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SUN-P224: Physicochemical Stability and Sterility of All-In-One Parenteral Emulsions for Neonates
Paediatrics 1
S127
SUN-P223 ADHERENCE TO PRESCRIPTION CLINICAL GUIDELINES FOR PARENTERAL NUTRITION IN PEDIATRIC PATIENTS HAVE NOT VALUED BY NUTRITIONAL SUPPORT UNIT FROM JUAREZ HOSPITAL OF MEXICO E. Perez Cruz1, K. P. Gonzalez Saucedo1. 1Nutrition Support. Critical Medicine, Hospital Juárez de México, Ciudad de Mexico, Mexico Rationale: Clinical guidelines are a useful tool in actual medical practice. We valuated the adherence of guidelines on the use of parenteral nutrition in pediatric patients that have not been valued by Nutritional Support Unit. Methods: Cross-sectional study in the Hospital Juárez of Mexico from January to December 2012 of pediatric patients requiring parenteral nutrition for >5 days and that were not evaluated by the Nutritional Support Unit. The parenteral nutrition prescriptions and the adherence of ASPEN and ESPGHAN clinical guidelines were reviewed. Results: 108 prescriptions were analyzed, 67% neonates and 33% pediatric patients, Table 1. Results show different levels of adherence. Prescription the energy expenditure was adherent to guidelines in 36.1%, for lipids 22.9%, carbohydrates 31.24% and proteins 31.94%. Implementation of the questionnaire aimed at assessing the knowledge concerning the prescription of PN in adherence to guidelines 21% of doctors in training were able to prove. Table 1: Characteristics of hospitalized patients Characteristics Age Median (ranges) Sex Female Male Principal diagnostics
Neonates
Pediatrics
8.7 (1–28 days)
4.8 (1–16 years)
48.6% 51.4% Sepsis Premature Neonatal pathologies Surgery Asphyxia
36.1% 63.9% Surgery Oncological pathology Acute pancreatitis
Conclusion: Adherence to guidelines appears insufficient since less than half of patients received an appropriate prescription. Nutrition education strategies are necessary to improve the knowledge of doctors in training and incorporate them into the multidisciplinary team of nutrition. References A.S.P.E.N. Clinical Guidelines: Nutrition Support of the Critically Ill Child. J Parenter Enteral Nutr. 2009; 33(3):260–76. Guidelines on Paediatric Parenteral Nutrition of ESPGHAN, ESPEN and ESPR. J of Pediatr Gastroenterol Nutr. 2005; 41(Suppl 2):S1–87. Disclosure of Interest: None declared
SUN-P224 PHYSICOCHEMICAL STABILITY AND STERILITY OF ALL-IN-ONE PARENTERAL EMULSIONS FOR NEONATES G. Garrido Alejos1, P. Riera Armengol1, J. Cardenete Ornaque1, J. Prenafeta Torres1, J. Estelrich Latras2, M. A. Mangues Bafalluy1, D. Cardona Pera1. 1Pharmacy, Hospital de la Santa Creu i Sant Pau, 2Physical Chemistry, Universitat de Barcelona, Barcelona, Spain
Rationale: Two standard lipid-free parenteral nutrition (PN) solutions are available in our hospital to ensure neonateś nutritional needs according to weight (below/above 1.5 kg). All-in-one (AIO) admixtures, incorporating lipids, are prepared for neonates who require long-term PN. After preparation, AIO PN are kept under refrigeration (6–48 h) until the moment they are distributed and administered (24-h continuous infusion). The aim of this study was to assess the physicochemical stability and sterility of these admixtures. Methods: We considered neonates’ fluid and lipid requirements: 50–150 mL/kg/d and 2 g/kg/d, respectively. Lipid needs were calculated for neonates under PN treatment over 2 days as AIO PN are prepared in these cases. Two AIO PN were designed for each standard lipid-free PN solution available, simulating fluid supply of 50 mL/kg/d and 150 mL/kg/d. PN were stored 48 h at 4°C and then 24 h at room temperature to simulate real life conditions. From each AIO PN, five samples were taken at 0, 48 and 72 h. Physicochemical parameters tested: