Metabolic bone diseases and parenteral nutrition in pediatric patients: clinical and nursing aspects
Keywords:
Bone, Metabolic disease, Parenteral nutrition, Pediatric, Nursing
Abstract
Total parenteral nutrition is a feeding strategy widely used in children and, particularly, in preterm infants, due to a variety of pathological conditions that hinder enteral feeding. Parenteral feeding has been associated with the development of metabolic bone diseases. These can manifest as rickets and/or pediatric osteoporosis, with a prevalence reaching 40%, while the nutritional limitations of parenteral feeding, along with the increased metabolic needs of the bones at this growth stage, further deteriorate the problem. There are plenty of theories regarding the underlying mechanisms. Deficiency or toxicity of nutrients, such as calcium, phosphorus and vitamin D, and cholestasis have been identified as risk factors. Another contributing factor is the contamination with aluminum, with its numerous deleterious effects, along with the composition of the fatty acid emulsions administered. Appropriate enrichment of parenteral nutrition solutions with specific nutrients plays a key role in managing or preventing the disease. High standards in the use of this method, including the restriction of aluminum contamination, are of high importance. The role of clinicians and nurses is crucial, since a significant level of alert for malnutrition signs is required, as well as high professional standards for applying and maintaining the parenteral nutrition setting.
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References
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3. Compston JE, Ayers AB, Horton LW, et al. Osteomalacia after small-intestinal resection. Lancet 1978; 1(8054): 9-12.
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8. Corkins MR, Guenter P, DiMaria-Ghalili RA, et al. Malnutrition diagnoses in hospitalized patients: United States, 2010. JPEN J Parenter Enteral Nutr 2014; 38(2): 186-95.
9. Rustico SE, Calabria AC, and Garber SJ. Metabolic bone disease of prematurity. J Clin Transl Endocrinol 2014; 1(3): 85-91.
10. Phillips SK. Pediatric parenteral nutrition: differences in practice from adult care. J Infus Nurs 2004; 27(3): 166-70.
11. Puntis JW. Nutritional support in the premature newborn. Postgrad Med J 2006; 82(965): 192-8.
12. Rigo J and Senterre J. Nutritional needs of premature infants: Current Issues. The Journal of Pediatrics 2006; 149(5, Supplement): S80-S88.
13. Mantegazza C, Landy N, Zuccotti GV, et al. Indications and complications of inpatient parenteral nutrition prescribed to children in a large tertiary referral hospital. Ital J Pediatr 2018; 44(1): 66.
14. Lee SM, Namgung R, Park MS, et al. High incidence of rickets in extremely low birth weight infants with severe parenteral nutrition-associated cholestasis and bronchopulmonary dysplasia. J Korean Med Sci 2012; 27(12): 1552-5.
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16. Klein GL. Aluminum in parenteral solutions revisited--again. Am J Clin Nutr 1995; 61(3): 449-56.
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34. Koo WW and Tsang R. Bone mineralization in infants. Prog Food Nutr Sci 1984; 8(3-4): 229-302.
35. Koo WW, Tsang RC, Succop P, et al. Minimal vitamin D and high calcium and phosphorus needs of preterm infants receiving parenteral nutrition. J Pediatr Gastroenterol Nutr 1989; 8(2): 225-33.
36. Hurley DL and McMahon MM. Long-term parenteral nutrition and metabolic bone disease. Endocrinol Metab Clin North Am 1990; 19(1): 113-31.
37. Ukarapong S, Venkatarayappa SKB, Navarrete C, et al. Risk factors of metabolic bone disease of prematurity. Early Hum Dev 2017; 112: 29-34.
38. Klein GL, Targoff CM, Ament ME, et al. Bone disease associated with total parenteral nutrition. Lancet 1980; 2(8203): 1041-4.
39. Klein GL. Metabolic bone disease of total parenteral nutrition. Nutrition 1998; 14(1): 149-52.
40. Klein GL and Coburn JW. Parenteral nutrition: effect on bone and mineral homeostasis. Annu Rev Nutr 1991; 11: 93-119.
41. Parisien M, Charhon SA, Arlot M, et al. Evidence for a toxic effect of aluminum on osteoblasts: a histomorphometric study in hemodialysis patients with aplastic bone disease. J Bone Miner Res 1988; 3(3): 259-67.
