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[PMID]:29374926
[Au] Autor:Wu YW; Liu J; Jin J; Liu LJ; Wu YF
[Ad] Endereço:Department of Critical Care Medicine, East Region of Suzhou Municipal Hospital, Suzhou Hospital Affiliated to Nanjing Medical University, Jiangsu 215001, China.
[Ti] Título:[Effects of early enteral nutrition in the treatment of patients with severe burns].
[So] Source:Zhonghua Shao Shang Za Zhi;34(1):40-46, 2018 Jan 20.
[Is] ISSN:1009-2587
[Cp] País de publicação:China
[La] Idioma:chi
[Ab] Resumo:To investigate the effects of early enteral nutrition (EEN) in the treatment of patients with severe burns. Medical records of 52 patients with severe burns hospitalized in the three affiliations of authors from August to September in 2014 were retrospectively analyzed and divided into EEN group ( =28) and non-early enteral nutrition (NEEN) group ( =24) according to the initiation time of enteral nutrition. On the basis of routine treatment, enteral nutrition was given to patients in group EEN within post injury day (POD) 3, while enteral nutrition was given to patients in group NEEN after POD 3. The following items were compared between patients of the two groups, such as the ratio of enteral nutrition intake to total energy intake, the ratio of parenteral nutrition intake to total energy intake, the ratio of total energy intake to energy target on POD 1, 2, 3, 4, 5, 6, 7, 14, 21, and 28, the levels of prealbumin, serum creatinine, blood urea nitrogen, total bilirubin, direct bilirubin, and Acute Physiology and Chronic Health Evaluation â…¡ (APACHE â…¡) score on POD 1, 3, 7, 14, and 28, the first operation time, the number of operations, and the frequencies of abdominal distension, diarrhea, vomiting, aspiration, catheter blockage, and low blood sugar within POD 28. Data were processed with (2)test, test, Wilcoxon rank sum test, and Bonferroni correction. (1) The ratio of parenteral nutrition intake to total energy intake of patients in group EEN on POD 1 was obviously lower than that in group NEEN ( =2.078, <0.05). The ratio of enteral nutrition intake to total energy intake and the ratio of total energy intake to energy target of patients in group EEN on POD 2 and 3 were obviously higher than those in group NEEN ( =5.766, 6.404, =4.907, 6.378, <0.01). The ratio of total energy intake to energy target of patients in group EEN was obviously lower than that in group NEEN on POD 4, 5, 6, and 7 ( =4.635, 2.547, 3.751, 5.373, <0.05 or <0.01). On POD 2, 4, 5, 14, 21, and 28, the ratio of enteral nutrition intake to total energy intake of patients in group EEN was obviously higher than the ratio of parenteral nutrition intake to total energy intake within the same group ( =5.326, 2.046, 2.129, 4.118, 3.174, 3.963, <0.05 or <0.01). In group NEEN, the ratio of enteral nutrition to total energy intake of patients on POD 1, 2, and 3 was obviously lower than the ratio of parenteral nutrition intake to total energy intake within the same group ( =2.591, 2.591, 3.293, <0.05 or <0.01), while the ratio of enteral nutrition to total energy intake of patients on POD 14, 21, 28 was obviously higher than the ratio of parenteral nutrition intake to total energy intake within the same group ( =2.529, 3.173, 3.133, <0.05 or <0.01). (2) The prealbumin levels of patients in the two groups were close on POD 1, 3, 7, and 14 ( =1.983, 0.093, 0.832, 1.475, >0.05). On POD 28, the prealbumin level of patients in group EEN was obviously higher than that in group NEEN ( =3.163, <0.05). The levels of serum creatinine, blood urea nitrogen, total bilirubin, and direct bilirubin of patients in the two groups at all time points post injury were close ( =1.340, 0.547, 0.245, 0.387, 0.009, 1.170, 0.340, 1.491, 0.274, 1.953, 0.527, 0.789, 0.474, 1.156, 0.482, 0.268, 0.190, 0.116, 1.194, 0.431, >0.05). (3) The APACHE â…¡ scores of patients in group EEN were (22.5±3.1) and (15.6±3.8) points respectively on POD 1 and 3, which were close to (23.6±3.0) and (17.6±4.2) points of patients in group NEEN ( =1.352, 1.733, >0.05). The APACHE â…¡ scores of patients in group EEN on POD 7, 14, and 28 were (13.6±3.6), (13.8±4.1), and (15.5±4.1) points, respectively, which were obviously lower than (18.5±3.9), (19.5±4.2) and (20.8±3.8) points of patients in group NEEN ( =4.677, 4.843, 4.792, <0.05). (4) Within POD 28, the time of the first operation, the number of operations, and the frequencies of abdominal distension, diarrhea, vomiting, aspiration, catheter blockage and hypoglycemia were similar between patients of the two groups ( =0.684, 0.782, =0.161, 1.751, 0.525, 0.764, 0.190, 0.199, >0.05). EEN in the treatment of patients with severe burns potentially increases the energy intake at early stage and improves APACHE â…¡ score and prealbumin level on POD 28, without increasing frequencies of adverse reactions.
