Journal of Parenteral and Enteral Nutrition最新文献

{"title":"Prognostic evaluation of nutrition risk screening tools in hospitalized adults with normal weight range, overweight, or obesity: A comparative analysis","authors":"Victória Silva Chites MSc, RD,&nbsp;Camila Ferri Burgel MSc, RD,&nbsp;Jussara Carnevale de Almeida PhD, RD,&nbsp;Flávia Moraes Silva PhD, RD","doi":"10.1002/jpen.2712","DOIUrl":"10.1002/jpen.2712","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Many nutrition risk screening tools include low body mass index (BMI). It remains uncertain whether it affects the validity of these tools in patients with overweight or obesity. We aimed to determine the frequency of malnutrition risk and evaluate its association with hospital length of stay in hospitalized adults according to BMI classification.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Secondary analysis involving inpatients with BMI ≥ 18.5 kg/m². Malnutrition risk was assessed using the Nutritional Risk Screening 2002 (NRS-2002), Malnutrition Screening Tool (MST), Malnutrition Universal Screening Tool, Short Nutritional Assessment Questionnaire, and Nutritional Risk in Emergency-2017. Length of hospital stay, in-hospital mortality, readmission, and mortality within 6 months postdischarge were considered as outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among the 582 patients analyzed, the malnutrition risk ranged from 34.5% to 49.7% in patients with normal weight (<i>n</i> = 171), 20.8% to 33.9% in patients with overweight (<i>n</i> = 221), and 5.3% to 22.1% in patients with obesity (<i>n</i> = 190). Malnutrition risk by the NRS-2002 was associated with prolonged hospital stay, regardless of BMI category, and with 6-month hospital readmission in normal weight and those with obesity. The MST was associated with prolonged hospital stay, mortality, and hospital readmission in 6 months in normal-weight patients and with the first two outcomes in patients with overweight. No tool was associated with in-hospital death.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The prognostic value of nutrition risk screening tools varies according to BMI: the MST appears to be more appropriate for normal-weight and overweight patients, whereas the NRS-2002 may be more suitable for patients with obesity.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"49 2","pages":"229-238"},"PeriodicalIF":4.1,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Forty-seventh ASPEN Presidential Address: Parenteral nutrition compounding—Advancement or regression, where do we stand?","authors":"Phil Ayers BS, PharmD","doi":"10.1002/jpen.2720","DOIUrl":"10.1002/jpen.2720","url":null,"abstract":"<p>Parenteral nutrition (PN), a high-alert medication, is an important lifesaving modality. The American Society for Parenteral and Enteral Nutrition (ASPEN) has historically provided guidelines and recommendations for the safe and efficacious use of PN. These recommendations have included detailed guidance regarding the compounding of this highly complex medication. Compounding standards have been recently updated, and PN is no longer listed in a dedicated category in the United States Pharmacopeia General Chapter &lt;797&gt;. Along with this change, the use of commercially available multichamber PN bags has increased in the United States. I will discuss PN from a historical perspective, review the state of compounding, and discuss concerns regarding the safe use of PN.</p>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"49 2","pages":"146-151"},"PeriodicalIF":4.1,"publicationDate":"2025-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Parenteral nutrition and bioelectrical impedance analysis estimated fat-free mass in adult patients with chronic intestinal failure: A descriptive cohort study","authors":"Julia W. Korzilius MD,&nbsp;Manon Dumont MSc,&nbsp;Harriët Jager-Wittenaar PhD,&nbsp;Geert J. A. Wanten PhD,&nbsp;Heidi E. E. Zweers- van Essen PhD","doi":"10.1002/jpen.2723","DOIUrl":"10.1002/jpen.2723","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>In patients with chronic intestinal failure, the content and type of parenteral nutrition are individually determined based on various factors, including body composition. In clinical practice, bioelectrical impedance analysis is used to assess body composition using standardized protocols. However, these protocols lack specific recommendations for patients receiving parenteral nutrition. Therefore, this study described the effect of parenteral nutrition infusion on fat-free mass as evaluated by single-frequency bioelectrical impedance analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a descriptive cohort study using bioelectrical impedance analysis to assess adult patients with chronic intestinal failure receiving parenteral nutrition. Measurements were performed at baseline (before parenteral nutrition infusion) and 0, 1, 2, and 4 h after (usually) 18-h parenteral nutrition infusion using hand-to-foot single-frequency bioelectrical impedance analysis (Bodystat 500). The primary outcome of fat-free mass was calculated using the Kyle equation. A linear mixed model was used to compare baseline values with other time points. A difference of &gt;1 kg in fat-free mass compared with baseline was considered clinically relevant.