J Am Vet Med Assoc. Erythromycin for the prevention of chronic lung disease in intubated preterm infants at risk for, or colonized or infected with Ureaplasma urealyticum. Semi-elemental and elemental formulas are available for patients with malabsorption who do not or will not tolerate standard formulas. There is concern that long-term use of oral nutrition supplements can result in taste fatigue and decreased compliance with recommendations. Consider psychological counseling or medications if you find yourself eating to address feelings of stress, fear, or depression, and try to find alternatives to eating out of boredom.
Continuous infusion versus intermittent flushing to prevent loss of function of peripheral intravenous catheters used for drug administration in newborn infants. Continuous nasogastric milk feeding versus intermittent bolus milk feeding for premature infants less than grams. Continuous positive airway pressure versus theophylline for apnea in preterm infants.
Continuous versus bolus intragastric tube feeding for preterm and low birth weight infants with gastro-oesophageal reflux disease. Cooling for newborns with hypoxic ischaemic encephalopathy. Corticosteroids for sepsis and septic shock in newborns. Corticosteroids for the prevention and treatment of bronchopulmonary dysplasia: Corticosteroids for treating hypotension in preterm infants. Cot-nursing versus incubator care for preterm infants. Cradle hold control versus alternate positions intervention during bottle feeding on physiological stability in preterm infants.
Cromolyn sodium for the prevention of chronic lung disease in preterm infants. Cup feeding versus other forms of supplemental enteral feeding for newborn infants unable to fully breastfeed. Cutaneous antisepsis for prevention of intravascular catheter—associated infection in newborn infants. Cycled light in the intensive care unit for preterm and low birth weight infants.
Cysteine, cystine or N-acetylcysteine supplementation in parenterally fed neonates. D-Penicillamine for preventing retinopathy of prematurity in preterm infants. Deep versus shallow suction of endotracheal tubes in ventilated neonates and young infants. Delayed introduction of progressive enteral feeds to prevent necrotising enterocolitis in very low birth weight infants.
Developmental care for promoting development and preventing morbidity in preterm infants. Devices and pressure sources for administration of nasal continuous positive airway pressure NCPAP in preterm neonates.
Dexmedetomidine for analgesia and sedation in newborn infants receiving mechanical ventilation. Dexmedetomidine for procedural analgesia in newborn infants. Diagnostic accuracy of C-reactive protein versus peripheral leukocyte counts for early-onset sepsis in asymptomatic, at-risk full-term neonates. Diagnostic accuracy of MRI for identifying neurodevelopmental impairment in infants with hypoxic ischemic encephalopathy.
Diagnostic accuracy of MRI versus cranial ultrasound for hypoxic ischaemic encephalopathy in neonates. Diaphragm-triggered non-invasive respiratory support for preventing respiratory failure in preterm infants. Diazepam for treating tetanus. Diazoxide for treatment of hypoglycemia in neonates. Different strains of probiotics for preventing morbidity and mortality in preterm infants: Digoxin for preventing or treating neonatal respiratory distress syndrome.
Dilute versus full strength formula in exclusively formula-fed preterm or low birth weight infants. Direct antiglobulin Coombs test for diagnosis of newborns at risk of immune haemolysis.
Diuretic therapy for newborn infants with posthemorrhagic ventricular dilatation. Diuretics acting on the distal renal tubule for preterm infants with or developing chronic lung disease. Diuretics for respiratory distress syndrome in preterm infants.
Diuretics for transient tachypnoea of the newborn. Dopamine for prevention of morbidity and mortality in term newborn infants with suspected perinatal asphyxia. Dopamine versus dobutamine for hypotensive preterm infants. Dopamine versus no treatment to prevent renal dysfunction in indomethacin-treated preterm newborn infants.
Double wall versus single wall incubator for reducing heat loss in very low birth weight infants in incubators. Doxapram for the prevention and treatment of apnea in preterm infants. Doxapram treatment for apnea in preterm infants. Doxapram versus methylxanthine for apnea in preterm infants.
Early within the first 7 days versus expectant management of hemodynamically significant patent ductus arteriosus PDA for preterm infants. Early administration of inhaled corticosteroids for preventing chronic lung disease in very low birth weight preterm neonates. Early developmental intervention programmes provided post hospital discharge to prevent motor and cognitive impairment in preterm infants.
Early discharge with home support of gavage feeding for stable preterm infants who have not established full oral feeds. Early enteral feeding strategies for preterm infants: Early erythropoiesis-stimulating agents in preterm or low birth weight infants. Early fortification of human milk versus delayed fortification to promote growth in preterm infants. Early intravenous nutrition for the prevention of neonatal jaundice.
Early introduction of lipids to parenterally-fed preterm infants. Early light reduction for preventing retinopathy of prematurity in very low birth weight infants. Early planned removal of umbilical venous catheters to prevent infection in newborn infants. Early planned removal versus expectant management of peripherally inserted central catheters to prevent infection in newborn infants.
Early removal versus expectant management of central venous catheters in neonates with bloodstream infection. Early surfactant administration with brief ventilation vs.
Early total enteral nutrition versus enteral plus parenteral nutrition for very preterm or very low birth weight infants. Early trophic feeding versus enteral fasting for very preterm or very low birth weight infants. Early versus delayed initiation of continuous distending pressure for respiratory distress syndrome in preterm infants. Early versus delayed selective surfactant treatment for neonatal respiratory distress syndrome. Early versus late administration of amino acids in preterm infants receiving parenteral nutrition.
Early versus late discontinuation of oxygen in preterm or low birth weight infants. Early versus late introduction of human milk fortification for preterm infants. Early versus late parenteral nutrition for critically ill term and late preterm infants. Early volume expansion for prevention of morbidity and mortality in very preterm infants. Early volume expansion versus inotrope for prevention of morbidity and mortality in very preterm infants.
Education of family members to support weaning to solids and nutrition in later infancy in infants born preterm. Education of family members to support weaning to solids and nutrition in later infancy in term-born infants. Effect of exchange transfusion on mortality in neonates with septicemia.
Effect of pre-exchange albumin infusion on neonatal hyperbilirubinaemia and long-term developmental outcomes. Effect of taurine supplementation on growth and development in preterm or low birth weight infants.
Effects of targeting lower versus higher arterial oxygen saturations on death or disability in preterm infants. Elective high frequency jet ventilation versus conventional ventilation for respiratory distress syndrome in preterm infants. Elective high frequency oscillatory ventilation versus conventional ventilation for acute pulmonary dysfunction in preterm infants.
Endothelin receptor antagonists for persistent pulmonary hypertension in term and late preterm infants. Endotracheal intubation at birth for preventing morbidity and mortality in vigorous, meconium-stained infants born at term.
Enteral antibiotics for preventing necrotizing enterocolitis in low birthweight or preterm infants. Enteral iron supplementation in preterm and low birth weight infants. Enteral lactoferrin supplementation for prevention of sepsis and necrotizing enterocolitis in preterm infants. Enteral lipid supplements for the prevention and treatment of intestinal failure-associated liver disease in infants.
