 Early
Enteral Immunonutrition
Reference: Chir Ital 2001;53(5):619-32.
Hypercatabolism after operations has a negative influence on nutritional
status, the healing
process, infective complications and hospital stay. Moreover, the immune
status of the patient has
been shown to be equally important for septic morbidity and mortality.
It is extensively accepted
that in critical situations, an adequate nutritional support (enteral or
parenteral) is absolutely
necessary, but subjects such as the best way of feeding, the kind of nutrients
to be used and the
administration time are still debatable issues. Our aim was to evaluate
the effectiveness (nutritional
and immunological features) and clinical outcomes (septic morbidity and
mortality) of total
parenteral nutrition (TPN), early enteral nutrition and early enteral immunonutrition
(EEN, EEIN)
in 171 patients undergoing major abdominal and urological surgery for neoplastic
pathology. Our
prospective, randomised study showed no significant differences among the
3 nutritional supports
(TPN, EEN, EEIN) with regard to restoration of normal nitrogen balance
during the acute phase
of surgical stress. No correlations were found in the 3 groups with immunoglobulin
percentage,
lymphocyte subpopulations and their functional patterns as studied by specific
immunological
tests. The skin test, on the other hand, seems to be more representative
of the immune condition
of the patients, demonstrating a faster improvement in immunological status
in the EEIN group as
compared to the control group. A smaller percentage of septic morbidity
and mortality was found
in both enteral nutritional groups (EEN and EEIN), although there was a
statistically significant
difference only between the TPN and EEIN groups. The hospital stay was
3.5 days shorter in
enteral feeding patients (EEN, EEIN). Finally, EEN was less expensive than
the other nutritional
conditions, this result depending on the cost of the different materials
used (infusion sets, linear
filters, prepacked diets, etc.).
Food
and nutritional care in hospitals: how to prevent undernutrition--report
and guidelines from the Council of Europe.
Reference: Clin Nutr 2001;20(5):455-60.
In 1999 the Council of Europe decided to collect information regarding
Nutrition programmes in hospitals and for this purpose a network
consisting of national experts from eight of the Partial Agreement member
states was established. The aim was to review the current practice in
Europe regarding hospital food provision, to highlight deficiencies and
to
issue guidelines to improve the nutritional care and support of hospitalized
patients. Five major problems seemed to be common in this context: 1)
lack of clearly defined responsibilities; 2) lack of sufficient education;
3)
lack of influence of the patients; 4) lack of co-operation among all staff
groups; and 5) lack of involvement from the hospital management. To
solve the problems highlighted, a combined 'team-effort' is needed from
national authorities and all staff involved in the nutritional care and
support,
including hospital managers.
Beneficial
effects of immediate enteral nutrition after esophageal cancer surgery.
Reference: Surg Today 2001;31(11):971-8.
This study was conducted to determine the effects of immediate enteral
nutrition (EN) on
nutritional status, immunological competence, and the suppression of excessive
inflammatory
responses in patients following esophageal cancer surgery. Twenty-four
patients who underwent
the same elective operation for thoracic esophageal carcinoma were randomized
into an
immediate enteral nutrition (IEN) group who received EN from postoperative
day (POD) 1 and
a parenteral nutrition (PAN) group. Both groups received comparable volumes
and calories on
the same POD. Laboratory studies were carried out preoperatively and on
PODs 1-7. Other
nutritional and immunological assessments were repeated on PODs 1 and 7.
Plasma
concentrations of nitrate and nitrite were also measured. All of the patients
in the IEN group
tolerated enteral feeding well. There were no significant differences in
the results of nutritional
assessments, lymphocyte function, or plasma nitrate and nitrite levels
between the two groups.
The IEN group showed a significantly earlier recovery of the total lymphocyte
count. The serum
levels of total bilirubin and C-reactive protein were significantly attenuated
in the IEN group.
These results indicate that immediate EN may have beneficial effects on
immunological
competence and the suppression of excessive inflammatory responses in patients
following
esophagectomy. Patients undergoing radical esophageal surgery who are subjected
to severe
surgical stress might benefit the most from early EN.
Parenteral
nutrition and immature neonates. Comparative study of neonates weighing
under 1000 and 1000-1250 g at birth.
Reference: Early Hum Dev 2001;65(S2):S133-44.
We studied the nutritional requirements of 53 neonates with a birth-weight
of 1250 g or less and
analysed the parenteral and enteral nutrition provided, the weight-gain
curves, the incidence of
prior pathology and complications. We compared those weighing under 1000
g at birth (n=25)
with those weighing 1001-1250 g (n=28). All neonates received central parenteral
nutrition at an
average age of 42.3 h. The liquid requirements of the lower birth-weight
group were significantly
greater. No differences were found in the supply of glucose, proteins,
lipids and calories until
after the first 15 days of life, when the <1000 g group required a greater
liquid and caloric intake.
Parenteral nutrition was suspended earlier for the >1000 g group (32.6
vs. 48.1 days). Maximum
weight loss (12.56%) for the two groups occurred at 5.23 days. No differences
in weight gain
(g/kg/day) between the groups were observed. The >1000 g group began enteral
nutrition
significantly earlier and presented greater tolerance. The incidence of
complications
(bronchopulmonary dysplasia, enterocolitis, nosocomial sepsis, Candidas
A sepsis, osteopenia)
was greater in the lower birth-weight group, as was that of hyaline membrane
disease and
mechanically assisted respiration. There were no differences in the incidence
of intracraneal
haemorrhage, ductus arteriosus, early sepsis, delayed intrauterine growth
or hypoglucemia.
Conclusions: The severity of the initial pathology and the greater incidence
of complications
among the lower birth-weight neonates (<1000 g) influenced both the
need for parenteral
nutrition and the reduced tolerance to enteral nutrition. Although the
rate of weight gain was
similar for the two groups, the <1000 g group required a longer period
of parenteral nutrition
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