JPEN. Journal of parenteral and enteral nutrition最新文献

{"title":"Nutrition care practice patterns for patients with COVID-19-A preliminary report.","authors":"Velarie Ansu,&nbsp;Constantina Papoutsakis,&nbsp;Nana Gletsu-Miller,&nbsp;Lisa A Spence,&nbsp;Kathryn Kelley,&nbsp;Lindsay Woodcock,&nbsp;Taylor C Wallace,&nbsp;Alison Steiber","doi":"10.1002/jpen.2106","DOIUrl":"https://doi.org/10.1002/jpen.2106","url":null,"abstract":"<p><strong>Background: </strong>Severe acute respiratory syndrome coronavirus 2 is a respiratory virus that poses risks to the nutrition status and survival of infected patients, yet there is paucity of data to inform evidence-based quality care.</p><p><strong>Methods: </strong>We collected data on the nutrition care provided to patients with coronavirus disease 2019 (COVID-19) by registered dietitian nutritionists (RDNs).</p><p><strong>Results: </strong>Hospitalized COVID-19 patients (N = 101) in this cohort were older adults and had elevated body mass index. The most frequent nutrition problems were inadequate oral intake (46.7%), inadequate energy intake (18.9%), and malnutrition (18.4%). These problems were managed predominantly with enteral nutrition, food supplements, and multivitamin-multimineral supplement therapy. Over 90% of documented problems required a follow-up.</p><p><strong>Conclusion: </strong>This data set is the first of its kind to report on the types of nutrition diagnoses and interventions for COVID-19 cases used by RDNs and highlights the need for increased and continued nutrition care.</p>","PeriodicalId":520701,"journal":{"name":"JPEN. Journal of parenteral and enteral nutrition","volume":" ","pages":"1774-1778"},"PeriodicalIF":3.4,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/jpen.2106","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25487385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Carnitine deficiency among hospitalized pediatric patients: A retrospective study of critically ill patients receiving extracorporeal membrane oxygenation therapy.","authors":"Jenna Kelley,&nbsp;Erin Sullivan,&nbsp;Marie Norris,&nbsp;Sarah Sullivan,&nbsp;Jennifer Parietti,&nbsp;Kimberly Kellogg,&nbsp;Anna I Scott","doi":"10.1002/jpen.2255","DOIUrl":"https://doi.org/10.1002/jpen.2255","url":null,"abstract":"<p><strong>Background: </strong>The metabolic demands associated with critical illness place patients at risk for nutrition deficits. Carnitine is a small molecule essential for fatty acid oxidation and gluconeogenesis. Secondary carnitine deficiency can have clinically significant complications and has been observed anecdotally in patients receiving extracorporeal membrane oxygenation (ECMO) therapy at our institution. Guidelines for monitoring and supplementing carnitine are lacking. This retrospective study determined whether critically ill pediatric patients receiving ECMO have an increased risk of carnitine deficiency.</p><p><strong>Methods: </strong>Acylcarnitine analysis was performed on residual specimens from patients who received ECMO therapy. The control data were a convenience sample gathered by chart review of patients who had been tested for carnitine during a hospitalization.</p><p><strong>Results: </strong>Acylcarnitines were measured in 217 non-ECMO patients and 81 ECMO patients. Carnitine deficiency, based on age-specific reference ranges, was observed in 41% of ECMO cases compared with 21% of non-ECMO cases. Multivariable analysis of age-matched patients identified that the odds of carnitine deficiency were significantly lower among patients on the floor compared with ECMO patients (odds ratio, 0.21; 95% CI, 0.10-0.44). Age-specific frequency of qualitative carnitine deficiency ranged from 15% (patients >5 years old) to 56% (patients 1 week to 1 month old) in ECMO patients and 15% (patients >5 years old) to 34% (patients 1-5 years old) in non-ECMO patients.</p><p><strong>Conclusion: </strong>In this study, ECMO patients were carnitine deficient more frequently compared with other inpatients, with the highest rates of deficiency among ECMO patients between 1 week and 1 month old.