Enteral zinc supplementation for prevention of morbidity and mortality in preterm neonates. Epinephrine for the resuscitation of apparently stillborn or extremely bradycardic newborn infants. Epinephrine for transient tachypnea of the newborn. Erythromycin for the prevention and treatment of feeding intolerance in preterm infants. Erythromycin for the prevention of chronic lung disease in intubated preterm infants at risk for, or colonized or infected with Ureaplasma urealyticum.
Erythropoietin for preterm infants with hypoxic ischaemic encephalopathy. Erythropoietin for term and late preterm infants with hypoxic ischemic encephalopathy. Ethamsylate for the prevention of morbidity and mortality in preterm or very low birth weight infants.
Exchange transfusion for neonatal jaundice. Exposure to the smell and taste of milk to accelerate feeding in preterm infants. Extracorporeal membrane oxygenation for severe respiratory failure in newborn infants.
Extubation from low-rate intermittent positive airway pressure versus extubation after a trial of endotracheal continuous positive airway pressure in intubated preterm infants. Fat supplementation of human milk for promoting growth in preterm infants. Feed thickener for infants up to six months of age with gastro-oesophageal reflux. Feeding during treatment of patent ductus arteriosus. Fetal lung maturity tests for prediction of Respiratory Distress Syndrome. Fibreoptic phototherapy for neonatal jaundice.
Flow-cycled versus time-cycled synchronized ventilation for neonates. Fluid restriction and prophylactic indomethacin versus prophylactic indomethacin alone for prevention of morbidity and mortality in extremely low birth weight infants.
Fluid restriction for symptomatic patent ductus arteriosus in preterm infants. Fluid restriction for term infants with hypoxic-ischaemic encephalopathy following perinatal asphyxia. Fluid restriction for treatment of preterm infants with chronic lung disease. Fluid restriction in the management of transient tachypnea of the newborn. Fluid supplementation for neonatal unconjugated hyperbilirubinaemia. Folic acid supplementation for the prevention of anaemia in preterm neonates.
Formula milk versus maternal breast milk for feeding preterm or low birth weight infants. Formula versus donor breast milk for feeding preterm or low birth weight infants. Frenotomy for tongue-tie in newborn infants. Frequency of endotracheal suctioning for the prevention of respiratory morbidity in ventilated newborns. Furosemide for prevention of morbidity in indomethacin-treated infants with patent ductus arteriosus.
Gastrografin for treatment of meconium obstruction in term and preterm infants. Glucose for the management of procedural pain in neonates. Glutamine supplementation for young infants with severe gastrointestinal disease. Glutamine supplementation to prevent morbidity and mortality in preterm infants. Glycerin laxatives for prevention or treatment of feeding intolerance in very low birth weight infants.
Glycerine suppository for fecal evacuation in preterm infants with constipation. Gowning by attendants and visitors in newborn nurseries for prevention of neonatal morbidity and mortality. Gradual versus abrupt discontinuation of oxygen in preterm or low birth weight infants.
Granulocyte transfusions for neonates with confirmed or suspected sepsis and neutropenia. Hand hygiene for the prevention of infections in neonates. Head midline position for preventing the occurrence or extension of germinal matrix-intraventricular hemorrhage in preterm infants. Heated and humidified inspired gas through heated humidifiers in comparison to non-heated and non-humidified gas in hospitalised neonates receiving respiratory support.
Heliox for prevention of morbidity and mortality in ventilated newborn infants. Heparin for prolonging peripheral intravenous catheter use in neonates. Heparin for the prevention of intraventricular haemorrhage in preterm infants. Heparin for the treatment of thrombosis in neonates. High flow nasal cannula for respiratory support in preterm infants. High flow nasal cannula for respiratory support in term infants. High frequency jet ventilation versus high frequency oscillatory ventilation for pulmonary dysfunction in preterm infants.
High frequency oscillatory ventilation versus conventional ventilation for infants with severe pulmonary dysfunction born at or near term. High versus low medium chain triglyceride content of formula for promoting short-term growth of preterm infants. High versus low thresholds for repeat administration of surfactant in intubated preterm neonates.
High versus low-dose parenteral administration of calcium and phosphorus for growth and bone health in preterm infants receiving parenteral nutrition. High versus standard protein content of human milk fortifier for promoting growth and neurological development in preterm infants. High versus standard volume enteral feeds to promote growth in preterm or low birth weight infants.
High vs low dose conventional phototherapy for neonatal jaundice. Higher versus lower amino acid intake in parenteral nutrition for newborn infants. Higher versus lower dose caffeine in preterm infants. Higher versus lower humidity for the prevention of morbidity and mortality in preterm infants in incubators. Higher versus lower protein intake in formula-fed low birth weight infants.
Higher versus lower sodium intake for preterm infants. Home- versus hospital-based phototherapy for the treatment of non-haemolytic jaundice in infants at more than 37 weeks' gestation. Human-milk derived fortifier versus bovine-milk derived fortifier for prevention of mortality and morbidity in preterm neonates.
Hydralazine in infants with persistent hypoxemic respiratory failure. Hyperbaric oxygen for term newborns with hypoxic ischemic encephalopathy. Ibuprofen for the treatment of patent ductus arteriosus in preterm or low birth weight or both infants. Immediate versus early surfactant replacement therapy for infants at risk of respiratory distress syndrome.
Immunoglobulin for alloimmune hemolytic disease in neonates. Indomethacin for asymptomatic patent ductus arteriosus in preterm infants. New Indomethacin for symptomatic patent ductus arteriosus in preterm infants.
Indomethacin for symptomatic patent ductus arteriosus in preterm infants. Infant isolation and cohorting for preventing or reducing transmission of healthcare-associated infections in neonatal units. Infant pacifiers for reduction in risk of sudden infant death syndrome. Infant position in neonates receiving mechanical ventilation.
Inhaled nitric oxide for respiratory failure in preterm infants. Inhaled versus systemic corticosteroids for preventing bronchopulmonary dysplasia in ventilated very low birth weight preterm neonates.
Inhaled versus systemic corticosteroids for the treatment of bronchopulmonary dysplasia in ventilated very low birth weight preterm infants. Initiation of complementary feeding before four months of age for prevention of postnatal growth restriction in preterm infants.
Inositol in preterm infants at risk for or having respiratory distress syndrome. Insertion strategies for peripherally inserted central venous catheters in newborn infants. Instruments for assessing readiness to commence suck feeds in preterm infants: Insulin-like growth factor-1 for the prevention or treatment of retinopathy of prematurity.
Intermittent phototherapy versus continuous phototherapy for neonatal jaundice. Interventions for improving perinatal palliative care in the delivery room. Interventions for non-oliguric hyperkalaemia in preterm neonates. Interventions for prevention of neonatal hyperglycemia in very low birth weight infants. Interventions for strengthening maternal and newborn health systems in developing country communities.