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty patients (70% female) with a mean age of 58 (SD, 14) years and a median body mass index of 22.3 (IQR, 21.2–24.8) kg/m² were included in the analysis. No significant change in fat-free mass after parenteral nutrition infusion was observed, and 90% (69/77 measurements) of all fat-free mass outcomes after parenteral nutrition infusion remained within the ≤1-kg clinically relevant range.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study found that parenteral nutrition infusion does not affect fat-free mass estimation as assessed by hand-to-foot single-frequency bioelectrical impedance analysis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"49 3","pages":"358-364"},"PeriodicalIF":4.1,"publicationDate":"2025-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jpen.2723","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Measured energy expenditure according to the phases of critical illness: A descriptive cohort study","authors":"Oana A. Tatucu-Babet PhD,&nbsp;Susannah J. King PhD,&nbsp;Andrew Y. Zhang MD,&nbsp;Kate J. Lambell PhD,&nbsp;Audrey C. Tierney PhD,&nbsp;Ibolya B. Nyulasi MSc,&nbsp;Steven McGloughlin MPH,&nbsp;David Pilcher MBBS,&nbsp;Michael Bailey PhD,&nbsp;Eldho Paul PhD,&nbsp;Andrew Udy PhD,&nbsp;Emma J. Ridley PhD","doi":"10.1002/jpen.2721","DOIUrl":"10.1002/jpen.2721","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Indirect calorimetry is recommended for directing energy provision in the intensive care unit (ICU). However, limited reports exist of measured energy expenditure according to the phases of critical illness in large cohorts of patients during ICU admission. This study aimed to analyze measured energy expenditure overall in adult patients who were critically ill and across the different phases of critical illness.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Indirect calorimetry measurements completed at a mixed ICU between January 2010 and July 2019 were eligible. Measured energy expenditure was analyzed and reported as kcal/day and kcal/kg/day overall, as the percentage increase above predicted basal metabolic rate and according to the phases of critical illness; acute early (day 1–2), acute late (day 3–7) and recovery (&gt;7 days) phases using mixed effects linear modelling.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were 629 patients with 863 measurements included; age mean (standard deviation) 48 (18) years, 68% male and 269 (43%) with a traumatic brain injury. Measured energy expenditure overall was 2263 (626) kcal/day (30 (7) kcal/kg/day), which corresponded to a median [interquartile range] of 135 [117–155] % increase above predicted basal metabolic rate. In patients with repeat measurements (<i>n</i> = 158), measured energy expenditure (mean ± standard error) increased over time; 27 ± 0.5 kcal/kg/day in the early acute, 30 ± 0.4 kcal/kg/day in the late acute, and 31 ± 0.4 kcal/kg/day in the recovery phases of critical illness (<i>P</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In a large cohort of ICU patients, measured energy expenditure was 135% above the basal metabolic rate and increased from the early acute to the late acute and recovery phases of critical illness.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"49 3","pages":"314-323"},"PeriodicalIF":4.1,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142909853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prediction of chronic severe intestinal failure–associated liver disease by current criteria in adults: A descriptive cohort study","authors":"Claudia Cipriano MBChB,&nbsp;Liat Deutsch MD,&nbsp;Maja Kopczynska MBBch,&nbsp;Liane Rabinowich MD,&nbsp;Anna Simona Sasdelli PhD,&nbsp;Loris Pironi PhD,&nbsp;Simon Lal PhD","doi":"10.1002/jpen.2719","DOIUrl":"10.1002/jpen.2719","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Intestinal failure–associated liver disease covers a spectrum of conditions from mild to end-stage disease. Currently, there are 9 diagnostic criteria divided to four categories: cholestasis, steatosis, fibrosis, and unclassified. Our aim was to evaluate the application of these criteria to patients with chronic severe liver disease in patients with intestinal failure.