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News from the Journal of Parenteral and Enteral Nutrition (JPEN) April 2014

To help healthcare providers stay abreast of the latest and ever-changing developments in clinical nutrition, the Journal of Parenteral and External Nutrition (JPEN) makes research available as soon as possible. The following are selections from JPEN's OnlineFirst articles, which are published online before they appear in a regular issue of the journal:

A.S.P.E.N. Clinical Guidelines: Support of Pediatric Patients With Intestinal Failure at Risk of Parenteral NutritionAssociated Liver Disease
Embargoed until 12:01 a.m. ET on Tuesday, April 1, 2014

Children in care for severe intestinal failure who receive prolonged intravenous feeding are susceptible to the development of liver disease. Through a review of existing evidence, this clinical guideline is designed to develop recommendations for the care of such pediatric patients by answering four questions:

1. Is ethanol lock effective at preventing blood-stream infection and catheter removal in children at risk?
2. What lipid strategies can be used to reduce the risk of or treat liver disease?
3. Can ursodeoxycholic acid through tube feeding improve the treatment of liver disease?
4. Are outcomes improved when patients are managed by a multidisciplinary intestinal rehabilitation team?

Causes and Consequences of Interrupted Enteral Nutrition: A Prospective Observational Study in Critically Ill Surgical Patients
Embargoed until 12:01 a.m. ET on Tuesday, April 8, 2014

Malnutrition and underfeeding are major challenges in caring for critically ill patients. This study looked at interruptions in enteral (tube) feeding and its impacts on patients in post-surgery intensive care. The study found that feeding interruption was frequent, typically unavoidable, and led to negative outcomes. One strategy to counter this problem is to maximize nutrient delivery before and after feeding interruptions.

Intensive Nutrition in Acute Lung Injury: A Clinical Trial (INTACT)
Embargoed until 12:01 a.m. ET on Thursday, April 10, 2014

Both intravenous and tube feeding have been common practices in ICUs for decades. However, there is little evidence to show how effective they are. In this trial of patients with acute lung injury, one set of patients received more than 75 percent of their nutrition needs through intravenous feeding and adequate oral diet (known as "intensive medical nutrition therapy,") while another set received standard nutrition care. The trial found that patients who received intensive therapy had a higher mortality rate than those who received standard care. In fact, the trial was stopped early due to higher mortality rates. Further analysis is needed to account for this difference.

ERASEnhanced Recovery After Surgery: Moving Evidence-Based Perioperative Care to Practice
Published online before print February 24, 2014:

Enhanced recovery after surgery (ERAS) is a term often used to describe care programs given before, during, and after surgery that have been shown to improve outcomes after major surgery. This article gives a brief history of the development from fast-track surgery to ERAS.

Vitamin D Status and Severity of Clostridium difficile Infections: A Prospective Cohort Study in Hospitalized Adults
Published online before print January 9, 2014:

Clostridium difficile is the most common cause of nosocomial diarrhea, affecting up to 10 percent of hospitalized patients. This study looked at suggested connections between vitamin D levels and the severity of Clostridium difficile infections. The study found that higher vitamin D levels reduced the severity of infections. Further studies are needed to see if vitamin D supplementation can improve patient outcomes.

Pediatric Intestinal FailureAssociated Liver Disease Is Reversed With 6 Months of Intravenous Fish Oil
Published online before print July 26, 2013:

Intravenous fish oil has been shown in studies to be effective at treating direct hyperbilirubinemia in pediatric patients. However, the duration of such treatment has not been established. This study looked at whether or not 24 weeks of fish oil treatment was effective for the treatment of intestinal failure associated liver disease (IFALD). The study found that a limited duration of fish oil is safe and effective in treating IFALD.


Contact: Troy Petenbrink
American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.)

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