Interventions for the management of transient tachypnea of the newborn- an overview of systematic reviews. Interventions for treatment of neonatal hyperglycemia in very low birth weight infants. Intramuscular penicillin for the prevention of early onset group B streptococcal infection in newborn infants. Intraosseous access for infant resuscitation. Intratracheal Clara cell secretory protein CCSP administration in preterm infants with or at risk of respiratory distress syndrome.
Intratracheal instillation of corticosteroids using surfactant as a vehicle for the prevention of chronic lung disease in preterm infants with respiratory distress syndrome. Intravenous dexamethasone for extubation of newborn infants.
Intravenous immunoglobulin for suspected or proven infection in neonates. Intravenous in-line filters for preventing morbidity and mortality in neonates. Intravenous midazolam infusion for sedation of infants in the neonatal intensive care unit. Intravenous or enteral loop diuretics for preterm infants with or developing chronic lung disease.
Intraventricular antibiotics for bacterial meningitis in neonates. Intraventricular streptokinase after intraventricular hemorrhage in newborn infants. Iodine supplementation for the prevention of mortality and adverse neurodevelopmental outcomes in preterm infants.
Kangaroo mother care to reduce morbidity and mortality in low birthweight infants. Kinesthetic stimulation for preventing apnea in preterm infants. Kinesthetic stimulation for treating apnea in preterm infants. Kinesthetic stimulation versus methylxanthine for apnea in preterm infants.
Lactase treated feeds to promote growth and feeding tolerance in preterm infants. Lactoferrin for the post-operative management of term neonates after gastrointestinal surgery. Laryngeal mask airway surfactant administration for prevention of morbidity and mortality in preterm infants with or at risk of respiratory distress syndrome.
Laryngeal mask airway versus bag-mask ventilation or endotracheal intubation for neonatal resuscitation. Laser photocoagulation versus transscleral cryotherapy for threshold retinopathy of prematurity.
Late surfactant therapy for prevention or treatment of bronchopulmonary dysplasia in preterm infants. Late versus early surgical correction for congenital diaphragmatic hernia in newborn infants. Leukotriene receptor antagonists for the prevention and treatment of chronic lung disease in preterm infants. Light-emitting diode phototherapy for unconjugated hyperbilirubinaemia in neonates. Lipid emulsions for parenterally fed preterm infants.
Lipid emulsions for parenterally-fed term and late preterm infants. Local anaesthetic eye drops for prevention of pain in preterm infants undergoing screening for retinopathy of prematurity. Local wound analgesia in infants undergoing thoracic or abdominal surgery. Long chain polyunsaturated fatty acid supplementation in infants born at term. Long versus short inspiratory times in neonates receiving mechanical ventilation. Longchain polyunsaturated fatty acid supplementation in preterm infants.
Loop diuretics during blood transfusion for anemia in preterm infants. Low versus high haemoglobin concentration threshold for blood transfusion for preventing morbidity and mortality in very low birth weight infants. Lower versus higher oxygen concentrations titrated to target oxygen saturations during resuscitation of preterm infants at birth.
Lung lavage for meconium aspiration syndrome in newborn infants. Lung recruitment manoeuvres for reducing respiratory morbidity in mechanically ventilated neonates.
Lutein and zeaxanthin for reducing morbidity and mortality in preterm infants. Magnesium sulfate for persistent pulmonary hypertension of the newborn.
Magnesium sulfate for term infants following perinatal asphyxia. Manual ventilation devices for neonatal resuscitation. Mask holding techniques for neonatal resuscitation at birth. Maternal probiotic supplementation for prevention of morbidity and mortality in preterm infants.
Mechanical ventilation for newborn infants with respiratory failure due to pulmonary disease. Medical therapies for parenteral nutrition-associated cholestasis in term and preterm infants. Melatonin treatment for newborns with hypoxic ischemic encephalopathy.
Mesenchymal stem cells for the prevention and treatment of bronchopulmonary dysplasia in preterm infants. Metalloporphyrins for treatment of unconjugated hyperbilirubinemia in neonates. Methods for securing endotracheal tubes in newborn infants. Methods of securing peripheral vascular catheters to reduce morbidity in neonates.
Methylxanthine for the prevention and treatment of apnea in preterm infants. Methylxanthine prophylaxis versus treatment for preterm infants at risk of apnea. Methylxanthine treatment for apnoea in preterm infants. Milrinone for persistent pulmonary hypertension of the newborn.
Milrinone for the treatment of cardiac dysfunction in neonates. Minimising sensory stimuli to improve growth and development for newborn infants in the neonatal unit. Moderately early days postnatal corticosteroids for preventing chronic lung disease in preterm infants.
Molecular assays for the diagnosis of sepsis in neonates. Multi-nutrient fortification of human milk for preterm infants. Multinutrient fortification of human breast milk for preterm infants following hospital discharge. Multiple versus single doses of exogenous surfactant for the prevention or treatment of neonatal respiratory distress syndrome. Multiple versus single lumen umbilical venous catheters for newborn infants. N-acetylcysteine for the prevention of chronic lung disease in very low birth weight infants.
Naloxone for opiate-exposed newborn infants. Naloxone for preventing morbidity and mortality in newborn infants of greater than 34 weeks' gestation with suspected perinatal asphyxia. Nasal airways single or double prong, long or short for neonatal resuscitation. Nasal continuous positive airway pressure nCPAP for term neonates with respiratory distress.
Nasal continuous positive airway pressure immediately after extubation for preventing morbidity in preterm infants. Nasal continuous positive airway pressure levels for the prevention of morbidity and mortality in very low birth weight infants. Nasal versus oral intubation for mechanical ventilation of newborn infants. Nasal versus oral route for placing feeding tubes in preterm or low birth weight infants.
Nebulised surfactant in preterm infants with or at risk of respiratory distress syndrome. Nebulized racemic epinephrine for extubation of newborn infants.
Needle aspiration versus intercostal tube drainage for pneumothorax in the newborn. Neonatal interventions for preventing cerebral palsy: Neonatal vitamin A supplementation for the prevention of mortality and morbidity in term neonates in low and middle income countries. Neurally adjusted ventilatory assist compared to other forms of triggered ventilation for neonatal respiratory support.
Neuromuscular paralysis for newborn infants receiving mechanical ventilation. Newborn resuscitation with intact cord for term infants. Nitric oxide for respiratory failure in infants born at or near term. Non-invasive high-frequency ventilation in newborn infants with respiratory distress. Non-invasive respiratory support for the management of transient tachypnea of the newborn. Non-nutritive sucking for gastro-oesophageal reflux disease in preterm and low birth weight infants.
Non-nutritive sucking for increasing physiologic stability and nutrition in preterm infants. Non-pharmacological care for opioid withdrawal in newborns. Non-pharmacological interventions for prevention of pain during endotracheal suctioning in ventilated neonates.