42. Ellis KJ, Shypailo RJ, Schanler RJ, et al. Body elemental composition of the neonate: New reference data. Am J Hum Biol 1993; 5(3): 323-30.
43. Viswanathan S, Khasawneh W, McNelis K, et al. Metabolic bone disease: a continued challenge in extremely low birth weight infants. JPEN J Parenter Enteral Nutr 2014; 38(8): 982-90.
44. Koo WW, Sherman R, Succop P, et al. Fractures and rickets in very low birth weight infants: conservative management and outcome. J Pediatr Orthop 1989; 9(3): 326-30.
45. Fitzgerald KA and MacKay MW. Calcium and phosphate solubility in neonatal parenteral nutrient solutions containing TrophAmine. Am J Hosp Pharm 1986; 43(1): 88-93.
46. Dunham B, Marcuard S, Khazanie PG, et al. The solubility of calcium and phosphorus in neonatal total parenteral nutrition solutions. JPEN J Parenter Enteral Nutr 1991; 15(6): 608-11.
47. Lenz GT and Mikrut BA. Calcium and phosphate solubility in neonatal parenteral nutrient solutions containing Aminosyn-PF or TrophAmine. Am J Hosp Pharm 1988; 45(11): 2367-71.
48. Kirkpatrick AE, Holcombe BJ, and Sawyer WT. Effect of retrograde aminophylline administration on calcium and phosphate solubility in neonatal total parenteral nutrient solutions. Am J Hosp Pharm 1989; 46(12): 2496-500.
49. Pelegano JF, Rowe JC, Carey DE, et al. Simultaneous infusion of calcium and phosphorus in parenteral nutrition for premature infants: use of physiologic calcium/phosphorus ratio. J Pediatr 1989; 114(1): 115-9.
50. Pelegano JF, Rowe JC, Carey DE, et al. Effect of calcium/phosphorus ratio on mineral retention in parenterally fed premature infants. J Pediatr Gastroenterol Nutr 1991; 12(3): 351-5.
51. Driscoll RH, Jr., Meredith SC, Sitrin M, et al. Vitamin D deficiency and bone disease in patients with Crohn’s disease. Gastroenterology 1982; 83(6): 1252-8.
52. Bar-Shavit Z, Teitelbaum SL, Reitsma P, et al. Induction of monocytic differentiation and bone resorption by 1,25-dihydroxyvitamin D3. Proc Natl Acad Sci U S A 1983; 80(19): 5907-11.
53. Lo CW, Paris PW, and Holick MF. Indian and Pakistani immigrants have the same capacity as Caucasians to produce vitamin D in response to ultraviolet irradiation. Am J Clin Nutr 1986; 44(5): 683-5.
54. Larchet M, Garabédian M, Bourdeau A, et al. Calcium metabolism in children during long-term total parenteral nutrition: the influence of calcium, phosphorus, and vitamin D intakes. J Pediatr Gastroenterol Nutr 1991; 13(4): 367-75.
55. Shike M, Shils ME, Heller A, et al. Bone disease in prolonged parenteral nutrition: osteopenia without mineralization defect. Am J Clin Nutr 1986; 44(1): 89-98.
56. Koo WW, Tsang RC, Steichen JJ, et al. Vitamin D requirement in infants receiving parenteral nutrition. JPEN J Parenter Enteral Nutr 1987; 11(2): 172-6.
57. Klein GL, Alfrey AC, Shike M, et al. Aluminum and TPN-related bone disease. Am J Clin Nutr 1992; 55(2): 483-5.
58. Lidor C, Schwartz I, Freund U, et al. Successful high-dose calcium treatment of aluminum-induced metabolic bone disease in long-term home parenteral nutrition. JPEN J Parenter Enteral Nutr 1991; 15(2): 202-6.
59. Hamilton C and Seidner DL. Metabolic bone disease and parenteral nutrition. Curr Gastroenterol Rep 2004; 6(4): 335-41.
60. Jimenez L, Mehta NM, and Duggan CP. Timing of the initiation of parenteral nutrition in critically ill children. Curr Opin Clin Nutr Metab Care 2017; 20(3): 227-31.
