Nutrition in Clinical Practice最新文献

Background: Although malnutrition in critically ill children is linked to poor outcomes, the impact of achieving guideline-recommended nutritional goals remains unclear. We examined the association between achievement of American Society for Parenteral and Enteral Nutrition (ASPEN) goals via enteral nutrition (EN) and clinical outcomes in a Japanese pediatric intensive care unit (PICU).

Methods: This single-center, retrospective cohort study included patients aged <16 years admitted between July 2022 and December 2024 who required mechanical ventilation and had a PICU/high care unit (HCU) stay of ≥7 days. We compared patients who achieved the ASPEN goal (≥2/3 of resting energy expenditure and ≥1.5 g/kg/day protein via EN) within 7 days with those who did not. Multivariable Cox proportional hazards models were used to evaluate the association between nutritional goal achievement and the primary outcome of total length of stay (LOS).

Results: Of the 110 patients, 80 (72.7%) achieved their nutritional goals. The achievement group had a significantly shorter total LOS (median 12 vs 20 days; P < 0.001). After multivariable adjustment, meeting the nutritional target was independently associated with a higher likelihood of discharge (adjusted hazard ratio: 2.41; 95% confidence interval: 1.45-4.02; P < 0.001). The achievement group also had fewer new-onset infections (8.8% vs 40%) and more ventilator-free days.

Conclusion: Achievement of ASPEN-recommended nutritional targets through EN within the first week is strongly associated with short LOS and reduced complications in critically ill children. Although early EN is a potential marker of better prognosis, our findings support its optimization in this vulnerable population.

Background: A randomized, double-blind, placebo-controlled trial was conducted to evaluate efficacy and safety of glepaglutide in patients who have short bowel syndrome with intestinal failure (SBS-IF). At the end of the trial, exit interviews were conducted to explore participants' experiences and to assess the impact of the disease and treatment during the trial.

Methods: Thirty patients from four countries were interviewed over the phone. Data were collected using a semistructured interview manual, and interviews were recorded and transcribed for analysis.

Results: Patients reported that SBS-IF negatively impacted their lives before the trial, causing loss of freedom, disrupted sleep, limited physical activity, and pain. During the interviews, patients reported that the treatment improved their well-being across multiple domains. Seventy-three percent of the patients receiving glepaglutide (n = 16/22) reported positive changes in health-related quality of life compared with 25% receiving placebo (n = 2/8). Twenty-six patients reported experiencing a reduction in parenteral support (PS) volume. Of these, 21 patients (18 glepaglutide, three placebo) reported a change in overall status, with 94% receiving glepaglutide (n = 17/18) and 67% (n = 2/3) receiving the placebo finding this change meaningful. Although descriptive, these findings should be interpreted cautiously given the small number of patients.

Conclusion: During exit interviews, patients receiving glepaglutide reported improvements in well-being across multiple domains, noting meaningful reductions in PS volume and a reduced impact of SBS-IF on daily life, which was proportionally greater than in those receiving placebo. These findings underscore the patient-reported positive experiences of glepaglutide and its beneficial effects.

Infants born large-for-gestational-age (LGA) are increasingly common because of the rising rates of maternal obesity and diabetes. Some infants born LGA require hospitalization and nutrition support, yet no specific growth standards exist to guide nutrition management. Feeding practices based on weight-based guidelines for infants born at appropriate weight for gestational age may unintentionally promote overfeeding and increase long-term obesity risk. This Clinical Dilemma explores the challenges of feeding hospitalized infants born LGA and highlights the urgent need for research to develop evidence-based growth standards for this at-risk population.

Chronic intestinal pseudo-obstruction (CIPO) is a rare, heterogeneous, and debilitating disorder characterized by profound intestinal dysmotility and severe nutrition challenges. Its presentation resembles that of mechanical bowel obstruction, but CIPO occurs in the absence of luminal obstruction. Pediatric-onset CIPO has higher morbidity and mortality and is termed pediatric intestinal pseudo-obstruction (PIPO) to differentiate it from adult-onset CIPO. PIPO often presents with vague abdominal symptoms such as abdominal pain, distension, bloating, constipation, and diarrhea. Nutrition therapy is the mainstay of the management of PIPO. The main management goals include maintaining an adequate caloric intake, avoiding fluid and electrolyte imbalance, minimizing/managing malnutrition, treating gastrointestinal symptoms, enhancing intestinal motility using pharmacological interventions, and managing complications such as small intestinal bacterial overgrowth. Surgical interventions are reserved for severe cases. Various modalities of nutrition intervention include modification of oral diet, enteral feeding, and parenteral nutrition. Most children with PIPO have a poor quality of life, and the prognosis is variable based on the underlying condition. Prognosis is better in an interdisciplinary team setting in specialized centers of excellence.

Type 2 diabetes is a global epidemic despite current medical treatments. Many patients are not responsive to medications, and patients with obesity are hesitant about bariatric surgery. Studies investigating the metabolic effects of Roux-en-Y gastric bypass have increasingly demonstrated that the duodenum plays a key role in the pathophysiology of type 2 diabetes. This has led to the emergence of small bowel endoscopic therapies for type 2 diabetes. These therapies include procedures such as duodenal ablation, luminal liners, endoscopic bypasses, and endoscopic injections.

Repair is an established method of line salvage and treatment for mechanical complications of the external component of long-term tunneled central venous catheters (CVCs). In this Clinical Observations article, the endoluminal metal stent of the repair segment was found to be dislodged and migrated toward the patient, representing a risk for CVC malfunction and embolization into the patient, thus requiring CVC replacement. All four patients required long-term parenteral nutrition for intestinal failure. In two cases, the stent migration was noticed by the caregiver, whereas the other two were discovered after the line was removed. Dislodgment of the metal stent used in CVC repair kits is a rare, although potentially dangerous, complication. Providers caring for patients with long-term tunneled CVCs should be aware of this potential risk.