[Mh] Termos MeSH primário: Queimaduras/terapia
Ingestão de Energia/fisiologia
Nutrição Enteral
Nutrição Parenteral
[Mh] Termos MeSH secundário: Seres Humanos
Tempo de Internação
Cuidados Pós-Operatórios
Estudos Retrospectivos
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180306
[Lr] Data última revisão:
180306
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180129
[St] Status:MEDLINE
[do] DOI:10.3760/cma.j.issn.1009-2587.2018.01.008


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[PMID]:29293196
[Au] Autor:Barnes JL
[Ad] Endereço:Illinois State University, Department of Family and Consumer Sciences, Normal, Illinois. Jennifer L. Barnes, PhD, RD, LDN, is an assistant professor at Illinois State University in the Department of Family and Consumer Sciences, where she teaches in Food, Nutrition, and Dietetics.
[Ti] Título:Enteral Nutrients and Gastrointestinal Physiology.
[So] Source:J Infus Nurs;41(1):35-42, 2018 Jan/Feb.
[Is] ISSN:1539-0667
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The gastrointestinal (GI) tract is a highly efficient organ system with specialized structures to facilitate digestion and absorption of nutrients to meet the body's needs. The presence of nutrients in the GI tract supports optimal structure and function, stimulates regulatory hormones, and supports the microbiota, the population of microorganisms residing in the GI tract. A lack of enteral nutrition (EN) results in impaired GI integrity and serious patient complications, making EN a priority. Normal GI physiology is reviewed, and the regulatory impact of luminal nutrients on GI function is discussed.
[Mh] Termos MeSH primário: Nutrição Enteral/métodos
Trato Gastrointestinal/anatomia & histologia
Trato Gastrointestinal/fisiologia
[Mh] Termos MeSH secundário: Hormônios Gastrointestinais
Seres Humanos
Tecido Linfoide
Necessidades Nutricionais
Nutrição Parenteral/métodos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Gastrointestinal Hormones)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:N
[Da] Data de entrada para processamento:180103
[St] Status:MEDLINE
[do] DOI:10.1097/NAN.0000000000000260


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[PMID]:29298359
[Au] Autor:Garcia J; Garg A; Song Y; Fotios A; Andersen C; Garg S
[Ad] Endereço:School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia.
[Ti] Título:Compatibility of intravenous ibuprofen with lipids and parenteral nutrition, for use as a continuous infusion.