Non-surgical and surgical interventions for airway obstruction in children with Robin Sequence. Nutrient-enriched formula milk versus human breast milk for preterm infants following hospital discharge. Nutrient-enriched formula versus standard formula for preterm infants following hospital discharge. Octreotide for the treatment of chylothorax in neonates. One dose per day compared to multiple doses per day of gentamicin for treatment of suspected or proven sepsis in neonates.
One-step techniques for primary distal hypospadias in children and adolescents. Opiate treatment for opiate withdrawal in newborn infants. Opioids for neonates receiving mechanical ventilation. Oral dextrose gel for the treatment of hypoglycaemia in newborn infants. Oral dextrose gel to prevent hypoglycaemia in at-risk neonates.
Oral immunoglobulin for preventing necrotizing enterocolitis in preterm and low birth weight neonates. Oral immunoglobulin for the prevention of rotavirus infection in low birth weight infants. Oral immunoglobulin for the treatment of rotavirus diarrhea in low birth weight infants. Oral lactoferrin for the treatment of sepsis and necrotizing enterocolitis in neonates.
Oral stimulation for promoting oral feeding in preterm infants. Oral synbiotics versus probiotics or placebo for the prevention of necrotizing enterocolitis and mortality in preterm infants.
Oral zinc for the prevention of hyperbilirubinaemia in neonates. New Oropharyngeal colostrum in preventing mortality and morbidity in preterm infants. Orotracheal intubation in infants performed with a stylet versus without a stylet.
Overview of ventilation strategies for the early management of intubated preterm infants. Pain relief for neonatal circumcision. Paracetamol acetaminophen for patent ductus arteriosus in preterm or low birth weight infants. Paracetamol acetaminophen for prevention or treatment of pain in newborns. Partial exchange transfusion to prevent neurodevelopmental disability in infants with polycythemia. Patient isolation measures for infants with candida colonization or infection for preventing or reducing transmission of candida in neonatal units.
Pentoxifylline for the prevention of bronchopulmonary dysplasia in preterm infants. Pentoxifylline for treatment of sepsis and necrotizing enterocolitis in neonates. Percutaneous central venous catheters versus peripheral cannulae for delivery of parenteral nutrition in neonates. Periodic change of body position under phototherapy in term and late preterm neonates with hyperbilirubinemia.
Peripheral retinal ablation for threshold retinopathy of prematurity in preterm infants. Peritoneal drainage versus laparotomy as initial surgical treatment for perforated necrotizing enterocolitis or spontaneous intestinal perforation in preterm low birth weight infants. Permissive hypercapnia for the prevention of morbidity and mortality in mechanically ventilated newborn infants. Pharmacological interventions for prevention and treatment of upper gastrointestinal bleeding in newborn infants.
Pharmacological interventions for prevention of pain during endotracheal suctioning in ventilated neonates. Pharmacological pain and sedation interventions for the prevention of intraventricular hemorrhage in preterm infants on assisted ventilation - an overview of systematic reviews.
Pharyngeal instillation of surfactant before the first breath for prevention of morbidity and mortality in preterm infants at risk of respiratory distress syndrome. Physical activity programs for promoting bone mineralization and growth in preterm infants.
Plasma transfusion to prevent intraventricular haemorrhage in very preterm infants. Platelet transfusion to reduce the incidence of intraventricular haemorrhage in preterm infants. Polyunsaturated fatty acid supplementation in infancy for the prevention of allergy. Position or posture for the treatment of gastroesophageal reflux in preterm infants.
Positive end expiratory pressure for preterm infants requiring conventional mechanical ventilation for respiratory distress syndrome or bronchopulmonary dysplasia. Positive end-expiratory pressure for resuscitation of newborn infants at birth. Postnatal corticosteroids for transient tachypnea of the newborn. Postnatal magnesium sulphate for neuroprotection in preterm infants. Postnatal phenobarbital for the prevention of intraventricular haemorrhage in preterm infants.
Postnatal thyroid hormones for preterm infants with transient hypothyroxinaemia. Postnatal thyroid hormones for respiratory distress syndrome in preterm infants. Pre-discharge "car seat challenge" for preventing morbidity and mortality in preterm infants. Prebiotics for the prevention of hyperbilirubinaemia in neonates.
Prebiotics for the prevention of necrotizing enterocolitis in preterm infants. Prebiotics in infants for prevention of allergy.
Premedication for non-urgent endotracheal intubation for preventing pain in neonates. Preoxygenation for tracheal suctioning in intubated, ventilated newborn infants. Preterm formula milk versus term formula milk for feeding preterm or low birth weight infants. Probiotics for prevention of necrotizing enterocolitis in preterm infants.
Probiotics for the post-operative management of term neonates after gastrointestinal surgery. Probiotics for the prevention or treatment of hyperbilirubinaemia in late preterm and term neonates. Probiotics in infants for prevention of allergic disease and food hypersensitivity. Procalcitonin for the diagnosis of sepsis in infants.
Prolonged versus short course of indomethacin for the treatment of patent ductus arteriosus in preterm infants. Prophylactic animal derived surfactant extract for preventing morbidity and mortality in preterm infants. Prophylactic antibiotics to reduce morbidity and mortality in neonates with umbilical artery catheters. Prophylactic antibiotics to reduce morbidity and mortality in neonates with umbilical venous catheters.
Prophylactic antibiotics to reduce morbidity and mortality in newborn infants with intercostal catheters. Prophylactic antibiotics to reduce morbidity and mortality in ventilated newborn infants. Prophylactic barbiturate use for the prevention of morbidity and mortality following perinatal asphyxia. Prophylactic caffeine to prevent postoperative apnoea following general anaesthesia in preterm infants.
Prophylactic doxapram for the prevention of morbidity and mortality in preterm infants undergoing endotracheal extubation. Prophylactic intravenous calcium therapy for exchange blood transfusion in the newborn. Prophylactic intravenous indomethacin for preventing mortality and morbidity in preterm infants. Prophylactic methylxanthine for prevention of apnoea in preterm infants. Prophylactic methylxanthines for endotracheal extubation in preterm infants. Prophylactic nasal continuous positive airway pressure for preventing morbidity and mortality in very preterm infants.
Prophylactic phototherapy for preventing jaundice in preterm or low birth weight infants. Prophylactic postnatal thyroid hormones for prevention of morbidity and mortality in preterm infants. Prophylactic protein free synthetic surfactant for preventing morbidity and mortality in preterm infants.
Prophylactic surgical ligation of patent ductus arteriosus for prevention of mortality and morbidity in extremely low birth weight infants. Prophylactic systemic antibiotics to reduce morbidity and mortality in neonates with central venous catheters.
Prophylactic systemic antifungal agents to prevent mortality and morbidity in very low birth weight infants. Prophylactic theophylline or aminophylline for prevention of renal dysfunction in newborns with perinatal asphyxia. Prophylactic versus selective antibiotics for term newborn infants of mothers with risk factors for neonatal infection. Prophylactic versus selective use of surfactant in preventing morbidity and mortality in preterm infants.