phase separation (observation), mean lipid droplet size distribution (dynamic light scattering; Zetasizer NanoZS90, Malvern NK). Peroxide and vitamins concentrations were not analysed due to the short storage time, the multi-layered and the light-protection bags. Sterility was assessed with agar blood culture (0.45 μm membrane filtration method). Results: No alterations were detected by visual inspection. Physical stability was considered acceptable as average droplet size remained below 500 nm in all the emulsions at all the times tested. All agar blood cultures were negative. Average droplet size at 72 h (nm) PN < 1.5 kg (150 mL/kg/d) PN < 1.5 kg (50 mL/kg/d) PN > 1.5 kg (150 mL/kg/d) PN > 1.5 kg (50 mL/kg/d)
304 ± 7 310 ± 9 311 ± 7 321 ± 5
Conclusion: Our study shows that the four AIO PN for neonates are physicochemically stable and sterile in the studied conditions. Disclosure of Interest: None declared
SUN-P225 SUPERIORITY OF ENTERAL OVER PARENTERAL NUTRITION ON EARLY OUTCOME IN CHILDREN UNDERGOING ALLOGENEIC STEM CELL TRANSPLANTATION: A MULTICENTER 10-YEAR MATCHED COHORT STUDY G. Fanny1, B. Bénédicte1, A. F. Martin1, B. Hélène2, D. B. Eva1, N. Brigitte1, Y.-A. Ibrahim3, G. Virginie4, S. Alexandra5, S. Anne6, D. Alain2, S. David7,8. 1Service d’hématologie pédiatrique, Hôpital Jeanne de Flandre, 2Département de Biostatistiques, Université Lille Nord de France, 3Service des Maladies du Sang, Hôpital Claude Huriez, Lille, 4Service d′ Onco-Hématologie Pédiatrique, Hôpital Sud, Chu Rennes, Rennes, 5Service d’hématologie et d’oncologie pédiatrique, Hôpital Hautepierre, Strasbourg, 6Unité d’onco-hématologie pédiatrique, Centre Hospitalier Régional Universitaire de Montpellier, Montpellier, 7LIRIC - UMR 995, Chu Lille, 8Service de Nutrition, Hôpital Claude Huriez, Lille, France Rationale: There is no consensus on which nutritional support is best suited for children undergoing allogeneic stem cell transplantation (allo-SCT) after myeloablative conditioning (MAC).
S127
SUN-P223 ADHERENCE TO PRESCRIPTION CLINICAL GUIDELINES FOR PARENTERAL NUTRITION IN PEDIATRIC PATIENTS HAVE NOT VALUED BY NUTRITIONAL SUPPORT UNIT FROM JUAREZ HOSPITAL OF MEXICO E. Perez Cruz1, K. P. Gonzalez Saucedo1. 1Nutrition Support. Critical Medicine, Hospital Juárez de México, Ciudad de Mexico, Mexico Rationale: Clinical guidelines are a useful tool in actual medical practice. We valuated the adherence of guidelines on the use of parenteral nutrition in pediatric patients that have not been valued by Nutritional Support Unit. Methods: Cross-sectional study in the Hospital Juárez of Mexico from January to December 2012 of pediatric patients requiring parenteral nutrition for >5 days and that were not evaluated by the Nutritional Support Unit. The parenteral nutrition prescriptions and the adherence of ASPEN and ESPGHAN clinical guidelines were reviewed. Results: 108 prescriptions were analyzed, 67% neonates and 33% pediatric patients, Table 1. Results show different levels of adherence. Prescription the energy expenditure was adherent to guidelines in 36.1%, for lipids 22.9%, carbohydrates 31.24% and proteins 31.94%. Implementation of the questionnaire aimed at assessing the knowledge concerning the prescription of PN in adherence to guidelines 21% of doctors in training were able to prove. Table 1: Characteristics of hospitalized patients Characteristics Age Median (ranges) Sex Female Male Principal diagnostics
Neonates
Pediatrics
8.7 (1–28 days)
4.8 (1–16 years)
48.6% 51.4% Sepsis Premature Neonatal pathologies Surgery Asphyxia
36.1% 63.9% Surgery Oncological pathology Acute pancreatitis