[So] Source:PLoS One;13(1):e0190577, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:There is increasing interest to administer ibuprofen as a continuous infusion instead of a traditional bolus for treating Patent Ductus Arteriosus (PDA). However, its compatibility data with commonly used drugs in the neonatal period, including parenteral nutrition (PN) and lipids is unavailable. The aim is to determine the compatibility of intravenous ibuprofen lysine with various ANZNN parenteral nutrition consensus group standard neonatal PN formulations and lipids. The PN and lipid solutions used in a tertiary neonatal unit were obtained. These included a Starter, Standard Preterm and low carbohydrate PN, and IV SMOF lipid admixture (SMOFLipid 20% 15 mL; Vitalipid N infant 4 mL, Soluvit N 1 mL) plus vitamin mixtures. 10% glucose was used as a control. 1:1 mixtures of different concentrations (1.25 to 5mg/mL) of ibuprofen lysine and each of the PN/glucose/lipid formulations were made. Samples were taken at hourly intervals for a total of 4 hours and tested for both physical (visual assessment, pH and microscopy) and chemical compatibility (High Performance Liquid Chromatography analysis). Zeta potential and particle diameter were measured for SMOF lipid admixture and ibuprofen combination to assess emulsion stability. 24 hour stability of ibuprofen dilution in 5 mL BD Luer-lok polypropylene syringes at 25°C was also assessed. Most PN formed opaque solutions when mixed with ibuprofen 2.5 and 5mg/mL solutions. However, ibuprofen dilution of 1.25mg/mL produced clear, colourless solutions with no microscopic particles when mixed with all PN/glucose/lipid formulations tested. Ibuprofen was chemically stable with all PN and SMOF lipid admixture, for a period of 4 hours. The zeta potential and particle diameter were within acceptable limits. Ibuprofen lysine was stable over 24 hours in Luer-lok polypropylene syringes. Ibuprofen 1.25mg/mL is physically and chemically compatible with 10% glucose, starter PN, standard preterm and low carbohydrate PN, and SMOF lipid admixture plus vitamins for a period of four hours, which is the maximum time they could be in an admixture during a continuous infusion.
[Mh] Termos MeSH primário: Permeabilidade do Canal Arterial/tratamento farmacológico
Ibuprofeno/administração & dosagem
Lipídeos/administração & dosagem
Nutrição Parenteral
[Mh] Termos MeSH secundário: Cromatografia Líquida de Alta Pressão
Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE; VALIDATION STUDIES
[Nm] Nome de substância:
0 (Lipids); WK2XYI10QM (Ibuprofen)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180215
[Lr] Data última revisão:
180215
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180104
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0190577


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[PMID]:29202257
[Au] Autor:Bihari S; Gelbart B; Seppelt I; Thompson K; Watts N; Prakash S; Festa M; Bersten A; The George Institute for Global Health ; The Australian and New Zealand Intensive Care Society Clinical Trials Group
[Ad] Endereço:Department of ICCU, Flinders Medical Centre, Adelaide, SA, Australia. biharishailesh@gmail.com.
[Ti] Título:Maintenance fluid practices in paediatric intensive care units in Australia and New Zealand.
[So] Source:Crit Care Resusc;19(4):310-317, 2017 Dec.
[Is] ISSN:1441-2772
[Cp] País de publicação:Australia
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Maintenance fluid administration is a common practice in paediatric intensive care units (PICUs), contributing to daily fluid intake and fluid balance, but little is known about this practice. OBJECTIVES: To determine the volume and type of maintenance fluid delivered to PICU patients, and to assess changes in practice compared with a previous time point. METHODS: A prospective, observational, single-day, point prevalence study of paediatric patients from 11 Australian and New Zealand PICUs, conducted in 2014. RESULTS: Seventy-two patients were enrolled. The median age and weight of infants aged < 1 year (n = 34) were 2 months (interquartile range [IQR],1-4) and 5 kg (IQR, 4-6), respectively; while in children ≥ 1 year of age (n = 38), these were 4 years (IQR, 2-8) and 17 kg (IQR, 12-23), respectively. On the study day, 19 infants (56%) and 19 children aged ≥ 1 year (50%) received maintenance fluids. Infants received a median of 23 mL/kg (IQR, 12-45) of maintenance fluid in addition to 51 mL/kg (IQR, 40-72) of fluid and nutrition from other sources; maintenance fluids contributed 29% (IQR, 13%-60%) of the total daily fluid intake. Children ≥ 1 year of age received a median of 18 mL/kg (IQR, 9-37) of maintenance fluid in addition to 39 mL/kg (IQR, 25-53) of fluid and nutrition from other sources; maintenance fluids contributed 33% (IQR, 17%-69%) of the total daily fluid intake. When compared with similar data from 2011, there was no change in the amount of maintenance fluid given, which was administered mostly as isotonic fluids. CONCLUSION: Maintenance fluid contributes about a third of total fluid administration in children in Australian and New Zealand PICUs and is mostly administered as isotonic solutions.