</p>","PeriodicalId":520701,"journal":{"name":"JPEN. Journal of parenteral and enteral nutrition","volume":" ","pages":"1663-1672"},"PeriodicalIF":3.4,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/jpen.2255","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39331326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Daikenchuto for Mechanically Ventilated Patients With Enteral Feeding Intolerance: A Propensity Score-Matched Analysis Using a Nationwide Administrative Inpatient Database.","authors":"Hiroyuki Ohbe,&nbsp;Taisuke Jo,&nbsp;Hiroki Matsui,&nbsp;Kiyohide Fushimi,&nbsp;Hideo Yasunaga","doi":"10.1002/jpen.2076","DOIUrl":"https://doi.org/10.1002/jpen.2076","url":null,"abstract":"<p><strong>Background: </strong>Daikenchuto, a Japanese herbal Kampo medicine, is used to improve gastrointestinal motility in critically ill patients with enteral feeding intolerance (EFI) in Japan. The present study aimed to investigate the effect of Daikenchuto for critically ill patients with EFI.</p><p><strong>Methods: </strong>Using the Japanese Diagnosis Procedure Combination inpatient database from July 2010 to March 2018, we identified mechanically ventilated patients in intensive care units (ICUs) who had EFI during mechanical ventilation. We defined EFI as receipt of intravenous metoclopramide during mechanical ventilation. Patients who started Daikenchuto within 2 days of EFI onset were defined as the Daikenchuto group, and the remaining patients were defined as the control group. Propensity score-matched analyses were performed to compare the outcomes between the 2 groups.</p><p><strong>Results: </strong>A total of 61,454 patients were included. Of these, 8842 patients (14%) were in the Daikenchuto group. One-to-one propensity score matching created 8701 matched pairs. After propensity score matching, the total number of days receiving enteral nutrition within 28 days of EFI onset was significantly longer in the Daikenchuto group than in the control group (risk difference, 0.9 days; 95% CI, 0.5-1.3 days). There were no significant differences in 28-day in-hospital mortality, hospital-acquired pneumonia, ventilator-free days, length of ICU stay, time to discharge alive, and adverse complications.</p><p><strong>Conclusion: </strong>This nationwide observational study suggested that use of Daikenchuto may increase the total number of days receiving enteral nutrition in mechanically ventilated patients with EFI.</p>","PeriodicalId":520701,"journal":{"name":"JPEN. Journal of parenteral and enteral nutrition","volume":" ","pages":"1703-1713"},"PeriodicalIF":3.4,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/jpen.2076","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38851397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of parenteral nutrition duration on patterns of growth and body composition in very low-birth-weight premature infants.","authors":"Zaineh Alja'nini,&nbsp;Stephanie Merlino-Barr,&nbsp;Alexa Brumfiel,&nbsp;Kera McNelis,&nbsp;Sreekanth Viswanathan,&nbsp;Marc Collin,&nbsp;Sharon Groh-Wargo","doi":"10.1002/jpen.2278","DOIUrl":"https://doi.org/10.1002/jpen.2278","url":null,"abstract":"BACKGROUND\u0000 Parenteral nutrition (PN) is essential to support premature infants' growth and varies with enteral nutrition (EN) advancement rates. Data on PN duration's impact on premature infants' growth is limited. The aim of this multicenter observational study was to determine early PN duration effect on body composition at term corrected gestation (CGA) in very low birth weight (VLBW) premature infants.\u0000\u0000\u0000METHODS\u0000  VLBW infants exposed to PN in the first week of life and exposed to significantly different EN regimens, were divided into two groups per early PN duration. Infants with a birth weight (BW) < 1000g and PN duration < 28 days, and those with a BW 1000-1500g and PN duration < 14 days were assigned to the 'Short-PN' group. Infants receiving PN for longer durations were assigned to the 'Long-PN' group. Body composition was assessed at term CGA or prior to discharge via air displacement plethysmography.\u0000\u0000\u0000RESULTS\u000062 and 53 infants were assigned to the short- and long- PN groups respectively. The two groups were significantly different in BW and gestational age (GA), so a nested case-control study was conducted after matching 36-infant pairs. Infants in the long-PN group had significantly lower fat-free mass (FFM) z-scores but both groups had comparable fat mass (FM) z-scores. Long-PN was a significant negative predictor of FFM z-score in the multivariate regression analysis.