Dataset Information

Optimal clinical management of children receiving ketogenic parenteral nutrition: a clinical practice guide.

ABSTRACT:

Aim

To give evidence-based recommendations on the application of ketogenic diet parenteral nutrition (KD-PN) in emergency situations.

Method

An international group of experts (n=14) researched the literature and distributed a survey among 150 expert centers. International accepted guidelines (European Society for Clinical Nutrition and Metabolism/European Society for Paediatric Gastroenterology Hepatology and Nutrition and the American Society for Parenteral and Enteral Nutrition) and handbooks for parenteral nutrition were considered general standards of care.

Results

In the literature, we identified 35 reports of patients treated by KD-PN. International guidelines and handbooks provided some conflicting information. Twenty-four expert teams from nine countries responded to the survey, reflecting the limited clinical experience.

Interpretation

This paper highlights 23 consensus-based recommendations for safe and effective KD-PN (e.g. diet initiation, calculation, application, monitoring, and evaluation) based on the best evidence available and expert opinions.

What this paper adds

In acute settings, ketogenic diet therapy (KDT) can be administered parenterally. Parenteral administration of KDT should be started only at the intensive care unit. Initiate ketogenic parenteral nutrition stepwise to the highest ratio possible with the lowest level of complications. Evaluate the risk-benefit ratio of parenteral administration continuously. Restart enteral feeding as soon as appropriate.

SUBMITTER: van der Louw E

PROVIDER: S-EPMC6916385 | biostudies-literature | 2020 Jan

REPOSITORIES: biostudies-literature

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Publications

Optimal clinical management of children receiving ketogenic parenteral nutrition: a clinical practice guide.

van der Louw Elles E Aldaz Vanessa V Harvey Jessica J Roan Marian M van den Hurk Dorine D Cross J Helen JH Auvin Stéphane S

Developmental medicine and child neurology 20190716 1

<h4>Aim</h4>To give evidence-based recommendations on the application of ketogenic diet parenteral nutrition (KD-PN) in emergency situations.<h4>Method</h4>An international group of experts (n=14) researched the literature and distributed a survey among 150 expert centers. International accepted guidelines (European Society for Clinical Nutrition and Metabolism/European Society for Paediatric Gastroenterology Hepatology and Nutrition and the American Society for Parenteral and Enteral Nutrition) ...[more]

PMID: 31313290

Similar Datasets

Project description:Manganese, an essential metal for normal growth and development, is neurotoxic on excessive exposure. Standard trace element-supplemented neonatal parenteral nutrition (PN) has a high manganese content and bypasses normal gastrointestinal absorptive control mechanisms, which places infants at risk of manganese neurotoxicity. Magnetic resonance (MR) relaxometry demonstrating short T1 relaxation time (T1R) in the basal ganglia reflects excessive brain manganese accumulation.This study tested the hypothesis that infants with greater parenteral manganese exposure have higher brain manganese accumulation, as measured by MR imaging, than do infants with lower parenteral manganese exposure.Infants exposed to parenteral manganese were enrolled in a prospective cohort study. Infants classified as having high manganese exposure received >75% of their nutrition in the preceding 4 wk as PN. All others were classified as having low exposure. Daily parenteral and enteral manganese intakes were calculated. Whole-blood manganese was measured by high-resolution inductively coupled plasma mass spectrometry. Brain MR relaxometry was interpreted by a masked reviewer. Linear regression models, adjusted for gestational age (GA) at birth, estimated the association of relaxometry indexes with total and parenteral manganese exposures.Seventy-three infants were enrolled. High-quality MR images were available for 58 infants, 39 with high and 19 with low manganese exposure. Four infants with a high exposure had blood manganese concentrations >30 ?g/L. After controlling for GA, higher parenteral and total manganese intakes were associated with a lower T1R (P = 0.01) in the globus pallidus and putamen but were not associated with whole-blood manganese (range: 3.6-56.6 ?g/L). Elevated conjugated bilirubin magnified the association between parenteral manganese and decreasing T1R.A short T1R for GA identifies infants at risk of increased brain manganese deposition associated with PN solutions commonly used to nourish critically ill infants. These trials were registered at clinicaltrials.gov as NCT00392977 and NCT00392730.

Dataset Information

Optimal clinical management of children receiving ketogenic parenteral nutrition: a clinical practice guide.

Aim

Method

Results

Interpretation

What this paper adds

Publications

Optimal clinical management of children receiving ketogenic parenteral nutrition: a clinical practice guide.

Similar Datasets

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