Prophylactic vitamin K for the prevention of vitamin K deficiency bleeding in preterm neonates. Prophylactic vitamin K for vitamin K deficiency bleeding in neonates. Prostacyclins and analogues for the treatment of pulmonary hypertension in neonates. Prostaglandin E1 for maintaining ductal patency in neonates with ductal-dependent cardiac lesions.
Protein containing synthetic surfactant versus animal derived surfactant extract for the prevention and treatment of respiratory distress syndrome.
Protein hydrolysate versus standard formula for preterm infants. Protein supplementation of human milk for promoting growth in preterm infants.
Protein-containing synthetic surfactant versus protein-free synthetic surfactant for the prevention and treatment of respiratory distress syndrome. Protein-free synthetic surfactant for the prevention and treatment of respiratory distress syndrome in neonates. Protocolized versus non-protocolized weaning for reducing the duration of invasive mechanical ventilation in newborn infants. Decisions about the best approach for therapy are informed by symptom severity and function of the gastrointestinal GI tract.
Treatment could include multiple strategies based on these factors. Nutrition goals during and after cancer therapy are integrated with goals related to nutrition status and the presence of malnutrition.
A healthy diet with an emphasis on plant-based foods, regular physical activity, and achievement of a healthy weight has been recommended for all patients after cancer treatment on the basis of extensive reviews of the evidence.
Prompt and aggressive nutrition intervention is required for patients with precachexia or cancer cachexia. Intervention is more likely to be effective when started early. Interventions include an individualized approach to oral, enteral, and parenteral nutrition using evidence-based recommendations, guidelines, and program and regulatory standards. The dietitian works with the patient, caregivers, and members of the health care team to 1 improve compliance and the effectiveness of pharmacotherapy interventions prescribed to manage cancer and cancer treatment—related symptoms; and 2 counsel patients about behavioral strategies to alleviate nutrition impact symptoms.
The Association of Community Cancer Centers Cancer Program Guidelines [ 7 ] specify having a registered dietitian as the nutrition professional available to work with patients and their families, especially those at risk of developing nutrition problems. Registered dietitians work with the patient, family, and medical team to manage the nutrition and hydration status and maintain optimal nutrition status across the continuum of care through appropriate screening, assessment, and intervention.
The registered dietitian provides individualized care to each patient with nutrition- and diet-related needs, incorporates current research and utilizes evidence-based nutrition practice, and collaborates with the medical team to ensure integration of care with the overall treatment plan during active treatment and into survivorship.
Registered dietitians also serve as a resource and provide education related to reducing cancer risk and the risk of recurrence to patients and communities. A systematic review of randomized controlled trials led to the recommendation that patients be referred for nutrition counseling because of strong evidence of the beneficial effects it has on the prevention and reduction of malnutrition.
Cancer and cancer treatment result in a range of side effects, described as nutrition impact symptoms, that impede oral intake. While some patients experience few of these effects, others may have multiple symptoms, including anorexia, early satiety, constipation, diarrhea, dysphagia, fatigue, mucositis, nausea, taste and smell changes, and xerostomia.
These symptoms can result in a decline in nutrition status and quality of life. Behavioral strategies are essential in alleviating the impact of these symptoms and promoting adequate nutrient intake; pharmacologic interventions may be used in combination with these strategies to minimize symptom severity.
The following lists describe behavioral strategies to help alleviate nutrition-related symptoms of cancer treatment. Additional information about nutrition strategies during treatment is available from oncology-focused organizations such as ACS and AICR.
Commercially available oral nutrition supplements e. Patients with cancer need adequate protein to maintain and rebuild lean body mass. A systematic review of multinutrient, high-protein oral nutrition supplements found significant improvement in total energy and protein intake and reduced incidence of complications. In patients with resectable gastric cancer, supplementation did not change postoperative weight loss or complication rates. Although supplements containing fish oil alone do not seem to be beneficial in cachexia or surgery recovery, studies of immune-enhancing IE formulas containing fish oil, as well as arginine and nucleotides, suggest benefit for individuals undergoing GI surgery.
A Cochrane review found significant reduction in postoperative complications and infections when IE oral supplements or enteral feeding were given before GI surgery. Studies of both preoperative and postoperative use found that noninfectious complications and hospital length of stay were also reduced. There is concern that long-term use of oral nutrition supplements can result in taste fatigue and decreased compliance with recommendations.
A systematic review of compliance with oral nutrition supplements suggested that compliance is good, especially with higher-energy-density supplements.
Nutrition support is the delivery of nutrition that bypasses oral intake. Every measure is employed to sustain patients and improve their condition through oral intake before consideration is given to nutrition support. Enteral nutrition tube feeding provides nutrition directly into the GI tract. Parenteral nutrition is the intravenous IV infusion of nutrients.
The use of enteral and parenteral nutrition in the oncology population may be indicated when oral nutrition strategies are not possible or fail because of tumor location or severe side effects.
Although nutrition support is not recommended as standard treatment, it may be beneficial for patients who are malnourished and expected to become unable to take in adequate nutrition by mouth for an extended period of time. However, if nutrition support is clinically indicated, it should not be withheld because of concerns about tumor promotion. Enteral nutrition is preferred over parenteral nutrition in most instances. Enteral nutrition continues to use the gut, is associated with fewer infectious complications, is often easier to administer, and is more cost-effective than parenteral nutrition.
Indications for nutrition support include the following: Providing nutrition support routinely to patients undergoing chemotherapy or radiation therapy is not recommended; rather, nutrition support is reserved for patients who meet any of the criteria listed above.
It is sometimes difficult to know which patients will have a prolonged period of inadequate oral intake or malabsorption and will benefit from nutrition support. Although aggressive nutrition support has been shown to improve quality of life in patients with advanced cancer,[ 29 ] it is generally not recommended if life expectancy is shorter than 40 to 60 days. Several effective methods for the delivery of enteral nutrition exist.
Factors affecting a choice of the enteral route include anticipated length of need, aspiration risk, tumor location, and side effects.
Assessment of need is best performed early. If a malnourished patient requires surgery for an unrelated event, a feeding tube may be placed at that time to avoid an additional procedure. The risk of aspiration is considered in the determination of the proper termination point of the tube: Tubes are constructed of silicone or polyurethane and can vary in length from 30 to 43 inches, with the shorter tubes used for nasogastric feedings.
Diameters range from 5F catheters to 16F catheters. Tubes may have weighted tips to help passage through the gut. If a patient with cancer is at very high risk of aspiration, enteral nutrition may be contraindicated, and parenteral nutrition can be considered. Percutaneous tubes may be placed endoscopically, surgically, or with fluoroscopy by interventional radiology.
Percutaneous tube placement has a number of advantages: Administration methods vary depending on where in the GI tract the tube terminates and may be affected by treatment side effects. For tubes terminating in the stomach, a bolus or intermittent gravity drip may be possible and is preferable because it mimics normal feeding, requires less time and equipment, and offers greater flexibility to the patient. For tubes terminating in the duodenum or jejunum, an infusion pump is required because a slower administration rate is necessary.
