Reduced risk of pulmonary emboli in children treated with long-term parenteral nutrition. Issue 6 (December 2016)

• Record Type: Journal Article
• Authors: Pichler, Judith; Biassoni, Lorenzo; Easty, Marina; Irastorza, Inaki; Hill, Susan
• Is Part Of: Clinical nutrition. Volume 35:Issue 6(2016:Dec.)
• Page Start: 1406
• Page End: 1413
• Publication Date: 2016-12
• Subjects: Pulmonary emboli -- Children -- Long-term parenteral nutrition -- Ventilation-perfusion scintigraphy -- Intravenous lipid emulsions; CRBSI catheter related bloodstream infections -- CVC central venous catheter -- IF intestinal failure -- ILE intravenous lipid emulsion -- INR international normalized ratio -- PE pulmonary thromboembolism/pulmonary embolus -- PN parenteral nutrition -- SPECT single-photon emission computed tomography -- V/Q scan ventilation-perfusion scan; Critically ill -- Nutrition -- Periodicals; Diet therapy -- Periodicals; Parenteral feeding -- Periodicals; Enteral feeding -- Periodicals; Enteral Nutrition -- Periodicals; Parenteral Nutrition -- Periodicals; Metabolism -- Periodicals; Diétothérapie -- Périodiques; Alimentation parentérale -- Périodiques; Alimentation entérale -- Périodiques; Nutrition -- Périodiques; Diet therapy; Enteral feeding; Nutrition; Parenteral feeding; Electronic journals; Periodicals; Electronic journals; 615.854
• DOI: 10.1016/j.clnu.2016.03.016
• Languages: English
• ISSNs: 0261-5614

Abstract

Summary: Background & aims: Pulmonary embolism (PE) is a complication of parenteral nutrition (PN) with a prevalence of 35% in children. In 2003 new intravenous lipid emulsions (ILEs) with MCT, olive and/or fish oil in addition to soybean oil were introduced. The aim was to compare the incidence of PE before and after introduction. Methods: 327 surveillance ventilation-perfusion (V/Q) scintigraphies from 68 children aged 0.3–15 years, treated with PN from 1993 to 2010, were retrospectively reviewed. Rate of PE/1000 central venous catheter (CVC) days, number of children with PE pre- and post-introduction of ILEs were compared. Multivariate analyses were performed for risk factors. Results: Twenty-two (32%) children (19/42 before 2003 and 3/26 after 2003, p = 0.007) had at least one episode of PE. Thirty seven (11%) episodes of PE were detected accounting for a mean of 0.2/1000 CVC days prior to 2003 and 0.05/1000 CVC days after 2003, p = 0.04. Regression analysis indicated that higher content of ILE/infusion ( p = 0.045) and frequency of ILE of >3 nights/week were associated with more PE ( p = 0.001). New ILEs were associated with lower risk ( p = 0.003). Conclusion: With a four-fold fall in incidence with new ILE, PE remains a complication. We recommend 12–18 monthly surveillance with lung perfusion scan and anticoagulants if PE is diagnosed.