\u0000\u0000\u0000CONCLUSION\u0000 In VLBW premature infants, PN duration is negatively associated with FFM z-scores at term CGA without affecting FM z-scores. This article is protected by copyright. All rights reserved.","PeriodicalId":520701,"journal":{"name":"JPEN. Journal of parenteral and enteral nutrition","volume":" ","pages":"1673-1682"},"PeriodicalIF":3.4,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39533358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Malnutrition in Hospitalized Adults With Cerebral Palsy.","authors":"Ché Matthew Harris,&nbsp;Scott Mitchell Wright","doi":"10.1002/jpen.2067","DOIUrl":"https://doi.org/10.1002/jpen.2067","url":null,"abstract":"<p><strong>Background: </strong>Malnutrition among hospitalized adults with cerebral palsy (CP) has not been extensively explored. We sought to identify impacts of malnutrition on clinical and resource outcomes among hospitalized adults with CP.</p><p><strong>Methods: </strong>This retrospective cohort study surveyed years 2016 and 2017 from the National Inpatient Sample database. Regression models evaluated mortality and resource utilization.</p><p><strong>Results: </strong>154,219 adults with CP were hospitalized. Among them, 21,064/154,219 (13.5%) had malnutrition. Patients with and without malnutrition were similar in age (mean age ± SEM, 45.1 ± 0.30 vs 45.2 ± 0.18 years; P = .70). Patients with malnutrition were more likely male (12,175/21,604 [57.8%] vs 72,929/133,155 [54.8%], P < .01) and had higher comorbidity scores (Charlson comorbidity score ≥ 3; 2,464/21,064 [11.7%] vs 14,380/133,155 [10.8%]; P = .01). Mortality rates were higher among patients with malnutrition (905/21,064 [4.3%] vs 2,796/21,064 [2.1%], P < .01), and they had higher odds for mortality (adjusted odds ratio [aOR] = 2.1; CI, 1.7-2.5; P < .01). Those with malnutrition were less likely discharged home (aOR = 0.52; CI, 0.48-0.56; P < .01). Hospital charges were higher (adjusted mean difference [aMD] = +$42,540; CI, $36,934-48,146; P < .01) and length of stay longer (aMD = +4.3 days; CI, 3.9-4.7; P < .01) among patients with malnutrition.</p><p><strong>Conclusion: </strong>Malnutrition in hospitalized patients with CP is associated with increased mortality and hospital resource utilization. Flagging these patients as being \"high risk\" when they are hospitalized may result in heightened attentiveness about clinical outcomes in this vulnerable population.</p>","PeriodicalId":520701,"journal":{"name":"JPEN. Journal of parenteral and enteral nutrition","volume":" ","pages":"1749-1754"},"PeriodicalIF":3.4,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/jpen.2067","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38813700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Classification Tree-Based Machine Learning to Visualize and Validate a Decision Tool for Identifying Malnutrition in Cancer Patients.","authors":"Liangyu Yin,&nbsp;Xin Lin,&nbsp;Jie Liu,&nbsp;Na Li,&nbsp;Xiumei He,&nbsp;Mengyuan Zhang,&nbsp;Jing Guo,&nbsp;Jian Yang,&nbsp;Li Deng,&nbsp;Yizhuo Wang,&nbsp;Tingting Liang,&nbsp;Chang Wang,&nbsp;Hua Jiang,&nbsp;Zhenming Fu,&nbsp;Suyi Li,&nbsp;Kunhua Wang,&nbsp;Zengqing Guo,&nbsp;Yi Ba,&nbsp;Wei Li,&nbsp;Chunhua Song,&nbsp;Jiuwei Cui,&nbsp;Hanping Shi,&nbsp;Hongxia Xu","doi":"10.1002/jpen.2070","DOIUrl":"https://doi.org/10.1002/jpen.2070","url":null,"abstract":"<p><strong>Background: </strong>The newly proposed Global Leadership Initiative on Malnutrition (GLIM) framework is promising to gain global acceptance for diagnosing malnutrition. However, the role of machine learning in facilitating its application in clinical practice remains largely unknown.</p><p><strong>Methods: </strong>We performed a multicenter, observational cohort study including 3998 patients with cancer. Baseline malnutrition was defined using the GLIM criteria, and the study population was randomly divided into a derivation group (n = 2998) and a validation group (n = 1000). A classification and regression trees (CART) algorithm was used to develop a decision tree for classifying the severity of malnutrition in the derivation group. Model performance was evaluated in the validation group.</p><p><strong>Results: </strong>GLIM criteria diagnosed 588 patients (14.7%) with moderate malnutrition and 532 patients (13.3%) with severe malnutrition among the study population. The CART cross-validation identified 5 key predictors for the decision tree construction, including age, weight loss within 6 months, body mass index, calf circumference, and the Nutritional Risk Screening 2002 score. The decision tree showed high performance, with an area under the curve of 0.964 (κ = 0.898, P < .001, accuracy = 0.955) in the validation group. Subgroup analysis showed that the model had apparently good performance in different cancers. Among the 5 predictors constituting the tree, age contributed the least to the classification power.