[Mh] Termos MeSH primário: Hidratação/estatística & dados numéricos
Unidades de Terapia Intensiva Pediátrica
Padrões de Prática Médica/estatística & dados numéricos
[Mh] Termos MeSH secundário: Austrália
Cateteres de Demora/estatística & dados numéricos
Pré-Escolar
Nutrição Enteral/estatística & dados numéricos
Feminino
Seres Humanos
Lactente
Soluções Isotônicas/administração & dosagem
Masculino
Nova Zelândia
Nutrição Parenteral/estatística & dados numéricos
Estudos Prospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Nm] Nome de substância:
0 (Isotonic Solutions)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180104
[Lr] Data última revisão:
180104
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171205
[St] Status:MEDLINE


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[PMID]:29176758
[Au] Autor:Bonsante F; Gouyon JB; Robillard PY; Gouyon B; Iacobelli S
[Ad] Endereço:Réanimation Néonatale et Pédiatrique, Néonatologie, Centre Hospitalier Universitaire de la Réunion, Site Sud Saint Pierre, France.
[Ti] Título:Early optimal parenteral nutrition and metabolic acidosis in very preterm infants.
[So] Source:PLoS One;12(11):e0186936, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: It is currently recognized that an optimized nutritional approach, consisting of an early and substantial supply of protein and energy by parenteral route, may be beneficial for very low birth weight infants and recent guidelines endorse this strategy. However, the impact of the enhanced parenteral nutrition (PN) on acid-basic balance has never been investigated. The aim of the present study is to assess the effect of nutrient intake on acid-base homeostasis in a large population of preterm infants on PN. METHODS: This observational study described the acid-base profile of very preterm infants (≤29 week's gestation) receiving PN during the first week of life. For this purpose three different cohorts of infants who received increasing (group 1 to group 3) nutritional intakes were considered. Nutrition data were recorded daily and correlated to acid-base data (pH, base excess, and lactate). The outcome measure to assess metabolic acidosis was the base excess (BE). RESULTS: 161 infants were included. 1127 daily nutritional records and 795 blood gas data were analyzed. The three groups were different with regard to nutritional intravenous intakes. Group 3 in particular had a higher mean intake of both amino acids (3.3 ± 0.8 g/kg/d) and lipids (2.8 ± 1.4 g/kg/d) during the first week of life. Metabolic acidosis was more severe in the group with the highest parenteral intake of amino acids and lipids: mean BE = -8.7 ± 3.4 (group 3); -6.4 ± 3.4 (group 2); -5.1 ± 3.0 (group 1)]. At the multivariate analysis the significant risk factors for metabolic acidosis were: gestational age, initial base excess, amino acid and lipid intravenous intakes. DISCUSSION: Acid-base homeostasis was influenced by the nutritional intake. Earlier and higher intravenous amino acid and lipid intakes particularly increased the risk of metabolic acidosis. The nutritional tolerance was different depending on gestational age, and the smaller infants (24-26 week's gestation) displayed greater acidotic disequilibrium and a higher need of bicarbonate.
[Mh] Termos MeSH primário: Acidose/terapia
Recém-Nascido Prematuro/fisiologia
Nutrição Parenteral
[Mh] Termos MeSH secundário: Equilíbrio Ácido-Base
Aminoácidos/metabolismo
Idade Gestacional
Seres Humanos
Concentração de Íons de Hidrogênio
Recém-Nascido
Lipídeos
Análise Multivariada
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Nm] Nome de substância:
0 (Amino Acids); 0 (Lipids)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171219
[Lr] Data última revisão:
171219
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171128
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0186936


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[PMID]:29192482
[Au] Autor:MacDonald J; Kingdon J
[Ti] Título:B12 supplementation: Making the switch.
