Parenteral Nutrition in Infancy and Childhood PDF
Preview Parenteral Nutrition in Infancy and Childhood
PARENTERAL NUTRITION IN INFA NCY AND CHILDHOOD ADV ANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY Editorial Board: Nathan Back State University 0/ New York at Bu//alo N. R. Di Luzio Tulane University School 0/ Medicine Bernard Halpern College de France and Institute o/Immuno·Biology Ephraim Katchalski The Weizmann Institute 0/ Science David Kritehevsky Wistar Institute Abel Lajtha New York State Research Institute /or Neltrochemistry and Drug Addiction Rodolfo Paoletti University 0/ Milan Recent V olumes in this Series Volume 38 HUMAN HYPERLIPOPROTEINEMIAS: Prineiples and Methods Edited by R. Fumagalli, G. Rieci, and S. Gorini • 1973 Volume 39 CURRENT TOPICS IN CORONARY RESEARCH Edited by Colin M. Bloor and Ray A. Olsson • 1973 Volume 40 METAL IONS IN BIOLOGICAL SYSTEMS: Studies of Some Biochemical and Environmental Problems Edited by Sanat K. Dahr • 1973 Volume 41A PURINE MET ABOLlSM IN MAN: Enzymes and Metabolie. Pathways Edited by O. Sperling, A. De Vries, and J. B. Wyngaarden • 1974 Volume 41B PURINE METABOLlSM IN MAN: Biochemistry and Pharmacology of Uric Acid Metabolism Edited by O. Sperlin!!, A. De Vries, and J. B. Wyngaarden • 1974 Volume 42 IMMOBILIZED BIOCHEMICALS AND AFFINITY CHROMATOGRAPHY Edited by R. B. Dunlap • 1974 Volume 43 ARTERIAL MESENCHYME AND ARTERIOSCLEROSIS Edited by William D. Wagner and Thomas B. Clarkson • 1974 Volume 44 CONTROL OF GENE EXPRESSION Edited by Alexander Kohn and Adam Shatkay • 1974 Volume 45 THE IMMUNOGLOBULIN A SYSTEM Edited by Jiri Mestecky and Alexander R. Lawton • 1974 Volume 46 PARENTERAL NUTRITION IN INFANCY AND CHILDHOOD Edited by Hans Henning Bode and Joseph B. Warshaw. 1974 Volume 47 CONTROLLED RELEASE OF BIOLOGICALLY ACTIVE AGENTS Edited by A. C. Tanquary and R. E. Lacey. 1974 ARENTERAL NUTRITION р IN INFANCY AND CHILDHOOD Edited Ьу Hans Henning Bode Department оС Pediatrics, Harvard Medical School, Massachusetts General Hospital, Shriners Burns InstitHte Boston, Massachusetts and Ј oseph В. W arsha w Departments оС Pediatrics, Obstetrics, and Gynecolo!ty Уаlе University School оС Medicine New Haven, ConnecticHt Springer Science+Business Media, LLC Library of Congress Cataloging in Publication Data Main entry under title: Parenteral nutrition in infancy and childhood. (Advances in experimental medic in" and biology, v. 46) Based in part on the papers of the International Symposium on Parenteral Nu. trition in Infancy and Childhood, held in Boston in 1972. Includes hibliographies. 1. Parenteral therapy-Congresses. 2. Pediatrics-Congresses. 1. Bode, Hans Henning, ed. II. Warshaw, Joseph B., 1936- ed. III. Series. [DNLM: 1. Paren teral feeding-In infancy and childhood-Congresses. WIAD559 v. 46 1972 I WB4I0 I64p 19i2] RJ53.F5P37 1972 615'.63 74·6060 ISBN 978-1-4684-3251-0 ISBN 978-1-4684-3249-7 (eBook) DOI 10.1007/978-1-4684-3249-7 Based in part on papers of the International Symposium on Parenteral Nutrition in Infancy and Childhood held at Boston, Massachusetts, August 29-31, 1972 © 1974 Springer Science+Business Media New York Originally published by Plenum Press, New York 1974 Softcover reprint ofthe hardcover Ist edition 1974 A Division of Plenum Puhlishing Corporation 227 West 17tlt Street, New York, N.Y. 10011 United Kingdom edition puhlished hy Plenum Press, London A Division of Plenum Puhlishing Company, Ltd. 4a Lower John Street, London WIR 3PD, England AU righte reserved No part of this hook may be reproduced, stored in a retrieval system, or transmitted, in any lorm or hy any means, electronic, mechanicai, photocopying, microfiiming, recording, or otlterwise, without written permission from tlte Publisher PREFACE "A tranquil mind puts flesh on a man" English proverb After aperiod of relative neglect, nutrition as a medical science is now an area of great clinical and investigative activ ity. This renewed interest in clinical nutrition derives in large part from observations suggesting that early nutritional depriva tion not only interferes