</p><p><strong>Conclusion: </strong>Using the machine learning, we visualized and validated a decision tool based on the GLIM criteria that can be conveniently used to accelerate the pretreatment identification of malnutrition in patients with cancer.</p>","PeriodicalId":520701,"journal":{"name":"JPEN. Journal of parenteral and enteral nutrition","volume":" ","pages":"1736-1748"},"PeriodicalIF":3.4,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/jpen.2070","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38795929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retrospective Analysis of the Safety and Outcomes of Percutaneous Radiologic Gastrostomy in Obese vs Nonobese Patients.","authors":"Sheetal Sethupathi,&nbsp;Kate Walter,&nbsp;Maria Lim,&nbsp;Adam Fang","doi":"10.1002/jpen.2075","DOIUrl":"https://doi.org/10.1002/jpen.2075","url":null,"abstract":"<p><strong>Background: </strong>The purpose of this study is to compare the safety and outcomes of percutaneous radiologic gastrostomy (PRG) in obese vs nonobese patients.</p><p><strong>Methods: </strong>This is an institutional review board-approved retrospective study of 109 patients (male:female, 68:41; mean age, 64.7 years; range, 21-94 years) who underwent PRG with or without gastropexy at a single academic medical center between 2015 and 2018. Body mass index (BMI) of ≥30 kg/m² was defined as obese. Patient demographics, indications, technical success, intraoperative variables, and major/minor complications were analyzed. Major and minor complications occurring within 30 days of the procedure were recorded and categorized based on the Society of Interventional Radiology Quality Improvement guidelines.</p><p><strong>Results: </strong>Of 109 patients included in the study, 22.9% (n = 25) of patients were obese (average BMI, 34.6 kg/m² ; range, 30-50). Overall technical success in the obese and nonobese groups was 100% each. In the obese vs nonobese group, major and minor complications were not significantly different. There were also no significant differences in procedure time, fluoroscopy time, or contrast volume. However, mean peak skin dose was significantly increased in the obese group vs nonobese group (190.3 ± 224.2 vs 59.1 ± 71.1 mGy; P < .0001).</p><p><strong>Conclusion: </strong>PRG is a safe procedure in obese patients with similar technical success, major and minor complication rates, procedure time, fluoroscopy time, and contrast volume. However, PRG is associated with increased radiation dose with obese patients; therefore, optimal methods of radiation protection should be utilized.</p>","PeriodicalId":520701,"journal":{"name":"JPEN. Journal of parenteral and enteral nutrition","volume":" ","pages":"1714-1719"},"PeriodicalIF":3.4,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/jpen.2075","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38810257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Term Infants Fed Exclusively With Donor Milk May Require Vitamin C Supplementation.","authors":"Marina Castro,&nbsp;Michael A Pitino,&nbsp;Nicole Bando,&nbsp;Susanne Aufreiter,&nbsp;Debbie Stone,&nbsp;Deborah L O'Connor,&nbsp;Sharon Unger","doi":"10.1002/jpen.2073","DOIUrl":"https://doi.org/10.1002/jpen.2073","url":null,"abstract":"BACKGROUND When there is insufficient mother's milk for preterm infants, fortified human donor milk (DM) is the preferred supplement. Recently, there is growing interest in providing DM to term infants. Aside from vitamin D, mother's milk is a complete source of nutrition for term infants. It is unknown whether supplementation of micronutrients is required for term infants exclusively fed DM, particularly nutrients affected by heat processing, such as vitamin C. The objective of this study was to determine the total vitamin C content in DM and whether it would be adequate for an infant exclusively fed DM. METHODS DM samples (n = 56) were collected at a Canadian milk bank from April to August 2018. Vitamin C concentration was determined by high-performance liquid chromatography. RESULTS DM samples had a vitamin C concentration of 17.7±9.8 mg/L (mean ± SD) and were variable, ranging from 1.9-43.2 mg/L. Using these values and assuming an exclusive DM consumption of 780mL/day, the estimated vitamin C intake would be 13.8±8.6 mg (mean ± SD), falling below the Adequate Intake of 40 mg/day for infants (0-6 months). CONCLUSION Vitamin C supplementation is required for all infants if DM is the sole source of nutrition. Future studies should