We present the case of a 99-year-old woman who developed functional short bowel syndrome after an emergency laparotomy for mesenteric ischemia. Her initial management was palliative care because of hemodynamic instability and subsequently because of advanced age. Following 3 months of recurrent infections and 30% weight loss, her dependence on intravenous hydration and her declining quality of life led to a reassessment of treatment goals. Ultimately, she underwent successful intestinal reconstruction with a side-to-side jejuno-jejunal anastomosis after reaching 100 years of age during the preoperative period. She achieved independence from intravenous nutrition and recovered her desired quality of life. This case highlights the dynamic, multidisciplinary approach required for such patients and the need for continuous reassessment of therapeutic plans, even for frail nonagenarians or centenarians.

Background: This study aimed to develop and assess a bedside nasojejunal tube placement technique designed for resource-limited settings to address the specific challenges of enteral nutrition (EN) delivery in neurocritical care patients, particularly those at high risk of reflux and aspiration. The technique sought to overcome the drawbacks of conventional placement methods that depend on specialized equipment or are time-consuming, thereby improving accessibility in constrained healthcare environments.

Methods: A simplified nasojejunal tube placement method not requiring specialized equipment was implemented. Fifty-six neurocritically ill patients were enrolled, and outcomes-including success rate, placement time, operator variability, and adverse events-were evaluated. Minor adverse events were managed using standard care protocols.

Results: The technique achieved a 91.07% success rate, with a mean placement time of 21.27 min (range, 10-30 min). Comparative analysis showed minimal interoperator variability, with no significant differences in placement time (P = 0.667) or number of attempts (P = 0.644), confirming the method's reproducibility and ease of learning. No severe complications occurred, and minor events such as nasal mucosal bleeding were effectively managed. General adverse events were observed in 32.14% of cases with no long-term complications.

Conclusion: The bedside nasojejunal tube placement technique is a safe, practical, and cost-effective approach for optimizing EN delivery in neurocritical care patients. By simplifying the procedure and eliminating the need for specialized equipment, this method enhances clinical efficiency and feasibility in resource-limited settings. Its high success rate and adaptability support its potential for broader clinical implementation.

Background: Pediatric patients with intestinal failure (IF) require long-term central vascular catheters (CVCs) for parenteral nutrition, placing them at high risk for catheter-related bloodstream infections (CRBSIs). Sodium bicarbonate (NaHCO₃) locks have shown potential in reducing CRBSIs in adult populations, but data in pediatric patients with IF remain limited.

Methods: We conducted an open-label prospective cohort study at a tertiary medical center to evaluate the impact of 8.4% NaHCO₃ locks on CRBSI and CVC replacement rates in pediatric patients with IF (ClinicalTrials.gov NCT05927484). The baseline period (heparin locks) was assessed retrospectively, whereas the intervention period (NaHCO₃ locks) was evaluated prospectively. Primary outcome was CRBSI rate; secondary outcomes included CVC replacement because of CRBSI and infection-related hospitalizations.

Results: In the per‑protocol analysis, six patients contributed 5733 total catheter days (3244 on heparin, 2489 on NaHCO₃). CRBSI rates decreased from a median of 8.2 to 3.0 per 1000 catheter days after switching to NaHCO₃ locks (P = 0.11). A similar downward trend was observed in the intent‑to‑treat analysis. A statistically significant reduction in CVC replacement because of CRBSI was observed (2.3 vs 0 per 1000 catheter days; P = 0.03). Trends toward reduced hospital and intensive care unit admissions were also noted in the intervention group. No serious adverse events were attributed to NaHCO₃ lock use.

Conclusion: NaHCO₃ locks appear to be a safe and promising strategy for reducing CRBSI-related complications in pediatric patients with IF, especially where access to more effective lock solutions is limited. Larger prospective studies are needed to confirm these findings.

Background: Early documentation of energy goals has been associated with better nutrition outcomes. We performed a successful project improving the rate of early documentation of energy goals from 30% to 97%. We then conducted a retrospective study of children admitted to the pediatric intensive care unit (PICU) the year before and after intervention to determine whether we improved initiation and delivery of nutrition.

Materials and methods: We identified patients with PICU length of stay (LOS) of at least 48 h from Virtual Pediatrics Systems, LLC (VPS) from May 2020 to April 2022. We obtained clinical, demographic, and nutrition data for the first 96 h of admission from the electronic medical record and VPS. We defined early enteral nutrition (EEN) as delivery of 25% of goal calories within 48 h of admission. We analyzed data using Mann-Whitney test for continuous variables and chi-square test for categorical variables and multivariable regression analyses.

Results: A total of 1510 patients were included (702 preintervention, 808 postintervention). Median ICU LOS (4.05 vs 3.64 days; P = 0.030) and hospital LOS (8.25 vs 6.99 days; P = 0.009) were significantly reduced. EEN was significantly more likely to be initiated in the postintervention group than in the preintervention group (P < 0.0001), adjusted for age, sex, race, ethnicity, Pediatric Index of Mortality 3 (PIM3) score, and documentation of energy goal.

Conclusion: Energy goal documentation improved EEN initiation and demonstrated shorter LOS in multivariable analysis. Findings highlight need for standardized documentation, greater dietitian involvement, and further study of how nutrition planning affects outcomes in critically ill children.