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a cross-sectional study of patients attending the home parenteral nutrition clinic of a national UK reference intestinal failure center from March 2015 to December 2019. Exclusion criteria included active malignancy, home parenteral nutrition for &lt;6 months duration, and liver transplantation. Clinically significant intestinal failure–associated liver disease was defined as moderate-severe fibrosis or cirrhosis on liver biopsy and/or radiological imaging compatible with liver cirrhosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Two hundred and twenty-one patients were included (age at home parenteral nutrition initiation: 50 ± 16.0 years; 63.6% female). There was a wide range of intestinal failure–associated liver disease point prevalence depending on the established criteria used (2.9%–35.1%). Twenty-three patients (9.5%) were diagnosed with clinically significant intestinal failure–associated liver disease, but no patient with clinically significant intestinal failure–associated liver disease met all diagnostic criteria, and 6 of 23 (26.1%) did not fit any of the established criteria.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Intestinal failure–associated liver disease is a poorly defined medical condition, and current noninvasive diagnostic methods are unreliable in predicting disease severity. Further studies are needed to develop the definition to reflect that intestinal failure–associated liver disease is a spectrum of disease that includes chronic severe liver disease and improve methods of disease diagnosis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"49 3","pages":"349-357"},"PeriodicalIF":4.1,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142895597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complications that arise with nasogastric tubes after hospitalization in the pediatric population: A mixed methods systematic review","authors":"Samantha Mekhuri MSc,&nbsp;Naomi Dussah MSc,&nbsp;Julie Quet MD,&nbsp;Margaret Sampson PhD,&nbsp;Katie O'Hearn MSc,&nbsp;Sara Loree MSLS,&nbsp;Julia Orkin MD,&nbsp;Krista Keilty PhD,&nbsp;Stephanie Chu MN,&nbsp;Nathalie Major MD,&nbsp;Reshma Amin MD","doi":"10.1002/jpen.2716","DOIUrl":"10.1002/jpen.2716","url":null,"abstract":"<p>Children use nasogastric tubes (NGTs) to ensure optimum nutrition and medication delivery when oral feeding fails or when they experience faltering growth. Although this method is less invasive, children may experience complications associated with NGTs. There is a gap in the literature regarding the types and prevention of complications of NGTs in the pediatric population at home. This review determines at-home complications associated with NGTs in the pediatric population (aged 0–18 years) and the type of education and support provided to caregivers. Databases MEDLINE, Embase using the Ovid interface, and CINAHL using the EBSCOhost interface were searched for relevant studies from January 1946 to November 2022. Twenty-four articles were found, of which 16 studies with 902 children with NGTs feeding were systematically reviewed. Two themes emerged: (1) prevalence and types of NGT complications and (2) preventable complications and education/management strategies for prevention. Seven studies reported main complications of vomiting, retching and gagging, nausea, aspiration, local granulation tissue, and inadvertent removal, with two studies reporting no complications. Most complications were managed at home, suggesting caregivers were able to address issues without seeking additional medical intervention. Key recommendations to mitigate complications included training caregivers in NGT management, troubleshooting common complications, and evaluating caregiver competency before discharge. This systematic review emphasized the need for structured training programs to improve caregiver competence and safety practices, highlighting key areas for clinical improvement, including caregiver education, reducing at-home complications, and standardizing care for children using NGTs.