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      Turkish Neonatal Society guideline on parenteral nutrition in preterm infants Translated title: Türk Neonatoloji Derneği prematüre bebeklerin parenteral beslenmesi rehberi

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          Abstract

          Postnatal growth failure due to inappropriate and insufficient nutrition is a risk for preterm infants, especially for very-low-birth-weight or extremely-low-birth-weight infants. This extrauterine growth failure causes negative effects on long-term neurodevelopment. Early initiation of intensive parenteral nutrition with appropriate protein and energy supply is a nutritional emergency when enteral feeding cannot be achieved. This approach prevents protein catabolism and helps achievement of positive protein balance and postnatal growth. Protein, lipid, and glucose initiation with appropriate doses that reach timely goals constitute the major elements of parenteral nutrition. The transition to enteral nutrition with the mother’s milk at the earliest convenience must be targeted in parenteral nutrition.

          Translated abstract

          Prematürelerin özellikle çok düşük doğum ağırlıklı ve aşırı düşük doğum ağırlıklı bebeklerin uygun ve yeterli beslenememelerine bağlı postnatal dönemde büyüme geriliği riskleri vardır. Bu ekstrauterin büyüme geriliğinin prematürede uzun dönem nörogelişimsel olumsuz etkileri gösterilmiştir. Enteral beslenmenin başarılamadığı durumlarda, erken ve yoğun parenteral beslenmenin uygun protein ve enerji sağlayarak başlanması, bu riskli prematüreler için yaşamsal bir acil durum kabul edilmektedir. Bu sayede protein katabolizması önlenmekte, pozitif protein dengesine erişmelerine ve büyümelerine olumlu katkı sağlanmaktadır. Parenteral beslenmede protein, lipid ve glukozun uygun dozda başlanarak belli hedeflere erişmesi prematüre bakımının ana elemanlarından biridir. Parenteral beslenen bebeklerin en kısa zamanda anne sütü ile enteral beslenmeye geçişleri de hedeflenmelidir.

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          Most cited references42

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          Enteral nutrient supply for preterm infants: commentary from the European Society of Paediatric Gastroenterology, Hepatology and Nutrition Committee on Nutrition.

          The number of surviving children born prematurely has increased substantially during the last 2 decades. The major goal of enteral nutrient supply to these infants is to achieve growth similar to foetal growth coupled with satisfactory functional development. The accumulation of knowledge since the previous guideline on nutrition of preterm infants from the Committee on Nutrition of the European Society of Paediatric Gastroenterology and Nutrition in 1987 has made a new guideline necessary. Thus, an ad hoc expert panel was convened by the Committee on Nutrition of the European Society of Paediatric Gastroenterology, Hepatology, and Nutrition in 2007 to make appropriate recommendations. The present guideline, of which the major recommendations are summarised here (for the full report, see http://links.lww.com/A1480), is consistent with, but not identical to, recent guidelines from the Life Sciences Research Office of the American Society for Nutritional Sciences published in 2002 and recommendations from the handbook Nutrition of the Preterm Infant. Scientific Basis and Practical Guidelines, 2nd ed, edited by Tsang et al, and published in 2005. The preferred food for premature infants is fortified human milk from the infant's own mother, or, alternatively, formula designed for premature infants. This guideline aims to provide proposed advisable ranges for nutrient intakes for stable-growing preterm infants up to a weight of approximately 1800 g, because most data are available for these infants. These recommendations are based on a considered review of available scientific reports on the subject, and on expert consensus for which the available scientific data are considered inadequate.
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            Inflammatory bowel disease in children and adolescents: recommendations for diagnosis--the Porto criteria.

            (2005)
            Ulcerative colitis and Crohn disease may present before the age of 20 years in 25% to 30% of all patients with inflammatory bowel disease. Reported incidence figures vary considerably depending on the collection of data. Multicenter, multinational collaboration is needed when studying pediatric inflammatory bowel disease. The essential first step is uniformity in the work-up and criteria used for diagnosis. The Porto diagnostic criteria presented here provide the tool that is needed. These criteria are the result of consensus reached by the ESPGHAN inflammatory bowel disease working group. Diagnosis of Crohn disease, ulcerative colitis and indeterminate colitis is based on clinical signs and symptoms, endoscopy and histology and radiology. Every child suspected of inflammatory bowel disease should undergo a complete diagnostic program consisting of colonoscopy with ileal intubation, upper gastrointestinal endoscopy and (in all cases except in definite ulcerative colitis) radiologic contrast imaging of the small bowel. Multiple biopsies from all segments of the gastrointestinal tract are needed for a complete histologic evaluation. A diagnosis of indeterminate colitis cannot be made unless a full diagnostic program has been performed.
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              A.S.P.E.N. position paper: recommendations for changes in commercially available parenteral multivitamin and multi-trace element products.

              The parenteral multivitamin preparations that are commercially available in the United States (U.S.) meet the requirements for most patients who receive parenteral nutrition (PN). However, a separate parenteral vitamin D preparation (cholecalciferol or ergocalciferol) should be made available for treatment of patients with vitamin D deficiency unresponsive to oral vitamin D supplementation. Carnitine is commercially available and should be routinely added to neonatal PN formulations. Choline should also be routinely added to adult and pediatric PN formulations; however, a commercially available parenteral product needs to be developed. The parenteral multi-trace element (TE) preparations that are commercially available in the U.S. require significant modifications. Single-entity trace element products can be used to meet individual patient needs when the multiple-element products are inappropriate (see Summary/A.S.P.E.N. Recommendations section for details of these proposed modifications).
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                Author and article information

                Journal
                Turk Pediatri Ars
                Turk Pediatri Ars
                Turkish Archives of Pediatrics/Türk Pediatri Arşivi
                Kare Publishing (Turkey )
                1306-0015
                1308-6278
                2018
                25 December 2018
                : 53
                : Suppl 1
                : S119-S127
                Affiliations
                [1 ]Division of Neonatology, Department of Pediatrics, Gazi University, Faculty of Medicine, Ankara, Turkey
                [2 ]Division of Neonatology, Department of Pediatrics, Marmara University, Faculty of Medicine, İstanbul, Turkey
                [3 ]Division of Neonatology, Department of Pediatrics, Ege University Faculty of Medicine, İzmir, Turkey
                Author notes
                Corresponding Author / Sorumlu Yazar: Canan Türkyılmaz E-mail / E-posta: drcananturkyilmaz@ 123456gmail.com
                Article
                TPA-53-119
                10.5152/TurkPediatriArs.2018.01812
                6568298
                240bd21e-043f-4d32-af2c-a67c459a52ee
                Copyright: © 2018 Turkish Pediatric Association

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License

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                feeding,parenteral nutrition,preterm
                feeding, parenteral nutrition, preterm

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