Enteral nutrition safety

The Food and Drug Administration is reported to have released a long-awaited report on the safety of diethylhexyl phthalate, but the conclusion will not end the debate on the safety of PVC health-care products. According to the report, some young children undergoing medical procedures may be exposed to harmful levels of DEHP, one of the most widely used plasticisers in PVC health-care products. The report says that infants exposed to repeated treatments can receive between five and 20 times the safe levels. The report also says that a small number of adults undergoing some types of blood transfusion and patients who receive enteral nutrition treatments could be at risk. Details are given. 

T. R. Ziegler, K. Benfele, R. J. Smith, et al. Safety and metabolic effects of 1-giutamine administration in humans. Journal of Parenteral and Enteral Nutrition 14, 1375 (1990). 

In a prospective cohort study including 24 infants, the incidence and risk factors of parenteral nutrition-associated liver disease (PNALD) was determined. Eight infants developed PNALD. The concluded that the duration of enteral starvation, gastrointestinal surgery, duration of enteral nutrition, maximum caloric and carbohydrate intakes were significant risks of PNALD in newborn infants [lob ll. In a retrospective review of the safety and efficacy of PN among 105 paediatric patients with bum injuries (>30% total-body sxuface area), no respiratory or blood infections were observed with the use of parenteral nutrition, and the overall mortality rate was 4% [107 ]. 

Mancl EE, Muzevich KM. Tolerability and safety of enteral nutrition in critically iU patients receiving intravenous vasopressor therapy. JPEN J Parenter Enter Nutr September 2013 37(5) 641-51. 

After performing a nutrition assessment and estimating nutritional requirements, determine the optimal route to provide specialized nutrition support (e.g., oral, enteral, or parenteral). If PN is deemed necessary, venous access (i.e., peripheral or central see below) for PN infusion must be obtained. Finally, formulate a PN prescription, and administer PN according to proper safety guidelines. 

More recently, a range of other quality and safety issues have been recognised by consumers and now influence poultry meat and egg buying patterns and behaviour. Most importantly this includes (i) the routine use of antibiotics as growth promoters and curative medicines and the potential for development of transferable antibiotic resistance, (ii) risk associated with enteric pathogen (e.g. Salmonella and Campylobacter) and toxin (e.g. dioxin) contaminants of poultry products, (iii) the environmental impact of poultry production and (iv) the sensory and nutritional quality of eggs and poultry meat (Menzi et al., 1997 Hamm et al., 2002 Rodenburg et al., 2004 Horsted et al., 2005). 

Hornsby-Lewis L, Shike M, Brown P, Klang M, Pearlstone D, Brennan MF. L-glutamine supplementation in home total parenteral nutrition patients stability, safety, and effects on intestinal absorption. J Parenter Enteral Nutr 1994 18(3) 268-73. 

Law L 794.1 created the Agency of Health Safety of Foods under the control of the Ministers of Health, Agriculture and Food. The Agency deals with health and safety issues relevant to foodstuffs and materials entering the food chain. It evaluates the health and nutritional risks of products destined for human or veterinary use, animal foodstuffs, veterinary products and health foods. 

McQave SA, Greene LM, Snider HL, et al. Comparison of the safety of early enteral vs parenteral nutrition in mild acute pancreatitis. JPEN J Parenter Enter Nutr 1996 21 14-20. 

Systematic reviews In a meta-analysis of fom randomised trials, the safety and effectiveness of early EN after pancreatoduodenectomy was evaluated. There was no significant difference between early enteral feeding versus other nutritional routes for intra-abdominal complications (OR=0.89 95% Cl 0.36-2.18), mortality (OR=0.43 95% Q 0.11-1.62), infection (OR=0.55 95% Cl 0.29-1.07) or post-operative hospital stay (MD=-0.93 95% Cl 6.51-4.65) [133 ]. 

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