investigate other heat and light-sensitive nutrients. (CIHR-FDN#:143233) This article is protected by copyright. All rights reserved.","PeriodicalId":520701,"journal":{"name":"JPEN. Journal of parenteral and enteral nutrition","volume":" ","pages":"1785-1787"},"PeriodicalIF":3.4,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/jpen.2073","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38810482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The first case with FBXL4 mutation successfully treated with a parenteral ketogenic diet for lactic acidosis.","authors":"Aslı İnci,&nbsp;Emine Aktaş,&nbsp;Filiz Başak Cengiz Ergin,&nbsp;İlyas Okur,&nbsp;Gürsel Biberoğlu,&nbsp;Fatih Süheyl Ezgü,&nbsp;Leyla Tümer","doi":"10.1002/jpen.2121","DOIUrl":"https://doi.org/10.1002/jpen.2121","url":null,"abstract":"<p><strong>Background: </strong>The ketogenic diet (KD) is a low-carbohydrate, high-fat diet that has been used as an effective nonpharmacological treatment in many neurological and metabolic disorders for a long time. The effectiveness of the KD is revealed in mitochondrial disorders, mainly in pyruvate dehydrogenase deficiency.</p><p><strong>Case report: </strong>A 4-year-old girl who was diagnosed with an F-box and leucine-rich repeat protein 4 (FBXL4) gene mutation was hospitalized with sepsis. She was first given standard parenteral nutrition (PN) because of gastrointestinal problems. During the disease course, lactic acidosis became prominent and did not respond to pharmacological treatment; standard PN was gradually switched to parenteral KD, and lactate levels decreased after parenteral KD. The patient was discharged with an enteral KD.</p><p><strong>Conclusion: </strong>This is the first case of mitochondrial depletion syndrome effectively treated with parenteral KD for lactic acidosis.</p>","PeriodicalId":520701,"journal":{"name":"JPEN. Journal of parenteral and enteral nutrition","volume":" ","pages":"1788-1792"},"PeriodicalIF":3.4,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/jpen.2121","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38895578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Factors of Ambulatory Central Line-Associated Bloodstream Infection in Pediatric Short Bowel Syndrome.","authors":"Talal B Seddik,&nbsp;Lu Tian,&nbsp;Colleen Nespor,&nbsp;John Kerner,&nbsp;Yvonne Maldonado,&nbsp;Hayley Gans","doi":"10.1002/jpen.1667","DOIUrl":"https://doi.org/10.1002/jpen.1667","url":null,"abstract":"<p><strong>Background: </strong>Children with short bowel syndrome (SBS) receiving home parenteral nutrition (HPN) are predisposed to ambulatory central line-associated bloodstream infection (A-CLABSI). Data describing risk factors of this infection in children are limited.</p><p><strong>Methods: </strong>Retrospective cohort, single-center, case-crossover study of children ≤18 years old with SBS receiving HPN from January 2012 to December 2016. Univariate and multivariate mixed effect Poisson regression identified the relative risk (RR) of A-CLABSI with proposed risk factors.</p><p><strong>Results: </strong>Thirty-five children were identified; median follow-up was 30 months. A-CLABSI rate was 4.2 per 1000 central line (CL) days. Univariate analysis identified younger age (RR: 0.92 per 12-month increase [95% confidence interval {CI}: 0.85-0.99; P = 0.036]), shorter small intestine length (RR: 0.96 per 10-cm increase [95% CI: 0.92-0.99; P = 0.008]), lower citrulline level (RR: 0.86 per 5-nmol/mL increase [95% CI: 0.75-0.99; P = 0.036]), and recent CL break (RR: 1.55 [95% CI: 1.06-2.28; P = 0.024]) as risk factors for A-CLABSI. Multivariate analysis showed increased A-CLABSI with clinical diagnosis of small intestine bacterial overgrowth (SIBO) (RR: 1.87 [95% CI: 1.1-3.17; P = 0.021]) and CL breaks (RR: 1.49 [95% CI: 1-2.22; P = 0.024]).</p><p><strong>Conclusions: </strong>Factors influencing gut integrity increase A-CLABSI rate, supporting translocation as an important mechanism and target for prevention. Clinical diagnosis of SIBO increases A-CLABSI rate, but whether dysbiosis or diarrhea is responsible is an area for future research. CL maintenance is crucial, and prevention of breaks would likely decrease A-CLABSI rate.</p>","PeriodicalId":520701,"journal":{"name":"JPEN. Journal of parenteral and enteral nutrition","volume":" ","pages":"500-506"},"PeriodicalIF":3.4,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/jpen.1667","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40451044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}