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Nutrients
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Macronutrients and Micronutrients in Parenteral Nutrition
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Macronutrients and Micronutrients in Parenteral Nutrition

A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Clinical Nutrition".

Deadline for manuscript submissions: closed (20 January 2022) | Viewed by 22800

Special Issue Editor

Dr. Giovanna Verlato

E-Mail Website
Guest Editor
Pediatric Nutrition Service – Neonatal Intensive Care Unit, Department of Women’s and Children’s Health, University Hospital, Padova, Italy
Interests: nutrition in pediatrics; parenteral nutrition; preterm infants; growth; bone status; necrotizing enterocolitis; short bowel syndrome
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

It is well known that parenteral nutrition (PN), the intravenous infusion of nutrients in the elementary form, is a lifesaving treatment for newborns, children, and adults that do not receive all the required macro- and micronutrients by the enteral route.

The modern era of PN began in the 20th century, with Elman and Dudrick working respectively on protein hydrolysates and lipid emulsion to be infused intravenously. Since then, numerous advancements in PN were developed and are still in progress with the study of different types of lipids and their immunomodulatory influences, amino acid formulations in children and adults, and proper amounts of carbohydrates and micronutrients and their influence on metabolism.

Although PN has become a safe and efficient technique, the incidence of complications related to PN, such as intestinal failure-associated liver disease, remains high, and the assessment of proper intakes using markers has to be continuously performed, especially in rapidly growing newborns and children.

The nutritional research directions for achieving the best PN in newborns, children, and adults include:

  • study of the optimal intake of PN macronutrients and the best trajectory of growth in children
  • possible effects of macro- and micronutrients in PN on newborn and child development
  • quality and quantity of macronutrients and new potential components of PN
  • strategies to prevent and early detect macro- and micronutrient deficiencies in long-term PN
  • prevention of PN complications and, particularly, PN-associated liver disease

Dr. Giovanna Verlato
Guest Editor

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Keywords

  • parenteral nutrition
  • macronutrients
  • lipids
  • aminoacids
  • micronutrients
  • metabolism
  • parenteral nutrition associated liver disease

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Published Papers (5 papers)