The following lists summarize infusion methods and considerations for initiation and administration of enteral nutrition. Enteral formulas vary in nutrient composition and source. Most commercially available formulas are lactose free, kosher, and halal.
Semi-elemental and elemental formulas are available for patients with malabsorption who do not or will not tolerate standard formulas. The use of whole-food blenderized formulas is gaining in popularity. Some products are commercially available, and there are published recipes for home-made formula.
It is important for a dietitian to thoroughly review the nutrient content of these home-blenderized formulas to ensure adequacy. For patients in the perioperative setting, evidence supports the use of IE formulas. The most widely studied formula in this category contains a combination of arginine, omega-3 fatty acids, and nucleotides. If parenteral nutrition is determined to be beneficial and appropriate, it can be administered via central or peripheral venous access.
Many patients with cancer already have central IV catheters to accommodate multiple IV therapies. For patients who do not already have central line access or will not have it for a period of time, a peripheral catheter can be placed; however, care must be taken to avoid overuse of the peripheral IVs, as this can result in vessel sclerosis. To minimize venous complications, the use of peripheral parenteral nutrition is limited. Parenteral nutrition is a combination of dextrose carbohydrate , amino acids protein , and lipid emulsions fat with added electrolytes, vitamins, and trace elements.
It is recommended that parenteral nutrition management include clinicians with expertise in nutrition support and be made up of a multidisciplinary team, including a registered dietitian and clinical pharmacist. Parenteral nutrition is typically initiated as a hour infusion. After tolerance is established and generally after daily macronutrient goals are achieved, parenteral nutrition may be cycled typically to an infusion time of 10—14 hours.
For patients who will be receiving home parenteral nutrition, a cyclic infusion is preferred. Only if the benefits of home initiation far outweigh the risks should it be considered, and only for patients who are hemodynamically stable, at low risk of refeeding syndrome, and nondiabetic. Many treatments have been suggested for cachexia-anorexia syndrome CAS , but few of these treatments have resulted in consistent improvement, probably because of the multifactorial mechanisms involved.
The first issue widely studied for treatment has been anorexia associated with CAS. The use of agents that improve appetite and resultant caloric intake have been widely studied; these agents include corticosteroids, progesterone analogs, androgens, cannabinoids, and cyproheptadine.
Perhaps the earliest agents studied for the management of cancer cachexia are dexamethasone and prednisolone. Used in cancer treatment for their anti-inflammatory, antimalignancy, and antiemetic properties, steroids have produced side effects such as increased appetite and weight gain, probably because of their effects in the hypothalamus. Several large placebo-controlled studies have shown increases in appetite and weight gain associated with steroid use in this setting.
In a study of tumor-bearing rats, use of megestrol acetate resulted in a reversal of muscle wasting and improved physical performance. No definitive conclusions about other outcomes related to lean body mass, quality of life, or fatigue could be drawn.
No improvement in survival was found. A placebo-controlled study looked at megestrol acetate at a dose of 7.
The megestrol group had a mean weight gain of Interest in the use of cannabinoids in CAS is ongoing because of their effects on appetite and potential benefit in HIV-related cachexia. Cyproheptadine is a serotonin and histamine antagonist developed as an antihistamine. Side effects include increased appetite and weight gain.
Seventy-six percent of the patients were classified as responders, experiencing either weight gain or no further weight loss. Patients also showed a significant increase in serum leptin levels.
An increase in serum leptin has been correlated with an increase in body mass index. Increases in cytokines associated with cancer—including tumor necrosis factor-alpha TNF-alpha , interleukin-6 IL-6 , and interleukin-1—have been shown to be important in the etiology of this disorder.
Specific targeted agents have also been studied. These include agents targeting TNF-alpha, such as etanercept, infliximab, and pentoxifylline, which, in small trials, have not had a significant impact. Several studies using thalidomide, a nonspecific antagonist to TNF, have been performed. Thalidomide patients had a statistically significant reduction in weight loss compared with placebo patients.
There has been interest in several other agents for the management of CAS, including mirtazapine,[ 76 ] metoclopramide, formoterol, melatonin, and olanzapine. Given the multifactorial etiology of, and multiple mechanisms involved in, the development of CAS, it is possible that combining multiple agents with different mechanisms of action might result in greater efficacy.
In this study, the combination arm was found to be superior. Another trial used megestrol alone versus megestrol plus L-carnitine, celecoxib, and antioxidants to treat women with gynecologic malignancies.
Researchers also looked at the combination of formoterol, an anabolic beta-2 adrenergic agonist, and megestrol acetate in 13 patients. Six of seven evaluable patients achieved a major response, with increases in muscle mass. For these reasons, there is no recommended combination at this time. In addition, combining drug therapy with nutrition support and increased physical activity may have even greater efficacy.
CAS is a complex, multifactorial complication of cancer and its therapy, resulting in weight loss and decreased lean body mass. As understanding of the mechanisms of CAS improves and new agents that selectively target these proposed pathways become available, more efficacious treatments are also expected to become available. Trials of new agents must be able to compare similar groups of patients.
In addition, treating preventatively in high-risk patients, as opposed to treating patients already suffering from CAS, may be associated with better outcomes. Further clinical trials are essential to determine the best possible therapies.
Patients with advanced disease often develop new, or worsening, nutrition-related side effects associated with disease progression, treatment, or both. In a large systematic review of symptom prevalence in patients with incurable cancer, the most common nutrition impact symptoms were anorexia, xerostomia, constipation, and nausea.
Other symptoms among advanced-cancer patients receiving care in inpatient palliative care units,[ 2 , 3 ] cancer cachexia specialty clinics,[ 4 ] hospice, or non-hospice settings [ 3 ] included bloating, constipation, dysphagia, chewing difficulties, early satiety, mucositis, taste changes, and vomiting.
Clinically refractory cachexia develops as a result of very advanced cancer or rapidly progressive disease that is unresponsive to antineoplastic therapy. It is associated with active catabolism and weight loss that is unresponsive to nutrition therapy. At the end of life, patients often have severely restricted oral intake of food and fluids as part of the normal dying process. The primary objective of nutrition intervention in patients with advanced cancer is to conserve or restore the best possible quality of life and control any nutrition-related symptoms that cause distress.
Nutrition goals for a patient with advanced cancer may depend on the overall plan of care. These patients may be receiving anticancer therapy with or without concurrent palliative care , may be receiving palliative care alone, or may be enrolled in hospice. Regardless of the care setting, patients are screened to determine the need for nutrition intervention. As the focus of care shifts from cancer-modifying therapy to hospice or end-of-life care, nutrition goals may become less aggressive, with a shift in emphasis toward comfort.
Continued assessment and adjustment of nutrition goals and interventions is required throughout this continuum to meet the changing needs of the patient receiving palliative or hospice care services. Ethical issues may arise when patients, families, or caregivers request artificial nutrition and hydration when there is no prospect of recovering from the underlying illness or accruing appreciable benefit from the intervention. When there is uncertainty about whether a patient will benefit from artificial nutrition, hydration, or both, a time-limited trial may be useful.
