COVID-19) Arvanitakis et al 9 ESPEN guideline on clinical nutrition in acute and chronic pancreatitis Bischoff et al 10 ESPEN guideline on home enteral nutrition Bischoff et al 11 ESPEN practical guideline: Clinical nutrition in liver disease Bischoff et al 12 ESPEN practical guideline: Clinical nutrition in inflammatory bowel disease da Silva et al 13 ASPEN consensus recommendations for refeeding syndrome Gardner et al 14 ACG clinical guideline: Chronic pancreatitis Hardy et al 15 Parenteral provision of micronutrients to pediatric patients: An international expert consensus paper Lal et al 16 Considerations for the management of home parenteral nutrition during the SARS-CoV-2 pandemic: A position paper from the Home Artificial Nutrition and Chronic Intestinal Failure Special Interest Group of ESPEN Lobo et al 17 Perioperative nutrition: Recommendations from the ESPEN expert group Martindale et al 18 Summary of proceedings and expert consensus statements from the international summit "Lipids in parenteral nutrition" Osland et al 19 A framework to support quality of care for patients with chronic intestinal failure requiring home parenteral nutrition Pimental et al 20 ACG clinical guideline: Small intestinal bacterial overgrowth Pironi et al 21 ESPEN guideline on home parenteral nutrition Sheean et al 22 American Society for Parenteral and Enteral Nutrition clinical guidelines: The validity of body composition assessment in clinical populations Tume et al 23 Nutritional support for children during critical illness: European Society of Pediatric and Neonatal Intensive Care (ESPNIC) Metabolism, Endocrine and Nutrition Section position statement and clinical recommendations van der Louw et al 24 Optimal clinical management of children receiving ketogenic parenteral nutrition: A clinical practice guide it requires assessment of volume-weighted percent of fat greater than 5 µm (PFAT 5 ). PFAT 5 must be less than 0.05% to ensure acceptable globule-size distribution within the ILEcontaining formulation, but this was not analyzed in this study.…”

A review of the prevalence, trends, and determinants of coexisting forms of malnutrition in neonates, infants, and children

“…Similarly, fruits and vegetables are rich sources of fibres, vitamins, and minerals that protect an individual from micronutrient deficiencies [ 89 , 90 ]. Micronutrients are essential for growth, nourishment, and appropriate body functions, and their deficiency results in a wide range of neurocognitive and physical disorders, such as rickets in children and osteomalacia in adults [ 91 – 93 ]. For reducing CFM, it is essential to know about the caloric requirement and dietary benefits of all types of food to alleviate MRM together with undernutrition and/or overnutrition.…”

A Review of the Prevalence, Trends, and Determinants of Coexisting Forms of Malnutrition

“…Similarly, fruits and vegetables are rich source of bres, vitamins, and minerals that protecting an individual from micronutrient de ciencies (85,86) . Micronutrients are essential for the growth, nourishment and appropriate body functions, and their de ciency results in a wide range of neurocognitive and physical disorders, such as rickets in children and osteomalacia in adults (87)(88)(89) . For reducing CFM, it is essential to know about the caloric requirement and dietary bene ts of all types of food to alleviate MRM together with undernutrition and/or overnutrition.…”