Parenteral nutrition additive shortages: The short-term, long-term and potential epigenetic implications in premature and hospitalized infants

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Product shortages in the healthcare system can have a significant impact on the care provided to patients. In the case of premature or ill infants, high nutrient needs and a lack of nutrient stores make the appropriate administration of nutrition essential. At birth, the clamping of the umbilical cord immediately disrupts the delivery of nutrients from the placenta, which places these infants into a situation that makes adequate provision of nutrients extremely important and challenging. Though the preferred method of feeding, enteral feedings are often delayed in the premature infant due to the fragility and medical complications associated with prematurity. Management of co-morbid conditions, such as patent ductus arteriosis, chronic lung disease and feeding intolerance frequently involve restriction of fluids and delays in enteral feeding advancement. As a result, these cases usually remain dependent on parenteral nutrition (PN) for the first few weeks of life; however, those with complications, such as necrotizing enterocolitis, may require sole PN for much longer time periods. In the infant with congenital anomalies, such as gastroschisis, trachea-esophageal fistula or bowel disease, feedings may not be feasible for weeks or even months. There is growing evidence that inadequate nutrition in the first few weeks of life results in growth failure and poor long-term neurodevelopmental outcomes [1,2]. Due to concern for current shortages of parenteral nutrition (PN) micronutrient additives, the purpose of this paper is to review the potential effect of these shortages on premature and newborn infants and to present a case study of nutrient deficiency resulting from this shortage.

Original languageEnglish (US)
Title of host publicationClinical Nutrition
Subtitle of host publicationThe Interface Between Metabolism, Diet, and Disease
PublisherApple Academic Press
Pages297-314
Number of pages18
ISBN (Electronic)9781482239089
ISBN (Print)9781926895970
DOIs
StatePublished - Jan 1 2013

ASJC Scopus subject areas

  • Medicine(all)

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