61. Koo WW, Kaplan LA, Bendon R, et al. Response to aluminum in parenteral nutrition during infancy. J Pediatr 1986; 109(5): 877-83.
62. Feldman AG and Sokol RJ. Neonatal Cholestasis. Neoreviews 2013; 14(2).
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64. Bridges KM, Pereira-da-Silva L, Tou JC, et al. Bone metabolism in very preterm infants receiving total parenteral nutrition: do intravenous fat emulsions have an impact? Nutr Rev 2015; 73(12): 823-36.
65. Lukas R, Gigliotti JC, Smith BJ, et al. Consumption of different sources of omega-3 polyunsaturated fatty acids by growing female rats affects long bone mass and microarchitecture. Bone 2011; 49(3): 455-62.
66. Kuschel C and Harding J, Multicomponent fortified human milk for promoting growth in preterm infants, in The Cochrane Collaboration, editor. The Cochrane Database of Systematic Reviews, T.C. Collaboration, Editor. 1999, John Wiley & Sons, Ltd: Chichester, UK. p. CD000343.
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72. Commentary on parenteral nutrition. Committee on Nutrition. Pediatrics 1983; 71(4): 547-52.
73. Donor Human Milk for the High-Risk Infant: Preparation, Safety, and Usage Options in the United States. Pediatrics 2017; 139(1).
74. Nehra D, Carlson SJ, Fallon EM, et al. A.S.P.E.N. clinical guidelines: nutrition support of neonatal patients at risk for metabolic bone disease. JPEN J Parenter Enteral Nutr 2013; 37(5): 570-98.
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2. Shike M, Harrison JE, Sturtridge WC, et al. Metabolic bone disease in patients receiving long-term total parenteral nutrition. Ann Intern Med 1980; 92(3): 343-50.
3. Compston JE, Ayers AB, Horton LW, et al. Osteomalacia after small-intestinal resection. Lancet 1978; 1(8054): 9-12.
4. Abdelhadi RA, Bouma S, Bairdain S, et al. Characteristics of Hospitalized Children With a Diagnosis of Malnutrition: United States, 2010. JPEN J Parenter Enteral Nutr 2016; 40(5): 623-35.
5. Brown RO and Compher C. A.S.P.E.N. clinical guidelines: nutrition support in adult acute and chronic renal failure. JPEN J Parenter Enteral Nutr 2010; 34(4): 366-77.
6. Corkins MR, Griggs KC, Groh-Wargo S, et al. Standards for nutrition support: pediatric hospitalized patients. Nutr Clin Pract 2013; 28(2): 263-76.
7. Corkins MR, Guenter P, DiMaria-Ghalili RA, et al. A.S.P.E.N. data brief 2014: use of enteral and parenteral nutrition in hospitalized patients with a diagnosis of malnutrition: United States, 2010. Nutr Clin Pract 2014; 29(5): 698-700.
8. Corkins MR, Guenter P, DiMaria-Ghalili RA, et al. Malnutrition diagnoses in hospitalized patients: United States, 2010. JPEN J Parenter Enteral Nutr 2014; 38(2): 186-95.
9. Rustico SE, Calabria AC, and Garber SJ. Metabolic bone disease of prematurity. J Clin Transl Endocrinol 2014; 1(3): 85-91.
10. Phillips SK. Pediatric parenteral nutrition: differences in practice from adult care. J Infus Nurs 2004; 27(3): 166-70.
11. Puntis JW. Nutritional support in the premature newborn. Postgrad Med J 2006; 82(965): 192-8.
12. Rigo J and Senterre J. Nutritional needs of premature infants: Current Issues. The Journal of Pediatrics 2006; 149(5, Supplement): S80-S88.
13. Mantegazza C, Landy N, Zuccotti GV, et al. Indications and complications of inpatient parenteral nutrition prescribed to children in a large tertiary referral hospital. Ital J Pediatr 2018; 44(1): 66.
14. Lee SM, Namgung R, Park MS, et al. High incidence of rickets in extremely low birth weight infants with severe parenteral nutrition-associated cholestasis and bronchopulmonary dysplasia. J Korean Med Sci 2012; 27(12): 1552-5.
15. Faienza MF, D’Amato E, Natale MP, et al. Metabolic Bone Disease of Prematurity: Diagnosis and Management. Front Pediatr 2019; 7: 143.