[So] Source:Can Nurse;112(6):32-3, 2016 Sep.
[Is] ISSN:0008-4581
[Cp] País de publicação:Canada
[La] Idioma:eng
[Mh] Termos MeSH primário: Suplementos Nutricionais/estatística & dados numéricos
Nutrição Parenteral/enfermagem
Deficiência de Vitamina B 12/enfermagem
Vitamina B 12/administração & dosagem
[Mh] Termos MeSH secundário: Canadá
Estudos de Coortes
Relação Dose-Resposta a Droga
Seres Humanos
Deficiência de Vitamina B 12/tratamento farmacológico
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
P6YC3EG204 (Vitamin B 12)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171214
[Lr] Data última revisão:
171214
[Sb] Subgrupo de revista:IM; N
[Da] Data de entrada para processamento:171202
[St] Status:MEDLINE


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[PMID]:29073185
[Au] Autor:Cretin E; Pazart L; Rousseau MC; Noé A; Decavel P; Chassagne A; Godard-Marceau A; Trimaille H; Mathieu-Nicot F; Beaussant Y; Gabriel D; Daneault S; Aubry R
[Ad] Endereço:Clinical Investigation Center, CIC 1431 Inserm, University Hospital of Besançon, Besançon, France.
[Ti] Título:Exploring the perceptions of physicians, caregivers and families towards artificial nutrition and hydration for people in permanent vegetative state: How can a photo-elicitation method help?
[So] Source:PLoS One;12(10):e0186776, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The question of withdrawing artificial nutrition and hydration from people in a permanent vegetative state sparks considerable ethical and legal debate. Therefore, understanding the elements that influence such a decision is crucial. However, exploring perceptions of artificial nutrition and hydration is methodologically challenging for several reasons. First, because of the emotional state of the professionals and family members, who are facing an extremely distressing situation; second, because this question mirrors representations linked to a deep-rooted fear of dying of hunger and thirst; and third, because of taboos surrounding death. We sought to determine the best method to explore such complex situations in depth. This article aims to assess the relevance of the photo-elicitation interview method to analyze the perceptions and attitudes of health professionals and families of people in a permanent vegetative state regarding artificial nutrition and hydration. The photo-elicitation interview method consists in inserting one or more photographs into a research interview. An original set of 60 photos was built using Google Images and participants were asked to choose photos (10 maximum) and talk about them. The situations of 32 patients were explored in 23 dedicated centers for people in permanent vegetative state across France. In total, 138 interviews were conducted with health professionals and family members. We found that the photo-elicitation interview method 1) was well accepted by the participants and allowed them to express their emotions constructively, 2) fostered narration, reflexivity and introspection, 3) offered a sufficient "unusual angle" to allow participants to go beyond stereotypes and habits of thinking, and 4) can be replicated in other research areas. The use of visual methods currently constitutes an expanding area of research and this study stressed that this is of special interest to enhance research among populations facing end-of-life and ethical issues.
[Mh] Termos MeSH primário: Cuidadores
Família
Nutrição Parenteral
Percepção
Estado Vegetativo Persistente
Fotografia
Médicos
[Mh] Termos MeSH secundário: Feminino
Seres Humanos
Masculino
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171110
[Lr] Data última revisão:
171110
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171027
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0186776


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[PMID]:28866623
[Au] Autor:Batra A; Keys SC; Johnson MJ; Wheeler RA; Beattie RM
[Ad] Endereço:Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK.
[Ti] Título:Epidemiology, management and outcome of ultrashort bowel syndrome in infancy.
[So] Source:Arch Dis Child Fetal Neonatal Ed;102(6):F551-F556, 2017 Nov.