</p>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"49 3","pages":"280-306"},"PeriodicalIF":4.1,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142895596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Topiramate treatment of pediatric metabolic dysfunction–associated steatotic liver disease: A descriptive cohort study","authors":"Taisa Kohut MD,&nbsp;Andrea Tou MD,&nbsp;Emily Carr MD, MPH,&nbsp;Stavra Xanthakos MD, MS,&nbsp;Ana Catalina Arce-Clachar MD,&nbsp;Rima Fawaz MD,&nbsp;Pamela L. Valentino MD, MSc,&nbsp;Jennifer Panganiban MD,&nbsp;Marialena Mouzaki MD, MSc","doi":"10.1002/jpen.2722","DOIUrl":"10.1002/jpen.2722","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Metabolic dysfunction–associated steatotic liver disease (MASLD) is a common disease in children. Lifestyle modification is the primary treatment but difficult to achieve and maintain. Topiramate is a component of an approved weight loss medication (topiramate-phentermine) in children aged 12 years and older but is more commonly used as a single agent, off-label, for pediatric obesity. Our aim is to describe change in anthropometrics and laboratory values while providing topiramate treatment of pediatric MASLD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Descriptive cohort study including patients aged &lt;18 years with MASLD and body mass index (BMI) &gt;95th percentile treated with topiramate for weight loss for ≥3 months from January 1, 2010, to December 30, 2023. The primary outcome was change in serum alanine aminotransferase (ALT) levels from baseline to 3–6 months. Secondary outcomes were changes in BMI <i>z</i> score, glycated hemoglobin, and lipid profile.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 43 patients prescribed topiramate, 11 were excluded for nonadherence, leaving 32 (56% boys, 72% non-Hispanic) for further analyses. With topiramate, ALT levels improved (76 vs 50 U/L, <i>p</i> = 0.001). Further, 43% of patients had either ALT normalization or reduction by &gt;50% from baseline. BMI <i>z</i> score decreased by 0.1 from baseline to 3–6 months. There were no improvements in glycated hemoglobin or lipids. Eight patients (25%) reported mild side effects.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Topiramate, as an adjunct to lifestyle intervention, may be considered in the treatment of pediatric MASLD, specifically in the context of failed lifestyle modification and inability to tolerate or qualify for other obesity pharmacotherapy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"49 3","pages":"308-313"},"PeriodicalIF":4.1,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142885754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The relationship between muscle mass changes and protein or energy intake in critically ill children: A systematic review and meta-analysis","authors":"Lewis J. Stacey,&nbsp;Frederic V. Valla MD, PhD,&nbsp;Chao Huang PhD,&nbsp;Paul Comfort BSc, PhD,&nbsp;Corinne Jotterand Chaparro RD, PhD,&nbsp;Lynne Latten RD, BSc,&nbsp;Lyvonne N. Tume RN, PhD","doi":"10.1002/jpen.2715","DOIUrl":"10.1002/jpen.2715","url":null,"abstract":"<p>Survivorship after pediatric critical illness is high in developed countries, but many suffer physical morbidities afterwards. The increasing focus on follow-up after critical illness has led to more pediatric studies reporting muscle mass changes (using ultrasound), albeit with different results. A systematic literature review was undertaken examining muscle mass changes, assessed by ultrasound of the quadriceps femoris muscle in children who are critically ill. Secondary objectives were to determine if muscle mass was associated with protein intake and/or energy. Databases were searched in July 2024. Eligible experimental or observational studies, published from January 2010 to July 2024 and including children who are critically ill that were aged between ≥37 weeks' gestational age and 18 years who were admitted to the pediatric critical care unit were included. The Joanna Briggs Institute for observational studies critical appraisal instrument was used to assess studies for methodological quality. One hundred and thirty-five studies were screened, and eight prospective cohort studies were included, involving 411 children. Overall, muscle mass changes reported in seven out of eight of the papers showed a pooled mean muscle mass loss of 8.9% (95% confidence interval [CI] 6.6–11.4) from baseline to days 5–7. Five of the eight publications defined muscular atrophy as a decrease in muscle mass of &gt;10%. Using this cutoff, 92 (49.2%) children developed muscular atrophy during their PICU admission. Overall, muscle mass decreased by nearly 10% during a child's first week in PICU, with almost half of children developing muscular atrophy during their admission.