with the maintenance of health, growth and resistance to disease but if present during critical periods of central nervous system development may also cause permanent impairment of intellectual capacity. Studies on brain development during malnutrition have contin ued to demonstrate the vulnerability of the developing brain to nutritional insult. Winick (1968) has emphasized that nutritional deficiency occurring while cells of the central nervous system are actively dividing results in a permanent decrease in central ner vous system cell number. Later nutritional deficiency which re sults in decrease in cell size appears to be recoverable. Perhaps even more important than effects of malnutrition on brain cell number is the effect on brain protein synthesis and myelination. As different regions of the prain grow at different rates and human cerebellar and cerebral cell number increase for the first few months of life, newborn nutritional deficiency may compromise brain development. Dobbing (1973) has focused attention on the vulnerability of the brain to nutritional insult during the brain growth spurt which occurs around the time of birth. In the human, this period extends throughout the third trimester of pregnancy and into the second postnatal year. The full implication of nutritional deprivation on the devel opment of intelligence is not entirely clear. However, the data v vi PREFACE avai1ab1e do suggest a permanent decrease in inte11ectua1 function in infancy (Cravioto, J. and DeLicardie, 1971; Cabak, V. and Majanvik, 1965; Winick, M. and Rosso, P., 1969). Thus, great de mands are p1aced on the pediatricians and obstetricians who super vise the hea1th of pregnant mothers and infants to e1iminate sub normal substrate provision to the human fetus and the newborn dur ing this critica1 period when the infant is at its greatest risk. Wor1dwide, the most frequent cause of infant malnutrition is, unfortunate1y, still the 1imited avai1abi1ity of foodstuffs to both pregnant mothers and newborn infants. However, even in the more aff1uent societies malnutrition is frequent1y a consequence of utero-p1acenta1 insufficiency, prematurity or neonata1 starva tion due to surgica1 procedure, congenita1 anoma1ies or other forms of distress which prevent adequate oral feeding. Provision of ca10ries by means other than oral feeding are important not on1y during critica1 periods of ear1y brain deve10pment but may also be necessary in the older infant or chi1d with chronic dis ease associated with severe nutritiona1 impairment or in chi1dren requiring good nutrition for optimal recovery from an acute ai1- ment. Dudrick's work with intravenous feeding has paved the way for an aggressive nutritiona1 approach to infants ma1nourished or at risk of becoming ma1nourished. Dudrick showed that beagle puppies receiving a hypertonic mixture of glucose, pro tein hydro- 1ysate, minerals and vitamins by a centra1 vein cou1d maintain normal growth and deve10pment over pro1onged periods of time. This technique of intravenous feeding was adapted to human use and a110wed apremature newborn with intestinal atresia to sustain normal growth and deve10pment for aperiod of 44 days. Since this original case, total intravenous nutrition has been successfu11y administered to hundreds of infants, and the technique now occu pies a prominent p1ace in the therapy of the nutritiona11y endan gered chi1d. The technica1 details, the range of indications, and the modes of intravenous feeding are being refined, especia11y in the case of infants and chi1dren. New deve10pments and recent experience have accumu1ated at a rapid pace. For this reason, we arranged a Symposium on Parenteral Nutrition in Chi1dren in the Fall of 1972. This volume is an outgrowth of that conference. The editors are gratefu1 to J. Pfrimmer Company, Norwich Pharmaca1 Company and Vitrum Company for their support which made the con ference and this volume possib1e. Some of the studies reported on at the conference were con troversia1, and even though the editors and many of the partici pants did