[Is] ISSN:1468-2052
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Ultrashort bowel syndrome (USBS) is a group of heterogeneous disorders where the length of small bowel is less than 10 cm or 10% of expected for the age. It is caused by massive loss of the gut which in the neonatal period can be a result of vanishing gastroschisis or surgical resection following mid-gut volvulus, jejunoileal atresia and/or extensive necrotising enterocolitis. The exact prevalence of USBS is not known although there is a clear trend towards increasing numbers because of increased incidence and improved survival. Long-term parenteral nutrition (PN) is the mainstay of treatment and is best delivered by a multidisciplinary intestinal rehabilitation team. Promoting adaptation is vital to improving long-term survival and can be achieved by optimising feeds, reducing intestinal failure liver disease and catheter-related bloodstream infections. Surgical techniques that can promote enteral tolerance and hence improve outcome include establishing intestinal continuity and bowel lengthening procedures. The outcome for USBS is similar to patients with intestinal failure due to other causes and only a small proportion of children who develop irreversible complications of PN and will need intestinal transplantation. In this review, we will summarise the available evidence focusing particularly on the epidemiology, management strategies and outcome.
[Mh] Termos MeSH primário: Intestino Delgado/anormalidades
Nutrição Parenteral/métodos
Síndrome do Intestino Curto/epidemiologia
[Mh] Termos MeSH secundário: Feminino
Seres Humanos
Lactente
Recém-Nascido
Masculino
Síndrome do Intestino Curto/terapia
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171031
[Lr] Data última revisão:
171031
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170904
[St] Status:MEDLINE
[do] DOI:10.1136/archdischild-2016-311765


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[PMID]:28854319
[Au] Autor:Oddie SJ; Young L; McGuire W
[Ad] Endereço:Bradford Royal Infirmary, Duckworth Lane, Bradford, UK, BD9 6RJ.
[Ti] Título:Slow advancement of enteral feed volumes to prevent necrotising enterocolitis in very low birth weight infants.
[So] Source:Cochrane Database Syst Rev;8:CD001241, 2017 08 30.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Early enteral feeding practices are potentially modifiable risk factors for necrotising enterocolitis (NEC) in very preterm or very low birth weight (VLBW) infants. Observational studies suggest that conservative feeding regimens, including slowly advancing enteral feed volumes, reduce the risk of NEC. However, slow feed advancement may delay establishment of full enteral feeding and may be associated with metabolic and infectious morbidities secondary to prolonged exposure to parenteral nutrition. OBJECTIVES: To determine effects of slow rates of enteral feed advancement on the incidence of NEC, mortality, and other morbidities in very preterm or VLBW infants. SEARCH METHODS: We used the standard Cochrane Neonatal search strategy to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 5), MEDLINE via PubMed (1966 to June 2017), Embase (1980 to June 2017), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1982 to June 2017). We searched clinical trials databases, conference proceedings, previous reviews, and reference lists of retrieved articles for randomised controlled trials (RCTs) and quasi-randomised trials. SELECTION CRITERIA: Randomised or quasi-randomised controlled trials that assessed effects of slow (up to 24 mL/kg/d) versus faster rates of advancement of enteral feed volumes upon the incidence of NEC in very preterm or VLBW infants. DATA COLLECTION AND ANALYSIS: Two review authors assessed trial eligibility and risk of bias and independently extracted data. We analysed treatment effects in individual trials and reported risk ratio (RR) and risk difference (RD) for dichotomous data, and mean difference (MD) for continuous data, with respective 95% confidence intervals (CIs). We used a fixed-effect model for meta-analyses and explored potential causes of heterogeneity via sensitivity analyses. We assessed the quality of evidence at the outcome level using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. MAIN