Conclusion: Adherence to guidelines appears insufficient since less than half of patients received an appropriate prescription. Nutrition education strategies are necessary to improve the knowledge of doctors in training and incorporate them into the multidisciplinary team of nutrition. References A.S.P.E.N. Clinical Guidelines: Nutrition Support of the Critically Ill Child. J Parenter Enteral Nutr. 2009; 33(3):260–76. Guidelines on Paediatric Parenteral Nutrition of ESPGHAN, ESPEN and ESPR. J of Pediatr Gastroenterol Nutr. 2005; 41(Suppl 2):S1–87. Disclosure of Interest: None declared
SUN-P224 PHYSICOCHEMICAL STABILITY AND STERILITY OF ALL-IN-ONE PARENTERAL EMULSIONS FOR NEONATES G. Garrido Alejos1, P. Riera Armengol1, J. Cardenete Ornaque1, J. Prenafeta Torres1, J. Estelrich Latras2, M. A. Mangues Bafalluy1, D. Cardona Pera1. 1Pharmacy, Hospital de la Santa Creu i Sant Pau, 2Physical Chemistry, Universitat de Barcelona, Barcelona, Spain
Rationale: Two standard lipid-free parenteral nutrition (PN) solutions are available in our hospital to ensure neonateś nutritional needs according to weight (below/above 1.5 kg). All-in-one (AIO) admixtures, incorporating lipids, are prepared for neonates who require long-term PN. After preparation, AIO PN are kept under refrigeration (6–48 h) until the moment they are distributed and administered (24-h continuous infusion). The aim of this study was to assess the physicochemical stability and sterility of these admixtures. Methods: We considered neonates’ fluid and lipid requirements: 50–150 mL/kg/d and 2 g/kg/d, respectively. Lipid needs were calculated for neonates under PN treatment over 2 days as AIO PN are prepared in these cases. Two AIO PN were designed for each standard lipid-free PN solution available, simulating fluid supply of 50 mL/kg/d and 150 mL/kg/d. PN were stored 48 h at 4°C and then 24 h at room temperature to simulate real life conditions. From each AIO PN, five samples were taken at 0, 48 and 72 h. Physicochemical parameters tested: phase separation (observation), mean lipid droplet size distribution (dynamic light scattering; Zetasizer NanoZS90, Malvern NK). Peroxide and vitamins concentrations were not analysed due to the short storage time, the multi-layered and the light-protection bags. Sterility was assessed with agar blood culture (0.45 μm membrane filtration method). Results: No alterations were detected by visual inspection. Physical stability was considered acceptable as average droplet size remained below 500 nm in all the emulsions at all the times tested. All agar blood cultures were negative. Average droplet size at 72 h (nm) PN < 1.5 kg (150 mL/kg/d) PN < 1.5 kg (50 mL/kg/d) PN > 1.5 kg (150 mL/kg/d) PN > 1.5 kg (50 mL/kg/d)
304 ± 7 310 ± 9 311 ± 7 321 ± 5
Conclusion: Our study shows that the four AIO PN for neonates are physicochemically stable and sterile in the studied conditions. Disclosure of Interest: None declared
SUN-P225 SUPERIORITY OF ENTERAL OVER PARENTERAL NUTRITION ON EARLY OUTCOME IN CHILDREN UNDERGOING ALLOGENEIC STEM CELL TRANSPLANTATION: A MULTICENTER 10-YEAR MATCHED COHORT STUDY G. Fanny1, B. Bénédicte1, A. F. Martin1, B. Hélène2, D. B. Eva1, N. Brigitte1, Y.-A. Ibrahim3, G. Virginie4, S. Alexandra5, S. Anne6, D. Alain2, S. David7,8. 1Service d’hématologie pédiatrique, Hôpital Jeanne de Flandre, 2Département de Biostatistiques, Université Lille Nord de France, 3Service des Maladies du Sang, Hôpital Claude Huriez, Lille, 4Service d′ Onco-Hématologie Pédiatrique, Hôpital Sud, Chu Rennes, Rennes, 5Service d’hématologie et d’oncologie pédiatrique, Hôpital Hautepierre, Strasbourg, 6Unité d’onco-hématologie pédiatrique, Centre Hospitalier Régional Universitaire de Montpellier, Montpellier, 7LIRIC - UMR 995, Chu Lille, 8Service de Nutrition, Hôpital Claude Huriez, Lille, France Rationale: There is no consensus on which nutritional support is best suited for children undergoing allogeneic stem cell transplantation (allo-SCT) after myeloablative conditioning (MAC).