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[Total parenteral nutrition in surgical treatment of infants: recent progress and problems]
Insights
Total parenteral nutrition (TPN) is crucial for surgical infants, improving survival rates in those with massive intestinal resection. New amino acid solutions and careful monitoring enhance TPN effectiveness and safety.
Area of Science:
- Pediatric Surgery
- Neonatal Nutrition
- Gastroenterology
Context:
- Parenteral nutrition (TPN) is frequently utilized in surgical neonates and infants.
- Indications include intestinal atresia, Hirschsprung's disease, esophageal atresia, pyloric stenosis, and biliary atresia.
- TPN demonstrates improved survival in infants with massive intestinal resection.
Purpose:
- To evaluate the frequency, indications, and effectiveness of TPN in surgical infants.
- To introduce a newly devised amino acid solution (N1-2) for TPN.
- To identify key parameters for optimizing TPN administration and preventing complications.
Summary:
- TPN was administered to 37.8% of neonates and 9.7% of older infants over 15 years.
- A novel amino acid solution (N1-2) showed improved utility in young infants.
- Urinary phosphorus levels are critical for Vitamin D administration; TPN-induced hepatic dysfunction correlates with amino acid dosage.
- Closed infusion systems effectively prevent catheter-related sepsis.
- Nutritional care is vital for infants with biliary atresia and advanced neuroblastoma.
Impact:
- TPN significantly improves survival in critically ill surgical infants.
- Optimized amino acid formulations and monitoring parameters enhance TPN efficacy.
- Effective strategies for preventing TPN-related complications like sepsis and hepatic dysfunction are highlighted.
- Comprehensive nutritional support positively impacts outcomes in complex pediatric surgical conditions.
Abstract:
The frequency of TPN in surgical infants was 242/686 (37.8%) in neonates and 260/2693 (9.7%) in older infants for the past 15 years. The frequent indications of TPN were intestinal atresia, Hirschsprung's disease and esophageal atresia in the neonatal period, and Hirschsprung's disease, pyloric stenosis and biliary atresia in infancy. The effectiveness of TPN was impressively indicated by better survival rate in the infants with massive intestinal resection received TPN. An amino acid solution (N1-2) was newly devised, based on the analysis of plasma aminograms in 36 infants received TPN with a commercial amino acid solution (Proteamin), and theoretical considerations. It was more useful solution for TPN in 12 young infants. Urinary phosphorus was a considerable parameter for the administration of Vitamin D in TPN. The incidence of TPN-induced hepatic dysfunction was significantly referred to the amount of amino acid in TPN. Closed infusion system with a soft bag and triple bacterial filters in the line was effective for the prevention of sepsis caused by central venous catheter. The nutritional care was important in the treatment of infants with biliary atresia, because generally they had some nutritional defects such as essential fatty acid deficiency, insufficient amino acid metabolism and zinc deficiency. The nutritional care in infants with advanced neuroblastoma favorably altered the course of the disease.