title: Validating hyperbilirubinemia and gut mucosal atrophy with a novel ultramobile ambulatory total parenteral nutrition piglet model.
abstract: Total parenteral nutrition (TPN) provides all nutrition intravenously. Although TPN therapy has grown enormously, it causes significant complications, including gut and hepatic dysfunction. Current models use animal tethering which is unlike ambulatory human TPN delivery and is cost prohibitive. We hypothesize that using ultramobile infusion pumps, TPN can be delivered cost-effectively, resulting in classical gut and hepatic injury, and we thus aim to establish a new model system. Neonatal pigs (n=8) were implanted with jugular vein and duodenal catheters. Animals were fitted in dual-pocket jackets. An ultramobile ambulatory pump was placed in one pocket and connected to the jugular vein or duodenal catheter. Isocaloric TPN or swine formula was placed in the other pocket. Rigorous Wifi-based video and scheduled monitoring was performed. After 14days, the animals were euthanized. The mean (±SD) daily weight gain (in grams) for enteral-fed control (EN) vs TPN animals was 102.4±10.8 and 91.03±12.1 respectively (P<.05). Total parenteral nutrition resulted in significant conjugated bilirubin elevation and hepatomegaly. Mean (±SD) serum conjugated bilirubin (in μmol/L) was 1.5±0.7 for EN and 6.3±2.8 for TPN (P<.05). Marked gut atrophy was noted with TPN. The mean (±SD) gut weight as a percent of body weight was 4.30±0.26 for EN and 2.62±0.48 for TPN (P<.05). Surgical sites healed well. All animals remained completely mobile. We thus established that TPN can be successfully delivered using ultramobile pumps and believe that this remains the first such description of an ambulatory piglet TPN model system. In addition to cholestasis and gut atrophy, classical TPN-induced injury was documented.
authors: St Louis University School of Medicine, Cardinal Glennon Children's Medical Center, 1465 South Grand Blvd., St. Louis, MO 63104, USA. Electronic address: ajain3@slu.edu.
authors: Ajay K
authors: AK
authors: Jain
authors: St Louis University School of Medicine, Cardinal Glennon Children's Medical Center, 1465 South Grand Blvd., St. Louis, MO 63104, USA.
authors: Joy X
authors: JX
authors: Wen
authors: St Louis University School of Medicine, Cardinal Glennon Children's Medical Center, 1465 South Grand Blvd., St. Louis, MO 63104, USA.
authors: Sumit
authors: S
authors: Arora
authors: St Louis University School of Medicine, Cardinal Glennon Children's Medical Center, 1465 South Grand Blvd., St. Louis, MO 63104, USA.
authors: Keith S
authors: KS
authors: Blomenkamp
authors: St Louis University School of Medicine, Cardinal Glennon Children's Medical Center, 1465 South Grand Blvd., St. Louis, MO 63104, USA.
authors: Jonathan
authors: J
authors: Rodrigues
authors: St Louis University School of Medicine, Cardinal Glennon Children's Medical Center, 1465 South Grand Blvd., St. Louis, MO 63104, USA.
authors: Timothy A
authors: TA
authors: Blaufuss
authors: St Louis University School of Medicine, Cardinal Glennon Children's Medical Center, 1465 South Grand Blvd., St. Louis, MO 63104, USA.
authors: Victor
authors: V
authors: Liou
authors: Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA.
authors: Douglas G
authors: DG
authors: Burrin
authors: St Louis University School of Medicine, Cardinal Glennon Children's Medical Center, 1465 South Grand Blvd., St. Louis, MO 63104, USA.
authors: John P
authors: JP
authors: Long
authors: St Louis University School of Medicine, Cardinal Glennon Children's Medical Center, 1465 South Grand Blvd., St. Louis, MO 63104, USA.
authors: Jeffery H
authors: JH
authors: Teckman
mesh_terms: D000818:Animals; D000831:Animals, Newborn; D001284:Atrophy; D001835:Body Weight / Q000187:drug effects; D004333:Drug Administration Routes; D004750:Enteral Nutrition / Q000009:adverse effects / Q000379:methods*; D006932:Hyperbilirubinemia / Q000097:blood / Q000209:etiology*; D007262:Infusions, Intravenous / Q000379:methods; D007413:Intestinal Mucosa / Q000187:drug effects / Q000473:pathology*; D008099:Liver / Q000187:drug effects* / Q000378:metabolism; D010289:Parenteral Nutrition, Total / Q000009:adverse effects* / Q000379:methods; D013552:Swine; D016896:Treatment Outcome; D015430:Weight Gain / Q000187:drug effects
keywords: Administration; Liver and gut disease; Neonates; Parenteral nutrition; Pediatrics