Parenteral nutrition observational studies

Peroxide formation has also been observed in multivitamin solutions for parenteral nutrition. Lavoie and co-workers [30] have studied the action of light, air, and composition on the stability of multivitamin formulations, and also total parenteral nutrition (TPN) admixtures containing and not containing vitamins and fatty acids. They analyzed the generation of peroxide in multivitamin solutions and in TPN for adults and neonates. The analysis of multivitamin solutions for enteral use revealed the presence of peroxides at the initial opening of the bottle. The levels were higher in Poly-Vi-Sol (vitamin A, Vitamin D, and vitamin C, vitamin Bb riboflavin, and... 

Brain enlargement and cerebral edema were observed upon autopsy of a boy who died after ingesting potassium dichromate (Kaufman et al. 1970). However, more chronic lower exposures to chromium(III) did not result in any somatopsychic changes in patients on total parenteral nutrition (TPN) solutions (Lovrincevic et al. 1996). In this study, the TPN patients were examined for somatopsychic responses. 

More recently, similar signs of biotin deficiency have been observed in patients receiving total parenteral nutrition for prolonged periods, after major resection of the gut. The signs resolve after the provision of biotin, but again there have been no studies of the amounts of biotin required intakes have ranged between 60 to 200 /xg per day (Mock et al., 1985). 

A major complication of intravenous infusion is thrombophlebitis, which is a principle limitation of peripheral parenteral nutrition. Its precise pathogenesis is unclear, but venospasm has been proposed as the most likely cause. However, in a study with ultrasound techniques to monitor vein caliber, there was no evidence to support this hypothesis, although thrombophlebitis was observed (10). The author suggested that the initiating event may be venous endothelial trauma, caused by the venepuncture itself, abrasion at the catheter tip, or the delivery of the feeding solution. 

A theory has been proposed regarding a possible mechanism by which parenteral Upid solutions injure preterm infants namely, by free radical-induced lipid peroxidation in the lipid solution (142,143). How this happens is not explained. The result can be pulmonary damage and chronic lung disease. Premature infants are thought to be at particularly high risk. However, others (144,145) have suggested that Cooke s interpretation (142) was not based on solid clinical evidence, and that the data that he derived from his observations should be tested in controlled studies before parenteral nutrition is prescribed for infants of very low birth weights. 

The level of these potential carcinogens in some broiled or roasted foods, such as broiled sardines, is about 10 ng/g. This amount is much lower than those used in the carcinogenicity assays. The long-term cumulative effect of the carboline intake may be of great concern. In some experimental studies, tryptophan itself appears to promote the formation of tumors.287-289 Also, a tryptophan-riboflavin photoinduced adduct may have a role in the pathogenesis of hepatic dysfunction observed during parenteral nutrition.290... 

Natural diets will usually contain sufficient variety that such a low level of n-3 fat intake would be avoided. However, when the diet is limited to one food source such as when formulas are given to infants or in the case of parenteral nutrition, very low n-3 fatty acid intake becomes possible. In related studies in which nine groups of rats with varying levels of brain DHA were assessed for spatial task performance, it was observed that significant changes in performance could not be observed when the DHA level was more than 60% of the n-3 Adq level (47). Thus, the loss of 20% of brain DHA described in the human autopsy studies would probably not be expected to lead to spatial task performance losses. However, in many in-... 

The Food and Nutrition Board of the US National Research Council has released adequate intakes for infants, adults and pregnant women (Mock 2004 National Research Council 1989 Yates et al. 1998). These recommendations (Table 43.1) refer to studies assuming that, with a daily dose of 60 pg of biotin, adults on parenteral nutrition declared they were symptom-free for six months and with diets supplying 28 2pg/day, no inadequate biotin status was observed. The dietary biotin intake in Western populations has been estimated to be 35-70 pg per day (143-287 nmoles per day). 

Observational studies In 30 patients who underwent allogeneic stem-cell transplantation for leukemia and a retrospectively matched group of controls, the palifermin recipients who received a transplant from an unrelated donor had reduced severity, incidence, and duration of oral mucositis WHO grades 2—4, reduced need for opioid analgesics, and a shorter duration of total parenteral nutrition [15. However, there was no benefidal effect of palifermin on the incidence and severity of acute graft-versus-host disease. Febrile neutropenia. 

Observational studies The effect of peripherally inserted and non-peripherally inserted catheters on infection rates in adults requiring home parenteral nutrition (PN) has been examined in a retrospective study of 101 patients. Seventy-five percent of infections developed within the first 6 months of hospital discharge, and most of these were attributed to gram positive organisms. Patients with peripherally inserted catheters had a significantly higher rates of infections compared with non-peripherally inserted catheters (P=0.018) [lOl ]. A four-year review of 145 cases of peripherally inserted central catheters for long-term PN in infants with intestinal failure showed that the overall... 

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 ]. 

Liver The effect of weaning patients off PN and its relationship to liver histology has been evaluated in a study including 38 patients with paediatric intestinal failure. Abnormal histology was foxmd in 77% of patients weaned of parenteral nutrition. Portal inflammation and fibrosis were also observed [117 ]. In a prospective cohort study to determine the incidence and risk factors for development of abnormal LFTs in patients on short-term PN (8-54 days mean 15.9 days), 57.5% of 80 patients had abnormal LFTs [118 ]. Septic shock, hyperglycaemia, soybean lipid and absolute diet were associated with an increased risk of abnormal LFTs. 

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