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Research

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12 pages, 3264 KiB  
Article
Neonatal Hyperglycemia Related to Parenteral Nutrition Affects Long-Term Neurodevelopment in Preterm Newborn: A Prospective Cohort Study
by Giovanni Boscarino, Maria Giulia Conti, Corinna Gasparini, Elisa Onestà, Francesca Faccioli, Lucia Dito, Daniela Regoli, Alberto Spalice, Pasquale Parisi and Gianluca Terrin
Nutrients 2021, 13(6), 1930; https://doi.org/10.3390/nu13061930 - 4 Jun 2021
Cited by 24 | Viewed by 4286
Abstract
(1) Background: Recent evidence reported a reduced tolerance of macronutrient parenteral intakes in subjects in critically ill conditions. We designed a prospective cohort study to evaluate the effects of hyperglycemia (HG) related to parenteral nutrition (PN) on neurodevelopment (NDV) in survived preterm newborns. [...] Read more.
(1) Background: Recent evidence reported a reduced tolerance of macronutrient parenteral intakes in subjects in critically ill conditions. We designed a prospective cohort study to evaluate the effects of hyperglycemia (HG) related to parenteral nutrition (PN) on neurodevelopment (NDV) in survived preterm newborns. (2) Methods: Enrolled newborns with gestational age < 32 weeks or birth weight < 1500 g, were divided in two cohorts: (A) exposed to moderate or severe HG (glucose blood level > 180 mg/dL) in the first week of life; (B) not exposed to HG. We considered as the primary outcome the rate of preterm newborns survived without NDV delay at 24 months of life, evaluated with Bayley Scales of Infants Development III edition. (3) Results: We analyzed 108 (A 32 vs. B 76) at 24 months of life. Newborns in cohort A showed a higher rate of cognitive and motor delay (A 44% vs. B 22 %, p = 0.024; A 38% vs. B 8%, p < 0.001). When adjusting for background characteristics, HG remained a risk factor for motor delay. (4) Conclusions: High nutritional intakes through PN soon after birth increase the risk of HG. The consequences of this severe metabolic complication affect long-term NDV and survival in preterm newborns. Full article
(This article belongs to the Special Issue Macronutrients and Micronutrients in Parenteral Nutrition)
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10 pages, 663 KiB  
Article
Intravenous Lipid Emulsions Affect Respiratory Outcome in Preterm Newborn: A Case-Control Study
by Giovanni Boscarino, Maria Giulia Conti, Francesca De Luca, Maria Di Chiara, Giorgia Deli, Marco Bianchi, Paola Favata, Viviana Cardilli, Giovanni Di Nardo, Pasquale Parisi and Gianluca Terrin
Nutrients 2021, 13(4), 1243; https://doi.org/10.3390/nu13041243 - 9 Apr 2021
Cited by 14 | Viewed by 2941
Abstract
(1) Background: Hypertriglyceridemia (HiTG) is a metabolic complication of intravenous lipid emulsions (ILEs) infusion. We aimed to evaluate the influence of HiTG on the respiratory outcome of preterm babies; (2) Methods: We enrolled, in a case–control study, newborns with gestational age <32 weeks [...] Read more.
(1) Background: Hypertriglyceridemia (HiTG) is a metabolic complication of intravenous lipid emulsions (ILEs) infusion. We aimed to evaluate the influence of HiTG on the respiratory outcome of preterm babies; (2) Methods: We enrolled, in a case–control study, newborns with gestational age <32 weeks or birth weight <1500 g, over a 3-year period. They were divided into cases and controls; cases were defined by the detection of HiTG defined as serum triglycerides (TG) value >150 mg/dL; (3) Results: We enrolled 40 cases and 105 controls. Cases had an increased incidence of bronchopulmonary dysplasia (30.0% vs. 14.3%, p < 0.05) and longer duration of invasive mechanical ventilation (7 days, 95% CI 4–10 days vs. 4 days, 95% CI 1–7 days, p < 0.01) compared to controls. Multivariate analysis confirmed that HiTG independently influenced the duration of invasive mechanical ventilation, also in the subgroups with gestational age ≤28 + 6/7 weeks or birth weight ≤1000 g; (4) Conclusion: Newborns with HiTG related to ILEs had a longer duration of invasive mechanical ventilation. Temporary suspension or reduction in ILEs in the case of HiTG is associated with an improvement of respiratory outcome. Full article
(This article belongs to the Special Issue Macronutrients and Micronutrients in Parenteral Nutrition)
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Review