</p>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"49 2","pages":"152-164"},"PeriodicalIF":4.1,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jpen.2715","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142882278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between a 6-h feeding protocol and postprocedure hospital length of stay following percutaneous endoscopic gastrostomy in hospitalized adults: A before-and-after cohort study","authors":"Jeffrey L. Roberson MD, MBA,&nbsp;Jesse E. Passman MD, MPH,&nbsp;Marianne Aloupis MS, RD,&nbsp;Yessenia Caballero-Tilleria MA,&nbsp;Anthony Audia MA,&nbsp;Melissa R. Ramirez MA,&nbsp;Patricia Martinez Quinones MD, PhD,&nbsp;Patrick Kim MD, MHCI,&nbsp;Elinore J. Kaufman MD, MSHP,&nbsp;Catherine E. Sharoky MD, MSCE","doi":"10.1002/jpen.2718","DOIUrl":"10.1002/jpen.2718","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Tolerance of enteral nutrition following percutaneous endoscopic gastrostomy is a barrier to discharge. This study investigated the impact of an expedited feeding protocol following percutaneous endoscopic gastrostomy on postprocedure length of stay (LOS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a before-and-after cohort study on hospitalized adults in whom percutaneous endoscopic gastrostomy was placed by surgeons following the implementation of a standardized feeding protocol in which enteral feeds were resumed at the preoperative rate 6 h later.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Enteral feeding resumed within 6 h postoperatively in 93% of patients after protocol initiation. The mean ± SD time to the goal enteral rate after percutaneous endoscopic gastrostomy was significantly shorter following protocol implementation (15 ± 10 vs 50 ± 26 h, <i>P</i> ≤ 0.0001). Compared with the preprotocol cohort, there was no change in postoperative aspiration at 1 week (6% vs 4%, <i>P</i> = 0.531) or rates of tube dislodgement (10% vs 9%, <i>P</i> = 0.89), return to the operating room (10% vs 6%, <i>P</i> = 0.36), and surgical-site infection (9% vs 8%, <i>P</i> = 0.92) at 1 month in the protocol implementation cohort. On multivariable regression, an expedited feeding protocol generated a significantly shorter postprocedure LOS for patients remaining in the hospital for ≤1 week (<i>β</i> = −2.14, 95% CI, −2.98 to −1.30; <i>P</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>An expedited feeding protocol following percutaneous endoscopic gastrostomy placement had a high degree of provider uptake without any significant change in safety outcomes. Beginning enteral nutrition within 6 h postoperatively at the preoperative rate reduced LOS by &gt;2 days, suggesting that these protocols can address common delays to discharge.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"49 2","pages":"222-228"},"PeriodicalIF":4.1,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142877453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fish oil lipid emulsion compared with soybean oil lipid emulsion in pediatric patients with parenteral nutrition-associated cholestasis: A cost-effectiveness study","authors":"Massimiliano Povero PhD,&nbsp;Kathleen M. Gura PharmD,&nbsp;Muralidhar H. Premkumar MBBS,&nbsp;Lorenzo Pradelli MD,&nbsp;Mark Puder MD, PhD,&nbsp;Kara L. Calkins MD, MS","doi":"10.1002/jpen.2713","DOIUrl":"10.1002/jpen.2713","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Evidence indicates that, in pediatric patients with parenteral nutrition–associated cholestasis (PNAC), the use of a 100% fish oil lipid emulsion (FOLE) increased the likelihood of PNAC resolution and reduced the likelihood of liver transplantation compared with a 100% soybean oil lipid emulsion (SOLE). To evaluate the potential economic benefit, we conducted a cost-effectiveness analysis comparing FOLE with SOLE.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study Design</h3>\u0000 \u0000 <p>A discrete event simulation model evaluated cost-effectiveness by simulating clinical outcomes and estimating associated healthcare costs in pediatric patients with PNAC receiving parenteral nutrition (PN) with FOLE (1 g/kg) or SOLE (1.9 g/kg) over a time horizon of 6 years. Model inputs for clinical outcomes were derived from the integrated analysis of two US Phase 3 trials (NCT00910104 and NCT00738101). Cost estimates were estimated from the perspective of the US payer including the cost of PN, transplantation, and adverse events.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The total cost associated with FOLE was $69,847 USD vs $141,605 USD for SOLE. The cost reduction of $71,757 USD was attributable to the avoidance of liver transplantation (−15.7%) and reduction in adverse events (−4.8%). Life-years and the quality-adjusted life-years were increased with FOLE compared with SOLE (by 0.248 and 0.295, respectively).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>By reducing the need for liver transplant and providing time to transition to full enteral nutrition, FOLE leads to cost-savings, compared with SOLE, in pediatric patients with PNAC in the perspective of the US payer. These findings support the use of FOLE in pediatric patients with PNAC who require PN.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"49 2","pages":"180-188"},"PeriodicalIF":4.1,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}