Parenteral Nutrition Components and Requirements
Posted by Surgery on Sep 9, 2008
Composition of Parenteral Nutrition
PN is a source of macronutrients (amino acids, dextrose, lipid emulsions), micronutrients (multivitamins, trace minerals), fluids, and electrolytes.
Pediatric parenteral crystalline amino acid formulas provide essential and nonessential amino acids specifically balanced to meet the needs of the developing child. 
Neonatal-specific amino acid formulas (Aminosyn PF, Trophamine) are formulated to closely reproduce the plasma amino acid profile of breastfed infants. These formulas have led to greater weight gain and improved nitrogen balance in infants compared with standard amino acid formulas. Some amino acids such as cysteine, tyrosine, glycine, and taurine are considered conditionally essential to the child (Table 7-2). Taurine supplementation to premature infants is essential to promote bile acid conjugation and improve bile flow. Premature infants are at risk for taurine deficiency as a result of relatively high renal excretion and low synthetic capacity related to diminished cystathionase enzyme activity and can leap to inadequate retinal development (17). Amino acids are a source of energy (4 kcal per g) and nitrogen for protein synthesis. Parenteral amino acids should approximately provide 10% to 15% of total calories. Amino acids are generally started at 1 g per kg per day and advanced to goal over 2 to 3 days. To simulate intrauterine protein accretion rate, low birth weight infants may need up to 3.85 g per kg per day of amino acids (6,18). Amino acid requirements are 2.5 to 3 g per kg per day in term infants, 1.5 to 2 g per kg per day in older children, and 1 to 1.5 g per kg per day in adolescents. Amino acid doses should be adjusted based on the patient’s clinical condition and nutritional status. For example, higher amino acid doses may be required to heal a complex wound. Patients with liver failure require lower amino doses to avoid hyperammonemia. Higher amino acid doses are required in patients on renal dialysis or continuous renal replacement therapies to compensate for losses via the dialysis membrane and filter (19,20).
Neonatal-specific amino acid formulas (Aminosyn PF, Trophamine) are formulated to closely reproduce the plasma amino acid profile of breastfed infants. These formulas have led to greater weight gain and improved nitrogen balance in infants compared with standard amino acid formulas. Some amino acids such as cysteine, tyrosine, glycine, and taurine are considered conditionally essential to the child (Table 7-2). Taurine supplementation to premature infants is essential to promote bile acid conjugation and improve bile flow. Premature infants are at risk for taurine deficiency as a result of relatively high renal excretion and low synthetic capacity related to diminished cystathionase enzyme activity and can leap to inadequate retinal development (17). Amino acids are a source of energy (4 kcal per g) and nitrogen for protein synthesis. Parenteral amino acids should approximately provide 10% to 15% of total calories. Amino acids are generally started at 1 g per kg per day and advanced to goal over 2 to 3 days. To simulate intrauterine protein accretion rate, low birth weight infants may need up to 3.85 g per kg per day of amino acids (6,18). Amino acid requirements are 2.5 to 3 g per kg per day in term infants, 1.5 to 2 g per kg per day in older children, and 1 to 1.5 g per kg per day in adolescents. Amino acid doses should be adjusted based on the patient’s clinical condition and nutritional status. For example, higher amino acid doses may be required to heal a complex wound. Patients with liver failure require lower amino doses to avoid hyperammonemia. Higher amino acid doses are required in patients on renal dialysis or continuous renal replacement therapies to compensate for losses via the dialysis membrane and filter (19,20).Complications of Enteral Feeding
Posted by Surgery on Sep 9, 2008
The gastrointestinal tract generally tolerates feedings quite well once any postoperative ileus is resolved. Not uncommonly, however, a critically ill child will sustain a loss of a significant portion of the absorptive function, often due to acquired lactase deficiency. Symptoms are generally manifested by cramping, diarrhea, or emesis.:Pravachol Symptoms will often improve with the initiation of a lactose-free diet. Other alterations in the administration of the diet can also improve feeding tolerance. 
First, the gastrointestinal tract generally tolerates increased volume more readily than increased osmolarity. Therefore, adverse symptoms can be avoided by initiating 1/8 or 1/4 strength formula and slowly advancing the formula concentration. Second, administration of formula by continuous drip may be better tolerated than bolus feedings. The risk of gastroesophageal reflux and dumping symptoms are thereby greatly reduced. Third, care must be taken to ensure the enteral formula does not become contaminated, either during preparation or at the bedside. Expiration dates should be carefully observed. Finally, pectin, Metamucil, lomotil, paregoric, or Imodium may be required for those who have lost a significant amount of their bowel length (see the Short Bowel Syndrome section:Pravachol). Assessment of absorptive capacity can be done most readily by testing stool for the absorption of carbohydrates. This is done by measuring stool pH and checking for reducing substances. Stool pH less than or equal to 5.5, or a reducing substance of greater than one-half percent, indicates the passage of unabsorbed carbohydrates into the stool. Once demonstrated, these findings are best treated by decreasing the formula concentration of carbohydrate.
Tags: Metamucil, Nutrition Support in the Pediatric Surgical Patient, PARENTERAL NUTRITION, Pravachol, TraumaFirst, the gastrointestinal tract generally tolerates increased volume more readily than increased osmolarity. Therefore, adverse symptoms can be avoided by initiating 1/8 or 1/4 strength formula and slowly advancing the formula concentration. Second, administration of formula by continuous drip may be better tolerated than bolus feedings. The risk of gastroesophageal reflux and dumping symptoms are thereby greatly reduced. Third, care must be taken to ensure the enteral formula does not become contaminated, either during preparation or at the bedside. Expiration dates should be carefully observed. Finally, pectin, Metamucil, lomotil, paregoric, or Imodium may be required for those who have lost a significant amount of their bowel length (see the Short Bowel Syndrome section:Pravachol). Assessment of absorptive capacity can be done most readily by testing stool for the absorption of carbohydrates. This is done by measuring stool pH and checking for reducing substances. Stool pH less than or equal to 5.5, or a reducing substance of greater than one-half percent, indicates the passage of unabsorbed carbohydrates into the stool. Once demonstrated, these findings are best treated by decreasing the formula concentration of carbohydrate.Scope of the Problem men’s National Medical Center : Calan
Posted by Surgery on Jul 8, 2008
More children die from injuries each year than from all other diseases combined .Trauma disrupts more young lives and exacts a higher socioeconomic price than any other pediatric health-related issue in the industrialized world (Calan). More lives would be saved each year and more long-term disability prevented by the development of a successful treatment for traumatic brain injury (TBI: Calan) than from curing all childhood cancer. Despite this, trauma care receives only a small fraction of the public attention and research funding directed toward less important conditions. Each year more than 10,000 children and adolescents die of their injuries, and nearly 30,000 suffer permanent disability, most of which is neurologic (1: Calan ). Annually, one in four children receives medical care for an injury. The societal cost, in terms of both direct medical expenses for care and rehabilitation, lost productivity by care providers, and lost opportunities for socioeconomic contribution, is staggering.
Tags: Calan, NEWS SURGERY, SURGERY, Trauma, Trauma
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