title: The safety and efficacy of parenteral nutrition among pediatric patients with burn injuries.
abstract: OBJECTIVE
  Although enteral nutrition is the ideal mode of nutritional support following burn injury, it is often interrupted during episodes of severe sepsis and hemodynamic instability, leading to significant energy and protein deficits. Parenteral nutrition is not commonly used in burn centers due to concerns that it will lead to hyperglycemia, infection, and increased mortality. However, parenteral nutrition is often utilized in our burn unit when goal rate enteral nutrition is not feasible.To determine the safety and efficacy of a standardized protein-sparing parenteral nutrition protocol in which glucose infusion is limited to 5-7 mg/kg/hour.
  
  
  METHODS
  Retrospective observational study.
  
  
  METHODS
  Pediatric burn hospital.
  
  
  METHODS
  A retrospective medical record review of all children admitted to our hospital with burns ≥ 30% total body surface area was conducted. Only patients admitted within one week of injury and who survived > 24 hours after admission were included in this study.
  
  
  METHODS
  None.
  
  
  RESULTS
  Of the 105 patients who met the inclusion criteria, 96 (91%) received parenteral nutrition or a combination of parenteral nutrition and enteral nutrition at some point during their care. Nine patients received only enteral nutrition. Demographic data were similar between groups. Protein intake was significantly higher in the parenteral nutrition group. Incidence of catheter-related blood infections did not differ between groups. Use of parenteral nutrition was not associated with blood or respiratory infections. Overall mortality rate was low (4%), as most patients (96%) achieved wound closure and were discharged home.
  
  
  CONCLUSIONS
  Judicious use of parenteral nutrition is a safe and effective means of nutritional support when goal enteral nutrition cannot be achieved. A hypocaloric, high-nitrogen parenteral nutrition solution can reduce energy and protein deficits while minimizing complications commonly associated with parenteral nutrition usage.
authors: Shriners Hospitals for Children, Boston, MA, USA. mdylewski@shrinenet.org
authors: Maggie L
authors: ML
authors: Dylewksi
authors: Meghan
authors: M
authors: Baker
authors: Kathy
authors: K
authors: Prelack
authors: Joan M
authors: JM
authors: Weber
authors: Derek
authors: D
authors: Hursey
authors: Martha
authors: M
authors: Lydon
authors: Shawn P
authors: SP
authors: Fagan
authors: Robert L
authors: RL
authors: Sheridan
mesh_terms: D000293:Adolescent; D002056:Burns / Q000150:complications / Q000401:mortality / Q000628:therapy*; D055499:Catheter-Related Infections / Q000453:epidemiology / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D006801:Humans; D006943:Hyperglycemia / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D007223:Infant; D016015:Logistic Models; D010288:Parenteral Nutrition / Q000009:adverse effects / Q000379:methods; D057947:Parenteral Nutrition Solutions; D011014:Pneumonia / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D057947:Parenteral Nutrition Solutions