Metabolic bone diseases and parenteral nutrition in pediatric patients: clinical and nursing aspects

Authors

  • Stavroula P. Papanastasiou
  • Maria P. Torlachidou
  • Ioannis K. Triantafyllopoulos
  • George I. Lambrou

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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Author Biographies

Stavroula P. Papanastasiou

1Postgraduate Program “Metabolic Bones Diseases”, National and Kapodistrian University of Athens, Medical School, Mikras Asias 75, 11527, Goudi, Athens, Greece

Maria P. Torlachidou

Postgraduate Program “Metabolic Bones Diseases”, National and Kapodistrian University of Athens, Medical School, Mikras Asias 75, 11527, Goudi, Athens, Greece

Ioannis K. Triantafyllopoulos

1Postgraduate Program “Metabolic Bones Diseases”, National and Kapodistrian University of Athens, Medical School, Mikras Asias 75, 11527, Goudi, Athens, Greece

2Laboratory for the Research of the Musculoskeletal System “Th. Garofalidis”, National and Kapodistrian University of Athens, Medical School, Nikis 2, 14561, Kifissia, Athens, Greece

3 Head of the 5th Orthopaedic Dpt, HYGEIA Hospital, Athens, Greece

George I. Lambrou

Postgraduate Program “Metabolic Bones Diseases”, National and Kapodistrian University of Athens, Medical School, Mikras Asias 75, 11527, Goudi, Athens, Greece

Laboratory for the Research of the Musculoskeletal System “Th. Garofalidis”, National and Kapodistrian University of Athens, Medical School, Nikis 2, 14561, Kifissia, Athens, Greece

Choremeio Research Laboratory, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece, Thivon & Levadeias 8, 11527, Goudi, Athens, Greece

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Published

2020-12-11