Latest Updates

Nutrition For Healthy Infants And Toddlers 

Sharon Collier, RD, LDN, MEd, Jenny Kinne, MS, RD, LDN
    • Vitamin D supplementation at 400 IU/day for fully or partially breast-fed babies or infants taking less than 1 L/day of proprietary infant formula
    • Plot children under 2 years of age on the World Health Organization growth chart and assess nutritional status based on Z scores
    • Use the My Plate model for healthy eating portions and food groups versus the Food Guide Pyramid
    • Do not delay or limit the types of foods when introducing solids to prevent food allergies

Nutrition For The Healthy Adolescent

Lauren Cullity, MS, RD, LDN
    • My Plate model for healthy eating portions and food groups versus the Food Guide Pyramid
    • Estimated energy requirement to assess energy needs for adolescents
    • Avoidant restrictive intake disorder and binge eating disorder diagnosis criteria

Hand Fractures

Thomas B Hughes Jr, MD, Issei Komatsu, MD
    • Fish oil–based lipid emulsions may be efficacious in the treatment of parenteral nutrition–associated liver disease (PNALD).
    • Lipid reduction (e.g., to 1 g/kg/day) does not decrease the incidence of PNALD but does slow its progression.
    • Patients whose cholestasis reverses with fish oil therapy or achievement of enteral autonomy may have stable rather than progressive cirrhosis and should not be transplanted based on biopsy alone.

Parenteral Nutrition Associated Liver Toxicity: Prevention, Diagnosis, and Management

Lorenzo Anez-Bustillos, MD, Meredith A. Baker, MD, Duy T. Dao, MD, Gillian L. Fell, MD, Kathleen M. Gura, PharmD, Mark Puder, MD, PhD
    • Fish oil–based lipid emulsions may be efficacious in the treatment of parenteral nutrition–associated liver disease (PNALD).
    • Lipid reduction (e.g., to 1 g/kg/day) does not decrease the incidence of PNALD but does slow its progression.
    • Patients whose cholestasis reverses with fish oil therapy or achievement of enteral autonomy may have stable rather than progressive cirrhosis and should not be transplanted based on biopsy alone.

Endoscopic Techniques for Obtaining Enteral Access

Marvin Ryou, MD, Sanjay Salgado, MD
    • DPEJ tubes should be considered when percutaneous endoscopic gastrostomy (PEG) tubes are not feasible or are contraindicated.
    • Postpyloric feeding (percutaneous gastrostomy with a jejunal extension or direct percutaneous jejunostomy should be considered in severely ill patients (especially those with an APACHE II score over 20).
    • In patients with dementia, PEG tube placement does not enhance mortality, prevent aspiration pneumonia, improve nutritional status, or improve quality of life.

Nutritional Management of Celiac Disease

Ciarán P Kelly, MD, Satya Kurada, MD, Mariana Urquiaga, MD
    • Glutenases: Clinical trials using glutenases versus placebo have demonstrated worsening of histologic findings in the placebo group compared with glutenases on consumption of up to 2 g of gluten.
    • Tight junction regulators: Larazotide acetate demonstrated a reduction in gluten-induced immune reactivity and symptoms when celiac subjects were exposed to a 2.7 g gluten challenge when compared with placebo in a randomized, double-blind, placebo-controlled trial.
    • IgY antibodies: Animal studies using mice fed with gastric-stabilized antigliadin IgY antibodies derived from the egg yolks of gluten-immunized chickens in addition to gluten showed a reduction in gluten absorption from the diet.

Overview Of Enteral Nutrition

Rebecca Lynch, MS, RD, LDN, CNSC, Erin Sisk, MS, RD, LDN, CNSC
    • Immunomodulating formulas may not offer additional benefits to critically ill patients.
    • Special pulmonary formulas do not improve outcomes for patients with ARDS.
    • Gastric residuals are not a factor in assessing for enteral tolerance as they do not correlate with risk of aspiration and pneumonia.

The Immunocompromised Surgical Patient and Opportunistic Infections

Kiran Gajurel, MD, Aruna K Subramanian, MD
    • Solid-organ transplant recipients may not present with classic signs and symptoms of infections due to their immunosuppressive state
    • Due to overlapping radiologic and clinical features of various opportunistic infections, a tissue biopsy should be obtained, if feasible, to establish diagnosis.
    • Mycobacterium chimaera,associated with heater cooler devices used during cardiac surgery, has recently emerged as an important pathogen in post cardiac surgery patients.
    • Rapamycins cause delayed wound healing and should be avoided in the immediate postoperative period.
    • Isavuconazole is  as efficacious as voriconazole in the treatment of invasive aspergillosis.
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