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PP229-SUN: Hospital Parenteral Nutrition in Children
Nutritional techniques and formulations between January 2000 and November 2011, comprising 545 and 200 catheters during catheter lock therapy with heparin and taurolidine, respectively. We evaluated catheter-related bloodstream infection- and occlusion incidence rates using Poisson-normal regression analysis. Incidence rate ratios were calculated by dividing incidence rates of heparin by those of taurolidine, adjusting for confounders. Data of adverse events and hospital admission were also collected. Results: Bloodstream infection incidence rates were 1.1/year for heparin and 0.2/year for taurolidine locked catheters. Occlusion incidence rates were 0.2/year for heparin and 0.1/year for taurolidine locked catheters. Adjusted incidence ratios of heparin compared to taurolidine were 5.9 (95% CI, 3.9 8.7) for bloodstream infections and 1.9 (95% CI, 1.1 3.1) for occlusions. The ratio of hospital admission days per catheter day decreased by 60% from 0.055 in two pretaurolidine years to 0.022 in 2011. Seven percent of patients reported adverse events possibly related to the use of taurolidine. Conclusion: Given that no other procedural changes than the catheter lock strategy were implemented, these data strongly suggest that taurolidine decreases catheter-related complications in HPN patients compared with heparin. Disclosure of Interest: E. Olthof: None Declared, M. Versleijen: None Declared, G. Huisman-de Waal: None Declared, T. Feuth: None Declared, W. Kievit: None Declared, G. Wanten Grant/Research Support from: Geistlich Pharma (Wolhusen Switzerland), Other: GW has performed research and given presentations that were supported by fees from Geistlich and grants from Geistlich Pharma, Fresenius Kabi and Baxter.
PP229-SUN HOSPITAL PARENTERAL NUTRITION IN CHILDREN C. Mantegazza1 , L. Hughes2 , J. Koegmeier1 . 1 Gastroenterology, 2 Parenteral Nutrition, Great Ormond Street Hospital, London, United Kingdom Rationale: Parenteral nutrition (PN) is being commonly used in children with intestinal failure but it is by far no panacea and the complications can be serious. The 2010 national confidential enquiry into patient outcome and death (NCEPOD) has clearly demonstrated that hospital PN is lacking a good standard of practice in the majority of patients. Neonatal PN is missing a UK consensus and in children a large scale audit of PN care was recommended. The aim of this prospective observational study was to get an understanding of the indications and complications of PN prescribed in newborns and children in a large tertiary care children’s hospital. Methods: Neonates and children receiving hospital PN between October 2013 and March 2014 were included and data obtained prospectively. Underlying diagnosis, indication for PN, biochemistry, haematology, urine analysis, antropometry, fluid balance, medication and PN prescription were recorded and clinical information obtained from the case notes and dietetic charts. Results: 279 patients were identified (53.4% male), 54 were newborns. The average age of the children older than one month of age was 3.9 years (1 month to 18 years). PN was given from one to 155 days (mean 16.7 days). Metabolic complications were seen in 237 patients: 39.4% developed hypermagnesaemia, 39% hypercalcaemia, 33.3% hypokalaemia and 26.9% hypophosphataemia. Abnormal liver function oc-
S105 curred in 40% of the patients. Central venous catheter (CVC) complications were documented in 49/279 children (17.5%) of which 57.1% had a blocked CVC and 40.8% had a CVC infection resulting in line removal in 7 patients. Only 7 newborns (12.9%) had a CVC complication. Conclusion: Compared to the NCEPOD results metabolic disturbances were much more common in our cohort. CVC related complications were lower in the neonatal group. The study gives new insight into hospital PN in children. References The 2010 National Confidential Enquiry into Patient Outcome and Death (NCEPOD). Disclosure of Interest: None Declared.
PP230-SUN ADVANCED GLYCATION ENDPRODUCTS IN ENTERAL AND PARENTERAL FORMULATIONS: NEW TARGET FOR INVESTIGATIONS? J.P. Barbosa1 , A.E.G. Sant’Ana1 , J. Meltretter2 , ¨ streicher2 , P. Stahl3 . 1 Institute of Chemistry and C. O Biotechnology, Federal University of Alagoas, Macei´ o, Brazil; 2 Department of Chemistry and Pharmacy, Chair of Food Chemistry, Emil-Fischer-Center, University of Erlangen-Nuremberg, Erlangen, 3 MicroCoat Biotechnologie GmbH, MicroCoat Biotechnologie GmbH, Bernried, Germany Rationale: The Advanced Glycated Endproducts (AGEs) are formed from nonenzymatic reactions between reducing sugars and amines groups of proteins and are known to modulate a multitude of cellular structural and pro-oxidant effects, including inflammation, cell proliferation or apoptosis, as well as insulin signaling. Diet is considered the main source of exogenous AGEs, however there is a lack of information about the content of such compounds in dietary formulations for nutritional support, as well as their possible role on the clinical patients’ outcome. Methods: To obtain the concentrations of Ne -carboxymethyllysine (CML) a well-recognized AGE marker in enteral and parenteral diets, validated analytical methods were optimized. Representative groups of commercially available enteral tube feeding formulas (n = 10) and parenteral solutions (n = 5) were tested by ultra performance liquid chromatography connected to electrospray ionization tandem mass spectrometry (LC-ESI-MS-MS) and by a competitive enzyme linked immunosorbent assay (ELISA), respectively. Results: The CML was quantified in the enteral diets (n = 10) in the range of 6,300 to 178,500 ng/ml and in the parenteral solutions (n = 5) in the range of 595 to 1,900 ng/ml. A good linear correlation between corresponding concentrations of protein/amino acids and CML in both groups of formulations was obtained. Highest CML values were observed among the hypercaloric formulas compared to the normocaloric ones (ANOVA, p < 0.001). Conclusion: These results indicate that enteral and parenteral diets can be environmental sources of AGEs. Furthermore, the lack of data in the scientific literature to compare these results, as well as the lack of studies to evaluate the health impact of this compounds in such nutritional products endorses the implementation of future research protocols in the food industry and in the biomedical fields. Disclosure of Interest: None Declared.
