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Parenteral nutrition in the management of severe protracted diarrhea
Insights
Parenteral nutrition (PN) saved the lives of 13 out of 17 infants with severe protracted diarrhea. This life-saving intervention, despite some complications, proved invaluable for improving nutritional status and controlling diarrhea in critically ill children.
Area of Science:
- Pediatrics
- Clinical Nutrition
- Gastroenterology
Background:
- Severe protracted diarrhea (PD) in infants poses significant management challenges.
- Standard protocols, including special diets, may be insufficient for deteriorating patients.
- Nutritional support is critical for recovery in severe pediatric gastrointestinal disorders.
Purpose of the Study:
- To evaluate the efficacy and safety of parenteral nutrition (PN) in infants with severe protracted diarrhea.
- To assess the impact of PN on diarrheal control and nutritional status.
- To identify PN-related complications and their management in this vulnerable population.
Main Methods:
- Seventeen infants (3 weeks to 19 months) with severe PD received PN for 4-19 days.
- PN consisted of crystalline amino acids (Vamin N), dextrose, and lipid emulsion (Intralipid 10%).
- Peripheral lines were predominantly used; enteral feeds were reintroduced as tolerated.
Main Results:
- PN achieved mean daily intakes of 2.2 g/kg protein and 106 kcal/kg.
- Diarrheal control and improved nutrition were observed in 13 of 17 infants.
- Complications included thrombophlebitis (11.8%), sepsis (17.6%), and metabolic imbalance (17.6%); 4 infants died (2 from refractory diarrhea, 2 from sepsis).
- Relapse of PD occurred in 5 of 13 survivors, requiring further PN in 2.
Conclusions:
- Parenteral nutrition is a life-saving therapy for severe protracted diarrhea in infants when standard management fails.
- PN should be available in specialized units for managing critically ill children with severe PD.
- Careful monitoring is essential to manage PN-related complications effectively.
Abstract:
Seventeen children aged 3 weeks to 19 months with severe Protracted Diarrhea (PD), and who were deteriorating on our standard management protocol (including special diets) were given Parenteral Nutrition (PN) for 4 to 19 days with crystalline aminoacid solution (Vamin N) in 10% dextrose and lipid emulsion (Intralipid 10%). Peripheral lines were used in majority (84%). Enteral feeds were started early and rebuilt as per tolerance. The mean daily protein and caloric intake achieved by hyperalimentation was 2.2 +/- 0.7 g/kg and 106 +/- 41 K cal/kg respectively. Diarrheal control and improvement in nutritional status was achieved in all but 4 who died (2 of refractory diarrhea and 2 of sepsis, 1 of which was probably PN related). Other PN related, treatable complications included thrombophlebitis (11.8%), sepsis (17.6%), and metabolic imbalance (17.6%). PN solutions and accessories alone cost an approximate average of Rs. 280/day, with extras for biochemical monitoring (Rs. 70/day) and special nursing (Rs. 200/day). Only 5 of the 13 survivors had a significant relapse of PD, within 5 to 80 days of discharge, necessitating further PN in 2. There were no further deaths. PN was therefore, found to be of life saving value in 13 of 17 children with severe protracted diarrhea and therefore, must be available in specialised units caring for such children.