Parenteral nutrition brought about a paradigm shift in the way we approached feeding patients with intestinal failure. Yet despite its 50 year history, this life saving treatment still brings challenges faced by both patients and clinicians. Over the years the number of studies published has grown at an exponential rate, and so the 2005 guidelines were useful, though now, a little out of date. In 2018, to help with this, the European Society for Paediatric Gastroenterology, Hepatology and Nutrition and other bodies updated their guidelines. The article in Frontline Gastroenterology serves as a useful review of this extensive guideline.
Reading through this review, it was surprising to learn the significant difference the time to offering micro and macro nutrients can have: the sooner the better is NOT always the case! For example, holding parenteral nutrition for up to even 8 days in the ICU setting in ill newborns, infants and children actually reduced the number of infections, time on ventilator, incidence of kidney failure and length of stay in PICU. Having a summary of this is handy for daily practice.
With newer studies, best practice continues to change and having a review can be useful to learn this quickly. So whether it be prescribing multi-component lipid emulsions instead of the previously used soybean lipids or preventing infections of central venous catheter lines with taurolodine it’s good to know that the guidelines have been condensed into a quicker to read format.
As with all guidelines, there remains unanswered questions where there is currently a paucity of evidence. However, since 2005 it is clear that the field of infant parenteral nutrition has progressed. This review serves as a great update of the guidelines highlighting the changes that have been made since the previous version. As a result, this paper is a must for all paediatric gastroenterologists involved with the management of paediatric parenteral nutrition!
Full article available here:
Paediatric parenteral nutrition: current issues, http://dx.doi.org/10.1136/flgastro-2018-101127