PP229-SUN HOSPITAL PARENTERAL NUTRITION IN CHILDREN C. Mantegazza1 , L. Hughes2 , J. Koegmeier1 . 1 Gastroenterology, 2 Parenteral Nutrition, Great Ormond Street Hospital, London, United Kingdom Rationale: Parenteral nutrition (PN) is being commonly used in children with intestinal failure but it is by far no panacea and the complications can be serious. The 2010 national confidential enquiry into patient outcome and death (NCEPOD) has clearly demonstrated that hospital PN is lacking a good standard of practice in the majority of patients. Neonatal PN is missing a UK consensus and in children a large scale audit of PN care was recommended. The aim of this prospective observational study was to get an understanding of the indications and complications of PN prescribed in newborns and children in a large tertiary care children’s hospital. Methods: Neonates and children receiving hospital PN between October 2013 and March 2014 were included and data obtained prospectively. Underlying diagnosis, indication for PN, biochemistry, haematology, urine analysis, antropometry, fluid balance, medication and PN prescription were recorded and clinical information obtained from the case notes and dietetic charts. Results: 279 patients were identified (53.4% male), 54 were newborns. The average age of the children older than one month of age was 3.9 years (1 month to 18 years). PN was given from one to 155 days (mean 16.7 days). Metabolic complications were seen in 237 patients: 39.4% developed hypermagnesaemia, 39% hypercalcaemia, 33.3% hypokalaemia and 26.9% hypophosphataemia. Abnormal liver function oc-
S105 curred in 40% of the patients. Central venous catheter (CVC) complications were documented in 49/279 children (17.5%) of which 57.1% had a blocked CVC and 40.8% had a CVC infection resulting in line removal in 7 patients. Only 7 newborns (12.9%) had a CVC complication. Conclusion: Compared to the NCEPOD results metabolic disturbances were much more common in our cohort. CVC related complications were lower in the neonatal group. The study gives new insight into hospital PN in children. References The 2010 National Confidential Enquiry into Patient Outcome and Death (NCEPOD). Disclosure of Interest: None Declared.
PP230-SUN ADVANCED GLYCATION ENDPRODUCTS IN ENTERAL AND PARENTERAL FORMULATIONS: NEW TARGET FOR INVESTIGATIONS? J.P. Barbosa1 , A.E.G. Sant’Ana1 , J. Meltretter2 , ¨ streicher2 , P. Stahl3 . 1 Institute of Chemistry and C. O Biotechnology, Federal University of Alagoas, Macei´ o, Brazil; 2 Department of Chemistry and Pharmacy, Chair of Food Chemistry, Emil-Fischer-Center, University of Erlangen-Nuremberg, Erlangen, 3 MicroCoat Biotechnologie GmbH, MicroCoat Biotechnologie GmbH, Bernried, Germany Rationale: The Advanced Glycated Endproducts (AGEs) are formed from nonenzymatic reactions between reducing sugars and amines groups of proteins and are known to modulate a multitude of cellular structural and pro-oxidant effects, including inflammation, cell proliferation or apoptosis, as well as insulin signaling. Diet is considered the main source of exogenous AGEs, however there is a lack of information about the content of such compounds in dietary formulations for nutritional support, as well as their possible role on the clinical patients’ outcome. Methods: To obtain the concentrations of Ne -carboxymethyllysine (CML) a well-recognized AGE marker in enteral and parenteral diets, validated analytical methods were optimized. Representative groups of commercially available enteral tube feeding formulas (n = 10) and parenteral solutions (n = 5) were tested by ultra performance liquid chromatography connected to electrospray ionization tandem mass spectrometry (LC-ESI-MS-MS) and by a competitive enzyme linked immunosorbent assay (ELISA), respectively. Results: The CML was quantified in the enteral diets (n = 10) in the range of 6,300 to 178,500 ng/ml and in the parenteral solutions (n = 5) in the range of 595 to 1,900 ng/ml. A good linear correlation between corresponding concentrations of protein/amino acids and CML in both groups of formulations was obtained. Highest CML values were observed among the hypercaloric formulas compared to the normocaloric ones (ANOVA, p < 0.001). Conclusion: These results indicate that enteral and parenteral diets can be environmental sources of AGEs. Furthermore, the lack of data in the scientific literature to compare these results, as well as the lack of studies to evaluate the health impact of this compounds in such nutritional products endorses the implementation of future research protocols in the food industry and in the biomedical fields. Disclosure of Interest: None Declared.