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      Risk of Parenteral Nutrition in Neonates—An Overview

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          Abstract

          Healthcare-associated infections (HAI) in preterm infants are a challenge to the care of these fragile patients. HAI-incidence rates range from 6 to 27 infections per 1000 patient-days. Most nosocomial infections are bloodstream infections and of these, the majority is associated with the use of central venous catheters. Many studies identified parenteral nutrition as an independent risk factor for HAI, catheter-associated bloodstream infection, and clinical sepsis. This fact and various published outbreaks due to contaminated parenteral nutrition preparations highlight the importance of appropriate standards in the preparation and handling of intravenous solutions and parenteral nutrition. Ready-to-use parenteral nutrition formulations may provide additional safety in this context. However, there is concern that such formulations may result in overfeeding and necrotizing enterocolitis. Given the risk for catheter-associated infection, handling with parenteral nutrition should be minimized and the duration shortened. Further research is required about this topic.

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          Most cited references77

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          Neurodevelopmental and growth impairment among extremely low-birth-weight infants with neonatal infection.

          Neonatal infections are frequent complications of extremely low-birth-weight (ELBW) infants receiving intensive care. To determine if neonatal infections in ELBW infants are associated with increased risks of adverse neurodevelopmental and growth sequelae in early childhood. Infants weighing 401 to 1000 g at birth (born in 1993-2001) were enrolled in a prospectively collected very low-birth-weight registry at academic medical centers participating in the National Institute of Child Health and Human Development Neonatal Research Network. Neurodevelopmental and growth outcomes were assessed at a comprehensive follow-up visit at 18 to 22 months of corrected gestational age and compared by infection group. Eighty percent of survivors completed the follow-up visit and 6093 infants were studied. Registry data were used to classify infants by type of infection: uninfected (n = 2161), clinical infection alone (n = 1538), sepsis (n = 1922), sepsis and necrotizing enterocolitis (n = 279), or meningitis with or without sepsis (n = 193). Cognitive and neuromotor development, neurologic status, vision and hearing, and growth (weight, length, and head circumference) were assessed at follow-up. The majority of ELBW survivors (65%) had at least 1 infection during their hospitalization after birth. Compared with uninfected infants, those in each of the 4 infection groups were significantly more likely to have adverse neurodevelopmental outcomes at follow-up, including cerebral palsy (range of significant odds ratios [ORs], 1.4-1.7), low Bayley Scales of Infant Development II scores on the mental development index (ORs, 1.3-1.6) and psychomotor development index (ORs, 1.5-2.4), and vision impairment (ORs, 1.3-2.2). Infection in the neonatal period was also associated with impaired head growth, a known predictor of poor neurodevelopmental outcome. This large cohort study suggests that neonatal infections among ELBW infants are associated with poor neurodevelopmental and growth outcomes in early childhood. Additional studies are needed to elucidate the pathogenesis of brain injury in infants with infection so that novel interventions to improve these outcomes can be explored.
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            National Healthcare Safety Network (NHSN) report: data summary for 2006 through 2008, issued December 2009.

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              Neonatal candidiasis among extremely low birth weight infants: risk factors, mortality rates, and neurodevelopmental outcomes at 18 to 22 months.

              Neonatal candidiasis is associated with substantial morbidity and mortality rates. Neurodevelopmental follow-up data for a large multicenter cohort have not been reported. Data were collected prospectively for neonates born at or =14 days. Death or neurodevelopmental impairment (NDI) was observed for 73% of extremely low birth weight infants who developed candidiasis. Death and NDI rates were greater for infants who had delayed removal or replacement of central catheters (>1 day after initiation of antifungal therapy), compared with infants whose catheters were removed or replaced promptly. Blood cultures were negative for approximately one half of the infants with Candida meningitis. Persistent candidiasis was common. Delayed catheter removal was associated with increased death and NDI rates.
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                Author and article information

                Journal
                Nutrients
                Nutrients
                nutrients
                Nutrients
                MDPI
                2072-6643
                16 October 2012
                October 2012
                : 4
                : 10
                : 1490-1503
                Affiliations
                [1 ]Infection Control Programme, University of Geneva Hospitals, rue Gabrielle Perret-Gentil 4, 1211 Genève 14, Switzerland
                [2 ]Neonatology Unit, Department of Pediatrics, Stadtspital Triemli, Birmensdorferstrasse 497, 8055 Zürich, Switzerland; Email: maren.tomaske@ 123456triemli.zuerich.ch
                [3 ]Division of Infection Control and Hospital Epidemiology, Department of Environmental Health Sciences, University Medical Center Freiburg, Breisacher Str. 115b, 79106 Freiburg, Germany; Email: maria.martin@ 123456uniklinik-freiburg.de
                Author notes
                [* ] Author to whom correspondence should be addressed; Email: walter.zingg@ 123456hcuge.ch ; Tel.: +41-22-372-3364; Fax: +41-22-372-3987.
                Article
                nutrients-04-01490
                10.3390/nu4101490
                3497007
                23201767
                e14c70e9-77ea-4760-829d-52a76686bf9a
                © 2012 by the authors; licensee MDPI, Basel, Switzerland.

                This article is an open-access article distributed under the terms and conditions of the Creative Commons Attribution license ( http://creativecommons.org/licenses/by/3.0/).

                History
                : 15 July 2012
                : 29 August 2012
                : 25 September 2012
                Categories
                Review

                Nutrition & Dietetics
                newborn,intravenous catheter,ready-to-use,healthcare-associated infection,parenteral nutrition,bloodstream infection,compounded formula,preterm,neonate

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