Event Report | BAPEN Conference Review Micronutrients under the
Microscope Pharmacist Tony Murphy, who chaired this fascinating symposium, provides a summary. Dr Mary Fewtrell, a researcher in paediatric
nutrition at the Institute of Child Health in London, summarised the follow-up studies to Bishop’s seminal paper on ‘Aluminium exposure in preterm infants on parenteral nutrition (PN)’.
Infants
BAPEN Chair, and polar explorer, Mike Stroud tells the Mayor of Harrogate about getting frostbite in nasty places – like Antarctica
randomised to receive PN containing either ‘standard’ or ‘low’ amounts of aluminium were monitored for signs of aluminium toxicity.
At 18
BAPEN’s Rhonda Smith asks Gastroenterologist John McLaughlin if this is the type of camera they use for colonoscopies
months there were signs of neurological impairment in infants exposed for >10 days to standard PN. At 13-15 years, infants randomised to standard PN had lower lumbar spine bone mass, and those who had received aluminium intakes above the median (55mcg/kg) had lower hip bone mass. The follow up studies at 13-15yrs were not able to demonstrate any neurological effects, due in part, to the limitations of follow up. An important source of aluminium in injections, is the result of leaching from the glass of ampoules, particularly where the injection solution is highly acidic. Calcium gluconate is commonly added to paediatric PN solutions, and when supplied in small volume glass ampoules, is a known high source of aluminium. Recent advice from the MHRA to discontinue the use of calcium gluconate in glass ampoules, in all children <18 years, will have reduced the aluminium load in paediatric PN in the UK – an important step! Ken Newton, Principal Clinical Scientist, in the
Clinical Biochemistry department at Leeds, gave a sparkling presentation on the intricacies of monitoring trace elements in clinical samples. With panache, Ken introduced the audience to ‘Inductively Coupled Plasma Mass Spectroscopy’, collision cells, interference between masses and ions. Fortunately the UK still has a few specialist trace element monitoring laboratories with enthusiasts like Ken, working together on standardisation of techniques and accreditation.
Young scientists need to be
encouraged to carry on with this important work. Professor Mike Allwood, a pharmaceutical
The PEN Group’s Carole-Anne Fleming and Mel Baker enjoy a good wine at the poster session
The PEN Group’s Anne Holdoway invites CN readers to think of their own caption involving Mike Stroud’s shorts and this particular type of shellfish
consultant to the Homecare industry on PN stability, gave a talk on the stability of trace elements and vitamins in current PN feeds. Although micronutrients can compromise chemical stability of PN feeds, it is possible to provide ‘complete feeds’ with an extended shelf life, given an understanding of the chemical mechanisms which lead to instability. Degradation of vitamin C is dependant on the amount of oxygen (Oxygen load) in the compounded PN bag. By removing residual air from the compounded bag after mixing, by using oxygen scavengers between inner and outer packaging, and by using PN bags made with gas impermeable materials, it is possible to reduce vitamin C losses. Additional vitamin C is often added to PN for home patients to compensate for ‘unavoidable’ losses. The symposium ended with a question to Mike
Allwood from Susan Hill (Consultant Paediatrician GOS) – ‘What are we to do when you finally retire?’
44 | Complete Nutrition Vol.10 No.6 December/January 2010/11
This question could have been equally addressed to both Ken and Mary.
researchers with a solid background in science, to support ‘safety’ in the delivery of intravenous nutritional support.
Nutrition in Surgery Nutrition is the Cutting Edge in Surgery looked at the vital role of nutrition in improving outcomes in surgery. The importance of nutritional support in improving wound healing and immune function was reviewed by Professor Federico Bozzetti from Milan University, before Dietitian Caroline Kratzing showed how perioperative carbohydrate loading can reduce postoperative catabolism and insulin resistance. Routes of postoperative enteral nutrition were explored using jejunostomy in oesophagogastrectomy as shown in the example by Surgeon Graeme Couper and Research Fellow Tom Palser.
HIFNET and PN Symposium 8 explained the Home Intestinal Failure Network (HIFNET) and how it has the potential to improve the lives of people with intestinal failure.
Nestle Satellite Symposium: Best practice in the preparation
of patients for bariatric surgery This session is reviewed by Pharmacist Ruth Newton. Bariatric surgery is an unfortunate presence in our society today but is in many cases a life saver. However, like many aspects of healthcare, it must be done by specialists in the field to prevent complications such as intestinal failure. These patients have a lot of co-morbidities which are life threatening without the added pressures of poor outcome due to poor nutritional status. The symposium showed that even with the best intentions a long recovery is inevitable with these patients. Nutritional issues impact on wound healing, length of stay, sepsis and patient psych. As obesity is such a topical issue, there has been a lot of discussion about the way these patients are fed; the historical uneducated view being to ‘feed em lean’ has now been overturned and more evidence has been found to feed to basal requirements. The first two key speakers addressed the topics very well and gave us insight into an area which will impact on most of professional patient groups. Although, with the increasing budget cuts and pressures to turnaround patients faster, the obese with their co-morbidities have a large financial implication for our services. However, the new commissioning being brought into the NHS will reward for specialist services. This is a very positive step for us as it will mean that the funding will be given to the actual specialists rather than us having to tender for care with the purse strings being held by the group not looking after care. Currently, services such as intestinal failure are not resourced properly but with the proposed restructuring, and with help from BAPEN, The British Intestinal Failure Association (BIFA) and the new commissioning body, it can only mean the best care for our patients
PN needs enthusiasts,
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