16. Klein GL. Aluminum in parenteral solutions revisited--again. Am J Clin Nutr 1995; 61(3): 449-56.
17. Fanni D, Ambu R, Gerosa C, et al. Aluminum exposure and toxicity in neonates: a practical guide to halt aluminum overload in the prenatal and perinatal periods. World J Pediatr 2014; 10(2): 101-7.
18. Kolacek S, Enteral Nutrition, in World Review of Nutrition and Dietetics, H. Szajewska and R. Shamir, Editors. 2013, Karger: Basel. p. 86–90.
19. Steelman J and Zeitler P. Osteoporosis in pediatrics. Pediatr Rev 2001; 22(2): 56-65.
20. Rauch F, The Rachitic Bone, in Endocrine Development, Z. Hochberg, Editor. 2003, Karger: Basel. p. 69–79.
21. Pitt MJ, Rickets and Osteomalacia, in Pitt MJ. Rickets and Osteomalacia. In: Bone and Joint Imaging Elsevier; 2005. p. 563–75, D.L. Resnick and M.J. Kransdorf, Editors. 2005, Elsevier: Philadelphia, Pennsylvania. p. 563–75.
22. Fraser D, Kooh SW, Kind HP, et al. Pathogenesis of hereditary vitamin-D-dependent rickets. An inborn error of vitamin D metabolism involving defective conversion of 25-hydroxyvitamin D to 1 alpha,25-dihydroxyvitamin D. N Engl J Med 1973; 289(16): 817-22.
23. Buchman AL and Moukarzel A. Metabolic bone disease associated with total parenteral nutrition. Clin Nutr 2000; 19(4): 217-31.
24. Figueras-Aloy J, Álvarez-Domínguez E, Pérez-Fernández JM, et al. Metabolic bone disease and bone mineral density in very preterm infants. J Pediatr 2014; 164(3): 499-504.
25. Lucas A, Brooke OG, Baker BA, et al. High alkaline phosphatase activity and growth in preterm neonates. Arch Dis Child 1989; 64(7 Spec No): 902-9.
26. Mitchell SM, Rogers SP, Hicks PD, et al. High frequencies of elevated alkaline phosphatase activity and rickets exist in extremely low birth weight infants despite current nutritional support. BMC Pediatr 2009; 9: 47.
27. Abdallah EA, Said RN, Mosallam DS, et al. Serial serum alkaline phosphatase as an early biomarker for osteopenia of prematurity. Medicine (Baltimore) 2016; 95(37): e4837.
28. Bishop N. Bone disease in preterm infants. Arch Dis Child 1989; 64(10 Spec No): 1403-9.
29. Backström MC, Kouri T, Kuusela AL, et al. Bone isoenzyme of serum alkaline phosphatase and serum inorganic phosphate in metabolic bone disease of prematurity. Acta Paediatr 2000; 89(7): 867-73.
30. Faerk J, Peitersen B, Petersen S, et al. Bone mineralisation in premature infants cannot be predicted from serum alkaline phosphatase or serum phosphate. Arch Dis Child Fetal Neonatal Ed 2002; 87(2): F133-6.
31. Rehman MU and Narchi H. Metabolic bone disease in the preterm infant: Current state and future directions. World J Methodol 2015; 5(3): 115-21.
32. Rigo J, Nyamugabo K, Picaud JC, et al. Reference values of body composition obtained by dual energy X-ray absorptiometry in preterm and term neonates. J Pediatr Gastroenterol Nutr 1998; 27(2): 184-90.
33. Nemet D, Dolfin T, Wolach B, et al. Quantitative ultrasound measurements of bone speed of sound in premature infants. Eur J Pediatr 2001; 160(12): 736-40.
34. Koo WW and Tsang R. Bone mineralization in infants. Prog Food Nutr Sci 1984; 8(3-4): 229-302.
35. Koo WW, Tsang RC, Succop P, et al. Minimal vitamin D and high calcium and phosphorus needs of preterm infants receiving parenteral nutrition. J Pediatr Gastroenterol Nutr 1989; 8(2): 225-33.
36. Hurley DL and McMahon MM. Long-term parenteral nutrition and metabolic bone disease. Endocrinol Metab Clin North Am 1990; 19(1): 113-31.