Clear, measurable endpoints are outlined at the beginning of a time-limited trial. The caregiving team will explain that, as with other medical therapies, artificial nutrition and hydration can be stopped if the desired nutrition effects are not produced. Randomized controlled trials of enteral or parenteral nutrition in cancer patients receiving formal palliative care are lacking.
Patients with a life expectancy shorter than 40 days may be palliated with home intravenous IV fluid therapy, although this practice is controversial. Patients and caregivers often consider the provision of food and fluids to be basic care. However, the use of artificial nutrition and hydration at the end of life is a complex and controversial intervention that is influenced by clinical, cultural, religious, ethical, and legal factors. Patients and families often believe the use of these interventions will improve quality and length of life, but evidence of clear benefit is lacking.
In addition, agitated or confused patients receiving artificial nutrition and hydration may need to be physically restrained to prevent them from removing a gastrostomy tube, nasogastric tube, or central IV line. Patients at the end of life who have increased difficulty with swallowing have less risk of aspiration with thick liquids than with thin liquids. For patients at the end of life, the goals of nutrition therapy are directed at alleviating symptoms rather than reversing nutrition deficits.
The pleasure of tasting food and the social benefits of participating in meals with family and friends can be emphasized over increasing caloric intake. Other studies found no effect on terminal delirium, thirst, chronic nausea, or fluid overload. The American Academy of Hospice and Palliative Medicine suggests that providers facilitate respectful and informed discussions about the effects of artificial nutrition and hydration near the end of life among physicians, other health care professionals, patients, and families.
Ideally, patients will make their own decisions on the basis of a careful assessment of potential benefits and burdens, consistent with legal and ethical norms that permit patients to accept or forgo specific medical interventions.
Decisions about whether to provide artificial nutrition and hydration to patients in the late stages of life are complex and influenced by ethical, legal, cultural, and clinical considerations, and by patient and family preferences. Guidelines on the ethical considerations about whether to forgo or discontinue hydration and nutrition support have been published by a number of organizations, including the American Medical Association,[ 25 ] the American Academy of Hospice and Palliative Medicine,[ 11 ] the Hospice and Palliative Nurses Association,[ 18 ] the American Society for Parenteral and Enteral Nutrition,[ 26 , 27 ] and the Academy of Nutrition and Dietetics.
Religion and religious traditions provide a set of core beliefs about life events and an ethical foundation for clinical decision-making. To provide an optimal and inclusive healing environment, all palliative team members need to be aware of their own spirituality and how it may differ from that of fellow team members and the spirituality of the patients and families they serve.
Religious beliefs are often closely related to cultural views. Individuals living in the midst of a particular tradition can continue to be influenced by it, even if they have stopped believing in or practicing it.
Patients may rely on religion and spirituality as important means to interpret and cope with illness. The wide range of practices related to neutropenic diets reflects the lack of evidence regarding the efficacy of dietary restrictions in preventing infectious complications in cancer patients.
Studies evaluating various approaches to diet restrictions have not shown clear benefit. A meta-analysis and a systematic review of articles evaluating the effect of a neutropenic diet on infection and mortality rates in cancer patients found no superiority or advantage in using a neutropenic diet over a regular diet in neutropenic cancer patients. Even after the observational study was omitted from the analysis, the results persisted. The review concluded that these individual studies provided no evidence showing that the use of a low-bacterial diet prevents infections.
Other studies have demonstrated potential adverse effects of neutropenic diets. One group of investigators [ 6 ] conducted a retrospective review of patients who had undergone hematopoietic cell transplantation HCT. The patients who received the neutropenic diet experienced significantly more documented infections than did the patients receiving the general hospital diet that permitted black pepper and well-washed fruits and vegetables and excluded raw tomatoes, seeds, and nuts.
The neutropenic diet group had a significantly higher rate of infections that could be attributed to a gastrointestinal source, as well as a trend toward a higher rate of vancomycin-resistant enterococci infections. Without clinical evidence to define the dietary restrictions required to prevent foodborne infection in immunocompromised cancer patients, recommendations for food safety are based on general food safety guidelines and the avoidance of foods most likely to contain pathogenic organisms.
The effectiveness of these guidelines is dependent on patient and caregiver knowledge about, and adherence to, safe food handling practices and avoidance of higher-risk foods. Leading cancer centers provide guidelines for HCT patients and information about food safety practices related to food purchase, storage, and preparation e. Comprehensive food safety information designed by the U. Food and Drug Administration for people with cancer and for transplant recipients is also available online.
Recommendations support the use of safe food handling procedures and avoiding consumption of foods that pose a high risk of infection, as noted in Table 7. Maintaining adequate nutrition while undergoing treatment for cancer is imperative because it can reduce treatment-related side effects, prevent delays in treatment, and help maintain quality of life. Patients are likely to search the Internet and other lay sources of information for dietary approaches to manage cancer risk and to improve prognosis.
Unfortunately, much of this information is not supported by a sufficient evidence base. The sections below summarize the state of the science on some of the most popular diets and dietary supplements. A vegetarian diet is popular, is easy to implement and, if followed carefully, does not result in nutrition deficiencies. There is strong evidence that a vegetarian diet reduces the incidence of many types of cancer, especially cancers of the gastrointestinal GI tract.
There are no published clinical trials, pilot studies, or case reports on the effectiveness of a vegetarian diet for the management of cancer therapy and symptoms. There is no evidence suggesting a benefit of adopting a vegetarian or vegan diet upon diagnosis or while undergoing cancer therapy. On the other hand, there is no evidence that an individual who follows a vegetarian or vegan diet before cancer therapy should abandon it upon starting treatment.
One pilot study has suggested that following a plant-based diet can prevent tumor progression in men with localized prostate cancer.
It is a high-carbohydrate, low-fat, plant-based diet stemming from philosophical principles promoting a healthy way of living. Although there are anecdotal reports on the effectiveness of a macrobiotic diet as an alternative cancer therapy, none have been published in peer-reviewed, scientific journals.
No clinical trials, observational studies, or pilot studies have examined the diet as a complementary or alternative therapy for cancer. In fact, two reviews of the diet and its evidence for effectiveness in cancer treatment concluded that there is no scientific evidence for the use of a macrobiotic diet in cancer treatment. No current clinical trials are studying the role of the macrobiotic diet in cancer therapy. A ketogenic diet has been well established as an effective alternative treatment for some cases of epilepsy and has gained popularity for use in conjunction with standard treatments for glioblastoma.
The ketogenic diet can be difficult to follow and relies more on exact proportions of macronutrients typically a 4 to 1 ratio of fat to carbohydrates and protein than do other complementary and alternative medicine CAM diets. Because safety and feasibility have been proven, several trials are recruiting patients to study the effectiveness of the ketogenic diet on glioblastoma. Therefore, if a patient diagnosed with glioblastoma wishes to start a ketogenic diet, it would be safe if implemented properly and under the guidance of a registered dietitian,[ 10 ] but effectiveness for symptom and disease management remains unknown.