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15 pages, 311 KiB  
Review
Macronutrients and Micronutrients in Parenteral Nutrition for Preterm Newborns: A Narrative Review
by Valentina Rizzo, Manuela Capozza, Raffaella Panza, Nicola Laforgia and Maria Elisabetta Baldassarre
Nutrients 2022, 14(7), 1530; https://doi.org/10.3390/nu14071530 - 6 Apr 2022
Cited by 12 | Viewed by 5811
Abstract
Preterm neonates display a high risk of postnatal malnutrition, especially at very low gestational ages, because nutritional stores are less in younger preterm infants. For this reason nutrition and growth in early life play a pivotal role in the establishment of the long-term [...] Read more.
Preterm neonates display a high risk of postnatal malnutrition, especially at very low gestational ages, because nutritional stores are less in younger preterm infants. For this reason nutrition and growth in early life play a pivotal role in the establishment of the long-term health of premature infants. Nutritional care for preterm neonates remains a challenge in clinical practice. According to the recent and latest recommendations from ESPGHAN, at birth, water intake of 70–80 mL/kg/day is suggested, progressively increasing to 150 mL/kg/day by the end of the first week of life, along with a calorie intake of 120 kcal/kg/day and a minimum protein intake of 2.5–3 g/kg/day. Regarding glucose intake, an infusion rate of 3–5 mg/kg/min is recommended, but VLBW and ELBW preterm neonates may require up to 12 mg/kg/min. In preterm infants, lipid emulsions can be started immediately after birth at a dosage of 0.5–1 g/kg/day. However, some authors have recently shown that it is not always possible to achieve optimal and recommended nutrition, due to the complexity of the daily management of premature infants, especially if extremely preterm. It would be desirable if multicenter randomized controlled trials were designed to explore the effect of early nutrition and growth on long-term health. Full article
(This article belongs to the Special Issue Macronutrients and Micronutrients in Parenteral Nutrition)
17 pages, 795 KiB  
Review
Providing the Best Parenteral Nutrition before and after Surgery for NEC: Macro and Micronutrients Intakes
by Silvia Guiducci, Miriam Duci, Laura Moschino, Marta Meneghelli, Francesco Fascetti Leon, Luca Bonadies, Maria Elena Cavicchiolo and Giovanna Verlato
Nutrients 2022, 14(5), 919; https://doi.org/10.3390/nu14050919 - 22 Feb 2022
Cited by 4 | Viewed by 4599
Abstract
Necrotizing enterocolitis (NEC) is the main gastrointestinal emergency of preterm infants for whom bowel rest and parenteral nutrition (PN) is essential. Despite the improvements in neonatal care, the incidence of NEC remains high (11% in preterm newborns with a birth weight <1500 g) [...] Read more.
Necrotizing enterocolitis (NEC) is the main gastrointestinal emergency of preterm infants for whom bowel rest and parenteral nutrition (PN) is essential. Despite the improvements in neonatal care, the incidence of NEC remains high (11% in preterm newborns with a birth weight <1500 g) and up to 20–50% of cases still require surgery. In this narrative review, we report how to optimize PN in severe NEC requiring surgery. PN should begin as soon as possible in the acute phase: close fluid monitoring is advocated to maintain volemia, however fluid overload and electrolytes abnormalities should be prevented. Macronutrients intake (protein, glucose, and lipids) should be adequately guaranteed and is essential in each phase of the disease. Composite lipid emulsion should be the first choice to reduce the risk of parenteral nutrition associated liver disease (PNALD). Vitamin and trace elements deficiency or overload are frequent in long-term PN, therefore careful monitoring should be planned starting from the recovery phase to adjust their parenteral intake. Neonatologists must be aware of the role of nutrition especially in patients requiring long-term PN to sustain growth, limiting possible adverse effects and long-term deficiencies. Full article
(This article belongs to the Special Issue Macronutrients and Micronutrients in Parenteral Nutrition)
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Other

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27 pages, 640 KiB  
Systematic Review
Metabolic Bone Disease in Children with Intestinal Failure and Long-Term Parenteral Nutrition: A Systematic Review
by Simona Gatti, Sara Quattrini, Alessandra Palpacelli, Giulia N. Catassi, Maria Elena Lionetti and Carlo Catassi
Nutrients 2022, 14(5), 995; https://doi.org/10.3390/nu14050995 - 26 Feb 2022
Cited by 10 | Viewed by 3632
Abstract
Metabolic bone disease (MBD) is a possible complication of intestinal failure (IF), with a multi-factorial pathogenesis. The reduction of bone density (BMD) may be radiologically evident before manifestation of clinical signs (bone pain, vertebral compression, and fractures). Diagnosis relies on dual-energy X-ray absorptiometry [...] Read more.
Metabolic bone disease (MBD) is a possible complication of intestinal failure (IF), with a multi-factorial pathogenesis. The reduction of bone density (BMD) may be radiologically evident before manifestation of clinical signs (bone pain, vertebral compression, and fractures). Diagnosis relies on dual-energy X-ray absorptiometry (DXA). Incidence and evolution of MBD are not homogeneously reported in children. The aim of this systematic review was to define the prevalence of MBD in IF children and to describe risk factors for its development. A comprehensive search of electronic bibliographic databases up to December 2021 was conducted. Randomized controlled trials; observational, cross-sectional, and retrospective studies; and case series published between 1970 and 2021 were included. Twenty observational studies (six case-control) were identified and mostly reported definitions of MBD based on DXA parameters. Although the prevalence and definition of MBD was largely heterogeneous, low BMD was found in up to 45% of IF children and correlated with age, growth failure, and specific IF etiologies. Data demonstrate that long-term follow-up with repeated DXA and calcium balance assessment is warranted in IF children even when PN dependence is resolved. Etiology and outcomes of MBD will be better defined by longitudinal prospective studies focused on prognosis and therapeutic perspectives. Full article
(This article belongs to the Special Issue Macronutrients and Micronutrients in Parenteral Nutrition)
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