ROLE OF PARENTERAL NUTRITION IN THE COMPLEX OF PERIOPERATIVE INTENSIVE THERAPY IN CHILDREN
About the author:
Davydova A. G.
Type of article:
The difference between the child and the adult organisms is that children are more susceptible to lack of nutritional support due to the higher metabolic rate, which makes it more relevant to ensure adequate parenteral nutrition (PN) after major surgery, especially in infants. However, incorrect calculation of PN may lead to complications both in the case of its long term and in short term usage. Purpose of the work: determine the timing of appointment, effectiveness and safety of parenteral nutrition in the early postoperative period after major surgery in children. Object and methods. The study included 100 children aged 1.5 months to 17 years who had undergone major surgery on the abdominal organs. The study group consisted of patients who received parenteral nutrition in the early postoperative period (66 children), the control group – 34 children who did not receive PN. We have developed a program for calculating the PN in Microsoft Excel, which was used in drawing up an individual scheme of the PN. PN began in term from 2 to 48 hours after operative intervention, in average in 12 hours. We studied the dynamic of plasma protein and its fractures, levels of urea and creatinine, the level of glycemia and the presence of glucosuria before and during parenteral nutrition, and the terms of the persistent bowel peristalsis onset. All children underwent infusion, antibacterial therapy and adequate pain relief. Statistic methods included Mann-Whitney test using StatSoft 6.1 program. Results. In the study group, a significant (p <0.05) increase in the level of plasma protein was observed on the 4th – 6th days of PN, in contrast to the control group. A significant decrease in serum creatinine level by 26.0±7.3 μmol/l (p <0.05) from the baseline was observed in the study group. When analyzing the level of protein fractions in children undergoing major surgery on abdominal organs, it was found that the albumin fraction was within normal limits. These data may indicate that the correction of protein levels with albumin solutions in this group of children is not appropriate. As for other indicators of the proteogram, the phenomenon of dysproteinemia was observed in all examined children. In PN without the use of insulin, hyperglycemia higher than 8 mmol/L was not observed (4,25±1,8 mmol/l in average) when glucose uptake rate was not more than 0.5 g/kg/h, without dependence on its concentration insolution (from 10 to 20%). At the same time with the addition of insulin in children under 1 year of age, hyperglycemia was recorded, which was eliminated after its cancellation. No cases of glucosuria have been reported. But if there is no opportunity to observe the rate of PN uptake strictly by linear or exodrop, we recommend adding insulin at a rate of 1 U / 5 g of glucose only in older children and only when using 2-component parenteral nutrition when all non-protein calories are overlaped by glucose alone. The study group also noted earlier appearance of bowel movements compared to the control group. Conclusions. PN in the early postoperative period positively affects the metabolic and plastic processes in the organism and contributes to the earlier appearance of intestinal peristalsis. The use of insulin in PN in children is not indicated if the rate of glucose solutions administration is kept up. Correction of protein levels by other methods in the early postoperative period is impractical. The use of PТ after major surgical interventions is safe if the correct rate of infusion, as well as the correct selection of PN and its components is provided. In children in the early postoperative period, when enteral administration of nutrients is impossible, rapid achievement of the initial level of proteinemia seems to be impossible.
parenteral nutrition, child, general surgery.
- Puntis JWL, Hoisak I, Ksiazyk J. ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Organisational aspects. Clin nutr. 2018;37(6):2392-400.
- Mesotten D, Joosten K, van Kempen A, Verbruggen S. ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Carbohydrates. Clin nutr. 2018;37(6):2337-43.
- Jimenez L, Mehta NM, Duggan C. Timing of the initiation of parenteral nutrition in critically ill children. Curr Opin Clin Nutr Metab Care. 2017;20(3):227-31.
- Yerpuleva YuV, Chugunova OL, Vainshtein NP. Sovremennye tehnologii parenteralnogo pitaniya u novorozhdennyh i detej rannego vozrasta. Rossiyskiy vestnik detskoy hirurgii, anesteziologii i reanimatologii. 2016;4(3):87-94. [in Russian].
- Joosten K, Embleton N, Yan W, Senterre T. ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Energy. Clin nutr. 2018;37(6):2309-14.
- Van Goudoever JB, Carniellib V, Darmaunc D, Sainz de Pipaon M. ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Amino acids. Clin nutr. 2018;37(6):2315-23.
- Lapilonne A, Fidler Mis N, Goulet O, van den Akker CHP, Wu J, Koletzko B. ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Lipids. Clin nutr. 2018;37(6):2324-36.
- Bolisetty S, Osborn D, Sinn J, Lui K. Standardised neonatal parenteral nutrition formulations – an Australasian group consensus 2012. BMC Pediatrics. 2014;14. Available from: https://bmcpediatr.biomedcentral.com/articles/ 10.1186/1471-2431-14-48
- Tepaev RF, Kiryanova AN, Belousova AS, Ilyicheva EN, Lazareva AV, Kryzhanovskaya OA. Oslozhneniya parenteralnogo pitaniya v pediatrii. Pediatricheskaya farmakologiya. 2016;10(3):26-31. [in Russian].
- Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Intensive Care Med. 2017;43(3):302-77. DOI: 10.1007 / s00134-017-4683-6
- Sorokina OYu, Dubrov SO. 2016 god – novyiy shag v diagnostike i metodov terapii sepsisa i septicheskogo shoka. Bil, zneboliuvannia ta intensivna terapiia. 2017;4:8-15. [in Russian].
- Bronsky J, Campoy C, Braegger C. ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Vitamins. Clin nutr. 2018;37(6):2366-78.
- Mihatsch W, Fewtrell M, Goulet O, Molgaard C, Picaud JC, Senterre T. ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Calcium, phosphorus and magnesium. Clin nutr. 2018;37(6):2360-5.
- Chernii VI. Aktualniie aspekti infuzionnoi terapii. Meditsina nevidkladnykh staniv. 2015;3:43-53. [in Russian].
- Navarro LHC. Perioperative fluid therapy: a statement from the international Fluid Optimization Group. Perioper Med (Lond). 2015;4(3). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4403901
Publication of the article:
«Bulletin of problems biology and medicine» Issue 1 (155), 2020 year, 333-337 pages, index UDK 616-083.2-032:611.14]-053.2:616-089-039.72