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