37. Ukarapong S, Venkatarayappa SKB, Navarrete C, et al. Risk factors of metabolic bone disease of prematurity. Early Hum Dev 2017; 112: 29-34.
38. Klein GL, Targoff CM, Ament ME, et al. Bone disease associated with total parenteral nutrition. Lancet 1980; 2(8203): 1041-4.
39. Klein GL. Metabolic bone disease of total parenteral nutrition. Nutrition 1998; 14(1): 149-52.
40. Klein GL and Coburn JW. Parenteral nutrition: effect on bone and mineral homeostasis. Annu Rev Nutr 1991; 11: 93-119.
41. Parisien M, Charhon SA, Arlot M, et al. Evidence for a toxic effect of aluminum on osteoblasts: a histomorphometric study in hemodialysis patients with aplastic bone disease. J Bone Miner Res 1988; 3(3): 259-67.
42. Ellis KJ, Shypailo RJ, Schanler RJ, et al. Body elemental composition of the neonate: New reference data. Am J Hum Biol 1993; 5(3): 323-30.
43. Viswanathan S, Khasawneh W, McNelis K, et al. Metabolic bone disease: a continued challenge in extremely low birth weight infants. JPEN J Parenter Enteral Nutr 2014; 38(8): 982-90.
44. Koo WW, Sherman R, Succop P, et al. Fractures and rickets in very low birth weight infants: conservative management and outcome. J Pediatr Orthop 1989; 9(3): 326-30.
45. Fitzgerald KA and MacKay MW. Calcium and phosphate solubility in neonatal parenteral nutrient solutions containing TrophAmine. Am J Hosp Pharm 1986; 43(1): 88-93.
46. Dunham B, Marcuard S, Khazanie PG, et al. The solubility of calcium and phosphorus in neonatal total parenteral nutrition solutions. JPEN J Parenter Enteral Nutr 1991; 15(6): 608-11.
47. Lenz GT and Mikrut BA. Calcium and phosphate solubility in neonatal parenteral nutrient solutions containing Aminosyn-PF or TrophAmine. Am J Hosp Pharm 1988; 45(11): 2367-71.
48. Kirkpatrick AE, Holcombe BJ, and Sawyer WT. Effect of retrograde aminophylline administration on calcium and phosphate solubility in neonatal total parenteral nutrient solutions. Am J Hosp Pharm 1989; 46(12): 2496-500.
49. Pelegano JF, Rowe JC, Carey DE, et al. Simultaneous infusion of calcium and phosphorus in parenteral nutrition for premature infants: use of physiologic calcium/phosphorus ratio. J Pediatr 1989; 114(1): 115-9.
50. Pelegano JF, Rowe JC, Carey DE, et al. Effect of calcium/phosphorus ratio on mineral retention in parenterally fed premature infants. J Pediatr Gastroenterol Nutr 1991; 12(3): 351-5.
51. Driscoll RH, Jr., Meredith SC, Sitrin M, et al. Vitamin D deficiency and bone disease in patients with Crohn’s disease. Gastroenterology 1982; 83(6): 1252-8.
52. Bar-Shavit Z, Teitelbaum SL, Reitsma P, et al. Induction of monocytic differentiation and bone resorption by 1,25-dihydroxyvitamin D3. Proc Natl Acad Sci U S A 1983; 80(19): 5907-11.
53. Lo CW, Paris PW, and Holick MF. Indian and Pakistani immigrants have the same capacity as Caucasians to produce vitamin D in response to ultraviolet irradiation. Am J Clin Nutr 1986; 44(5): 683-5.
54. Larchet M, Garabédian M, Bourdeau A, et al. Calcium metabolism in children during long-term total parenteral nutrition: the influence of calcium, phosphorus, and vitamin D intakes. J Pediatr Gastroenterol Nutr 1991; 13(4): 367-75.
55. Shike M, Shils ME, Heller A, et al. Bone disease in prolonged parenteral nutrition: osteopenia without mineralization defect. Am J Clin Nutr 1986; 44(1): 89-98.
56. Koo WW, Tsang RC, Steichen JJ, et al. Vitamin D requirement in infants receiving parenteral nutrition. JPEN J Parenter Enteral Nutr 1987; 11(2): 172-6.