The use of probiotics has become prevalent within and outside of cancer therapy. Strong research has shown that probiotic supplementation during radiation therapy, chemotherapy, or both is well tolerated and can help prevent radiation- and chemotherapy-induced diarrhea, especially in those receiving radiation to the abdomen.
Melatonin is a hormone produced endogenously that has been used as a CAM supplement along with chemotherapy or radiation therapy for targeting tumor activity and for reducing treatment-related symptoms, primarily for solid tumors. Several studies have shown tumor response to, or disease control with, chemotherapy alongside oral melatonin, as opposed to chemotherapy alone; one study has shown tumor response with melatonin in conjunction with radiation therapy.
However, another study did not demonstrate increased survival with melatonin, but did demonstrate improved quality of life. Melatonin taken in conjunction with chemotherapy may help reduce or prevent some treatment-related side effects and toxicities that can delay treatment, reduce doses, and negatively affect quality of life.
Melatonin supplementation has been associated with significant reductions in neuropathy and neurotoxicity, myelosuppression, thrombocytopenia, cardiotoxicity, stomatitis, asthenia, and malaise. Overall, several small studies show some evidence supporting melatonin supplementation alongside chemotherapy, radiation therapy, or both for solid tumor treatment, for aiding tumor response and reducing toxicities, while negative side effects for melatonin supplementation have not been found.
Therefore, it may be appropriate to provide oral melatonin in conjunction with chemotherapy or radiation therapy to a patient with an advanced solid tumor. Glutamine is an amino acid that is especially important for GI mucosal cells and their replication. These cells are often damaged by chemotherapy and radiation therapy, causing mucositis and diarrhea, which can lead to treatment delays and dose reductions and severely affect quality of life.
Some evidence suggests that oral glutamine can reduce both of those toxicities by aiding in faster healing of the mucosal cells and entire GI tract. For patients receiving chemotherapy who are at high risk of developing mucositis, either because of previous mucositis or having received known mucositis-causing chemotherapy, oral glutamine may reduce the severity and incidence of mucositis.
For patients receiving radiation therapy to the abdomen, oral glutamine may reduce the severity of diarrhea and can lead to fewer treatment delays. In addition to reducing GI toxicities, oral glutamine may also reduce peripheral neuropathy in patients receiving the chemotherapy agent paclitaxel.
Oral glutamine is a safe, simple, and relatively low-cost supplement that may reduce severe chemotherapy- and radiation-induced toxicities. The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
Added Carneiro et al. Nutrition Screening and Assessment. Added Daniel et al. Added text to state that the prevalence of obesity is higher in adult cancer survivors than in those without a cancer history; and that cancer survivors with the highest rates of increasing obesity are colorectal and breast cancer survivors and non-Hispanic blacks cited Greenlee et al.
Added text about the benefits of using immune-enhancing formulas for preoperative and postoperative nutrition support for individuals undergoing gastrointestinal surgery cited Song et al. Added Pharmaceutical management of cancer-associated cachexia and weight loss as a new subsection.
This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about nutrition before, during, and after cancer treatment. It is intended as a resource to inform and assist clinicians who care for cancer patients. It does not provide formal guidelines or recommendations for making health care decisions. Board members review recently published articles each month to determine whether an article should:.
Changes to the summaries are made through a consensus process in which Board members evaluate the strength of the evidence in the published articles and determine how the article should be included in the summary. Any comments or questions about the summary content should be submitted to Cancer. Do not contact the individual Board Members with questions or comments about the summaries.
Board members will not respond to individual inquiries. Some of the reference citations in this summary are accompanied by a level-of-evidence designation. These designations are intended to help readers assess the strength of the evidence supporting the use of specific interventions or approaches. PDQ is a registered trademark. Although the content of PDQ documents can be used freely as text, it cannot be identified as an NCI PDQ cancer information summary unless it is presented in its entirety and is regularly updated.
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Drugs Approved for Conditions Related to Cancer. Access to Experimental Drugs. Chronic disease—related malnutrition e. Acute disease—related or injury-related malnutrition e. Loss of muscle mass. Loss of subcutaneous fat. Localized or generalized fluid accumulation that may sometimes mask weight loss. Diminished functional status as measured by hand grip strength. Screening Early recognition of nutrition-related issues is necessary for appropriate nutrition management of cancer patients.
Education by registered dietitian or other clinician. Intervention by registered dietitian. Critical need for improved symptom management. Food- and nutrition-related history. Biochemical data, medical tests, and procedures. Localized or generalized fluid accumulation.
Diminished functional status e. Subcutaneous fat loss Orbit. Thoracic and lumbar regions. Subcutaneous muscle loss Temple. Tumor location current or anticipated mechanical function impairment. Anticipated duration of symptoms. Eat foods that are high in protein and calories. Eat high-protein foods first in your meal while your appetite is strongest—foods such as beans, chicken, fish, meat, yogurt, and eggs.
Add extra protein and calories to food. Cook with protein-fortified milk. Drink milkshakes, smoothies, juices, or soups if you do not feel like eating solid foods. Prepare and store small portions of favorite foods. Seek foods that appeal to the sense of smell.
Experiment with different foods. Eat larger meals when you feel well and are rested. Sip only small amounts of liquids during meals. Eat your largest meal when you feel hungriest, whether at breakfast, lunch, or dinner. Be as active as possible to help develop a bigger appetite. Consider asking your health practitioner about blenderized drinks with a high nutrient density. Tell your doctor if you are having eating problems such as nausea, vomiting, or changes in how foods taste and smell.
Perform frequent mouth care to relieve symptoms and decrease aftertastes. Consider tube feedings if you are unable to sustain a certain amount of caloric intake to maintain strength. Drink plenty of fluids each day, including water, warm juices, and prune juice. Be active each day; take walks regularly.
Eat more fiber-containing foods. Drink hot liquids to help relieve constipation, including coffee, tea, and warm milk. Talk with your doctor before taking laxatives, stool softeners, or any medicine to relieve constipation.
Limit certain foods if you develop gas, including broccoli, cabbage, cauliflower, beans, and cucumbers. Eat a large breakfast, including a hot drink and high-fiber foods. Consider a fiber supplement. Drink plenty of fluids to replace those lost from diarrhea, including water, ginger ale, and sports drinks.
Let carbonated drinks lose their fizz before you drink them. Eat foods and liquids that are high in sodium and potassium. Very hot or cold drinks.
Greasy, fatty, and fried foods. Foods that can cause gas, such as carbonated beverages, cruciferous vegetables, legumes and lentils, and chewing gum. Milk products unless low lactose or lactose free. Sugar-free products sweetened with xylitol or sorbitol. Sip water throughout the day. Have very sweet or tart foods and drinks — such as lemonade, to help make more saliva.