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Published on: September 20, 2019
Biochemical stability during parenteral nutrition in children
J W Puntis1, S K Hall, A Green
1Institute of Child Health, University of Birmingham and Department of Clinical Chemistry the Children's Hospital, Birmingham UK.
Insights
Routine biochemical monitoring for infants receiving parenteral nutrition (PN) found few serious abnormalities directly from PN. Most issues arose before PN, suggesting simpler surveillance for stable patients is safe and cost-effective.
Area of Science:
- Pediatric Nutrition
- Clinical Biochemistry
- Neonatal Care
Background:
- Parenteral nutrition (PN) is crucial for infants unable to receive enteral feeding.
- Biochemical monitoring during PN is standard but may be overly intensive.
- Optimizing surveillance protocols can improve resource allocation and patient management.
Purpose of the Study:
- To evaluate the incidence and significance of biochemical abnormalities in infants on PN.
- To develop a rational policy for biochemical surveillance during PN.
- To assess the necessity of current intensive monitoring protocols.
Main Methods:
- A standard monitoring protocol was applied to 30 infants (3 days-3 years) receiving PN.
- Patients were referred to a pediatric nutritional care team.
- Data on biochemical status and fluid/electrolyte balance were collected.
Main Results:
- No serious biochemical abnormalities were directly attributed to PN itself.
- Electrolyte disturbances were more common prior to initiating PN.
- Patients with fluid and electrolyte losses were more prone to biochemical abnormalities.
- Current protocols may involve excessive testing for stable patients, increasing costs.
Conclusions:
- PN is generally safe regarding biochemical parameters in infants.
- Biochemical abnormalities are often pre-existing or related to underlying conditions.
- Less frequent and comprehensive biochemical surveillance may be appropriate for stable infants on PN, reducing costs.
- Tailored monitoring strategies are recommended based on patient stability and clinical status.
Abstract:
The aim of this study was to assess the frequency and importance of biochemical abnormality related to parenteral nutrition (PN) in a group of infants, and to devise an appropriate policy for routine biochemical surveillance. A standard monitoring protocol based on widely published guidelines was applied to 30 consecutive patients (age 3 days-3 years) referred to a children's hospital nutritional care team for PN. No serious biochemical abnormalities were observed to arise simply as a consequence of PN. Electrolyte disturbance most commonly occurred before starting PN. Biochemical abnormality was most likely to be found in patients with abnormal fluid and electrolyte losses. Protocols for biochemical surveillance during PN err on the side of caution and often suggest frequent and comprehensive testing. In stable patients such as the surgical newborn, this is both expensive and unnecessary, and simpler monitoring regimes may be used with safety.
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