57. Klein GL, Alfrey AC, Shike M, et al. Aluminum and TPN-related bone disease. Am J Clin Nutr 1992; 55(2): 483-5.
58. Lidor C, Schwartz I, Freund U, et al. Successful high-dose calcium treatment of aluminum-induced metabolic bone disease in long-term home parenteral nutrition. JPEN J Parenter Enteral Nutr 1991; 15(2): 202-6.
59. Hamilton C and Seidner DL. Metabolic bone disease and parenteral nutrition. Curr Gastroenterol Rep 2004; 6(4): 335-41.
60. Jimenez L, Mehta NM, and Duggan CP. Timing of the initiation of parenteral nutrition in critically ill children. Curr Opin Clin Nutr Metab Care 2017; 20(3): 227-31.
61. Koo WW, Kaplan LA, Bendon R, et al. Response to aluminum in parenteral nutrition during infancy. J Pediatr 1986; 109(5): 877-83.
62. Feldman AG and Sokol RJ. Neonatal Cholestasis. Neoreviews 2013; 14(2).
63. Feranchak AP, Suchy FJ, and Sokol RJ, Medical and nutritional management of cholestasis in infants and children, in Liver Disease in Children, F.J. Suchy, R.J. Sokol, and W.F. Balistreri, Editors. 2014, Cambridge University Press: Cambridge. p. 111–39.
64. Bridges KM, Pereira-da-Silva L, Tou JC, et al. Bone metabolism in very preterm infants receiving total parenteral nutrition: do intravenous fat emulsions have an impact? Nutr Rev 2015; 73(12): 823-36.
65. Lukas R, Gigliotti JC, Smith BJ, et al. Consumption of different sources of omega-3 polyunsaturated fatty acids by growing female rats affects long bone mass and microarchitecture. Bone 2011; 49(3): 455-62.
66. Kuschel C and Harding J, Multicomponent fortified human milk for promoting growth in preterm infants, in The Cochrane Collaboration, editor. The Cochrane Database of Systematic Reviews, T.C. Collaboration, Editor. 1999, John Wiley & Sons, Ltd: Chichester, UK. p. CD000343.
67. Bonsante F, Iacobelli S, Latorre G, et al. Initial amino acid intake influences phosphorus and calcium homeostasis in preterm infants--it is time to change the composition of the early parenteral nutrition. PLoS One 2013; 8(8): e72880.
68. Lukert BP and Raisz LG. Glucocorticoid-induced osteoporosis: pathogenesis and management. Ann Intern Med 1990; 112(5): 352-64.
69. Munns CF, Shaw N, Kiely M, et al. Global Consensus Recommendations on Prevention and Management of Nutritional Rickets. J Clin Endocrinol Metab 2016; 101(2): 394-415.
70. Agostoni C, Buonocore G, Carnielli VP, et al. Enteral nutrient supply for preterm infants: commentary from the European Society of Paediatric Gastroenterology, Hepatology and Nutrition Committee on Nutrition. J Pediatr Gastroenterol Nutr 2010; 50(1): 85-91.
71. Stalnaker KA and Poskey GA. Osteopenia of Prematurity: Does Physical Activity Improve Bone Mineralization in Preterm Infants? Neonatal Netw 2016; 35(2): 95-104.
72. Commentary on parenteral nutrition. Committee on Nutrition. Pediatrics 1983; 71(4): 547-52.
73. Donor Human Milk for the High-Risk Infant: Preparation, Safety, and Usage Options in the United States. Pediatrics 2017; 139(1).
74. Nehra D, Carlson SJ, Fallon EM, et al. A.S.P.E.N. clinical guidelines: nutrition support of neonatal patients at risk for metabolic bone disease. JPEN J Parenter Enteral Nutr 2013; 37(5): 570-98.
75. Mirtallo J, Canada T, Johnson D, et al. Safe practices for parenteral nutrition. JPEN J Parenter Enteral Nutr 2004; 28(6): S39-70.
76. DiMaria-Ghalili RA, Bankhead R, Fisher AA, et al. Standards of practice for nutrition support nurses. Nutr Clin Pract 2007; 22(4): 458-65.
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Published
2020-12-11
Section
Review
Copyright (c) 2020 Acta Orthopaedica Et Traumatologica Hellenica
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