RESULTS: We identified 10 RCTs in which a total of 3753 infants participated (2804 infants participated in one large trial). Most participants were stable very preterm infants of birth weight appropriate for gestation. About one-third of all participants were extremely preterm or extremely low birth weight (ELBW), and about one-fifth were small for gestational age (SGA), growth-restricted, or compromised in utero, as indicated by absent or reversed end-diastolic flow velocity (AREDFV) in the fetal umbilical artery. Trials typically defined slow advancement as daily increments of 15 to 20 mL/kg, and faster advancement as daily increments of 30 to 40 mL/kg. Trials generally were of good methodological quality, although none was blinded.Meta-analyses did not show effects on risk of NEC (typical RR 1.07, 95% CI 0.83 to 1.39; RD 0.0, 95% CI -0.01 to 0.02) or all-cause mortality (typical RR 1.15, 95% CI 0.93 to 1.42; typical RD 0.01, 95% CI -0.01 to 0.03). Subgroup analyses of extremely preterm or ELBW infants, or of SGA or growth-restricted or growth-compromised infants, showed no evidence of an effect on risk of NEC or death. Slow feed advancement delayed establishment of full enteral nutrition by between about one and five days. Meta-analysis showed borderline increased risk of invasive infection (typical RR 1.15, 95% CI 1.00 to 1.32; typical RD 0.03, 95% CI 0.00 to 0.05). The GRADE quality of evidence for primary outcomes was "moderate", downgraded from "high" because of lack of blinding in the included trials. AUTHORS' CONCLUSIONS: Available trial data do not provide evidence that advancing enteral feed volumes at daily increments of 15 to 20 mL/kg (compared with 30 to 40 mL/kg) reduces the risk of NEC or death in very preterm or VLBW infants, extremely preterm or ELBW infants, SGA or growth-restricted infants, or infants with antenatal AREDFV. Advancing the volume of enteral feeds at a slow rate results in several days of delay in establishing full enteral feeds and may increase the risk of invasive infection.
[Mh] Termos MeSH primário: Nutrição Enteral/métodos
Enterocolite Necrosante/prevenção & controle
Doenças do Prematuro/prevenção & controle
Recém-Nascido de muito Baixo Peso
[Mh] Termos MeSH secundário: Nutrição Enteral/efeitos adversos
Enterocolite Necrosante/epidemiologia
Enterocolite Necrosante/etiologia
Seres Humanos
Incidência
Recém-Nascido de Baixo Peso/crescimento & desenvolvimento
Recém-Nascido
Recém-Nascido Prematuro/crescimento & desenvolvimento
Doenças do Prematuro/etiologia
Infecção/epidemiologia
Nutrição Parenteral/efeitos adversos
Ensaios Clínicos Controlados Aleatórios como Assunto
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; RESEARCH SUPPORT, N.I.H., EXTRAMURAL; RESEARCH SUPPORT, NON-U.S. GOV'T; REVIEW
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170919
[Lr] Data última revisão:
170919
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170831
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD001241.pub7


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[PMID]:28813225
[Au] Autor:Duggan CP; Jaksic T
[Ad] Endereço:From the Center for Advanced Intestinal Rehabilitation (C.P.D., T.J.), Division of Gastroenterology, Hepatology, and Nutrition (C.P.D.), and the Department of Surgery (T.J.), Boston Children's Hospital and Harvard Medical School, Boston.
[Ti] Título:Pediatric Intestinal Failure.
[So] Source:N Engl J Med;377(7):666-675, 2017 08 17.
[Is] ISSN:1533-4406
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Fármacos Gastrointestinais/uso terapêutico
Nutrição Parenteral
Síndrome do Intestino Curto/terapia
[Mh] Termos MeSH secundário: Criança
Nutrição Enteral
Motilidade Gastrointestinal
Seres Humanos
Enteropatias
Intestinos/fisiologia
Intestinos/cirurgia
Intestinos/transplante
Síndrome do Intestino Curto/tratamento farmacológico
Síndrome do Intestino Curto/fisiopatologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T; REVIEW
[Nm] Nome de substância:
0 (Gastrointestinal Agents)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170830
[Lr] Data última revisão:
170830
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170817
[St] Status:MEDLINE
[do] DOI:10.1056/NEJMra1602650



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