not agree with some of the views expressed, we fe1t that the data presented had created sufficient stimulation to justify pub1ication. For examp1e, the very aggressive approach for treat ment of the fetus subjected to utero-p1acenta1 insufficiency out- 1ined by Dr. Heller opens a comp1ete1y unexp10red area of treat- PREFACE vii ment and preventive medicine. Much more research in this area is needed and should probably be performed in primates. The varying incidences of catheter sepsis in different centers clearly empha sizes the importance of aseptic techniques and supervision and improvement of these techniques should probably take precedence over the prophylactic administration of amphotericin B as sugges ted by Dr. Brennen. In this volume we have attempted to provide information con cerned with biochemical and metabolie adaptations during develop ment. We have organized this book so that the more basic chapters dealing with nutritional and metabolie development are presented early so as to provide a foundation for later chapters dealing with technique and application. It is our belief that only through an appreciation and understanding of biochemical and metabolie development can we rationally approach nutritional therapy of infants and children. Hans H. Bode Joseph B. Warshaw REFERENCES Cabak, V. and Majanvik, R. ~. Dis. Childh., 40:532, 1965. Carvioto, J. and DeLicardie, E. R. Nutr. Reviews, 29:107, 1971. Dobbing, J. Lipids, Malnutrition and the Developing Brain. Ciba Foundation Symposium. Associated Scientific Publishers. p. 1, Amsterdam, 1973. Winick, M. Pediat. Res., l:352, 1968. Winick, M. and Rosso, P. Pediat. Res., l:18l, 1969. CONTENTS page The his tory of parenteral alimentation by H. H. Bode 1 The regulation of energy intake by developing and adult animals by R. A. McCance 4 Factors influencing amino acid utilization by H. N. Munro 11 Amino Acid Requirements in childhood by D. M. Hegsted 27 Intravenous carbohydrate tolerance in infancy by G. W. Chance 38 Substrate supply and utilization in.various conditions by J. F. Biebuyck 54 The utilization of xylitol, fructose and sorbitol by H. Förster 71 Fatty acid oxidation during development by J. B. Warshaw 88 Utilization and tolerance of intravenous fat emulsions by R. P. Geyer 98 Alcohol metabolism during development by E. Mezey 112 Fluid and electrolyte requirements and tolerance by J. D. Crawford 119 Trace elements and vitamins by H. L. Greene, M. Hambidge and Y. F. Herrnan 131 ix x CONTENTS Page The rapid rehabilitation of severely undernourished children by E. M. Widdowson 146 Technique of total parenteral nutrition in infants by S. J. Dudrick, B. V. MacFadyen and R. W. Wint2rs 151 Postoperative parenteral feeding of neonates: Peripheral vein infusion technique, fat administration and metabolie studies by H. C. B~rresen, R. Bjordal and o. Knutrud 165 Controlled parenteral nutrition of premature infants by P. Jurgens, D. Dolif, C. Panteliadis and C. Hofert 178 Total intravenous alimentation in low birth weight premature infants by W. C. Heird, J. M. Driscoll and R. W. Winters 199 Intrauterine amino acid feeding of the fetus by L. Heller 206 The role and effect of parenteral nutrition on the liver and its use in chronic inflammatory bowel disease in childhood by M. I. Cohen, S. J. Boley, F. Daum, I. F. Litt and S. K. Schonberg 214 Parenteral nutrition of renal disease by J. E. Fischer 225 Parenteral nutrition in critical illness by J. T. Herrin 231 PARENTERAL NUTRITION IN CHILDREN WITH BURNS 239 Experience in the Shriners Burns Institute in Cincinnati by M. P. Popp, E. J. Law and B. G. MacMillan 240 Experience in the Shriners Burns Institute in Boston by A. Antoon and H. H. Bode 247 Experience with central venous catheters by C. Burri and H. H. Pässler 250 Metabolie complications of total parenteral nutrition by W. C. Heird, R. W. Winters and S. J. Dudrick 256 Infection in association with intravenous feeding by M. F. Brennan 269 CONTENTS xi Page Contributors 279 Author Index 283 Subject Index 29l
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