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Volume 31 Number 3

June 2009

TABLE OF CONTENTS
2	Guest Editor's Perspective Susan Roberts, MS, RD, LD, CNSD This issue of Support Line includes topics on children and adults. Although both the patient populations and nutrition interventions described vary, a common thread is present. Each article focuses on a very challenging area in nutrition support and provides clinicians with recommendations for care based on the best evidence available.
2	Chair's Column Jennifer A. Wooley, MS, RD, CNSD I'm excited to become the next Chair of Dietitians in Nutrition Support (DNS) and feel honored to carry the torch of my inspirational predecessors to lead this incredible dietetics practice group for the next year.
3	Nutritional Management of Chyle Leaks E. Annelie M. Vogt, MS, RD, LD, CNSD, Rebecca Brody, MS, RD, CNSD A chyle leak is a fairly uncommon condition that is due primarily to malignancies and, less frequently, cardiothoracic surgeries. Chylous leakage is generally characterized as chylothorax or chylous ascites, with visible effluent in the thoracic and abdominal cavities. Chyle leaks can be managed medically or surgically, and appropriate nutrition support is essential for timely closing of the leak. No consensus has been reached for the optimal nutritional treatment of chyle leaks, and no Level 1 evidence-based guidelines are available to direct care. However, nutrition management should begin soon after diagnosis and includes several options, depending on the severity of the leak. The more severe and sustained leaks require more conservative treatment in terms of allotment of fat and modality of feeding. Because current guidelines are based on cohort studies and case reports, the ideal directions for future study include large samples of patients for whom enteral and parenteral nutrition are compared to ascertain the optimal route of feeding and distribution of macronutrients.
9	Omegaven® Use in Neonates Sharon B. Collier, RD, LDN, MEd Parenteral nutrition-associated liver disease (PNALD) is a well-known risk of parenteral nutrition (PN) (1). This condition is often characterized by increased liver function tests and bilirubin concentrations. The cause, treatment, and methods of preventing PNALD have not yet been elucidated, but many risk factors are associated with its development, including preterm birth, duration of PN with no oral/enteral feedings, multiple surgeries, and sepsis episodes (1,2). A variety of modifications are made in the PN regimen when PNALD occurs. One area of focus has been altering the dose and/or type of intravenous fat emulsion (IVFE). Retrospective studies have demonstrated an association of infusion of more than 1 g/kg/day of fat with a greater incidence of PNALD (3–6). Omegaven® (Fresenius Kabi AG, Bad Homburg, Germany), a fish oil-based IVFE that is high in docosahexaenoic acid (DHA) and eicosapentanoic acid (EPA), has been used as monotherapy at a dose of 1 g/kg/day fat for the treatment of PNALD (7).
18	The Ins and Outs of Pediatric Short Bowel Kristi L. King, MPH, RD, Sarah M. Phillips, MS, RD One of the more challenging nutritional disorders in the pediatric population is short bowel syndrome, where the function and anatomy of the small and large intestines are significantly altered following resection. The result is intestinal failure, a clinically significant malabsorption caused by the shortened intestine. Nutritional rehabilitation is complicated by a variety of metabolic, infectious, and mechanical disorders that can affect nutrient utilization, bowel adaptation, and growth and development of the child. Some common causes of short bowel in the pediatric population are necrotizing enterocolitis, intestinal anomalies such as volvulus, malrotation, and intestinal atresias. The ability of the patient to transition from parenteral nutrition (PN) to an oral diet depends on the degree to which the gut can function, adapt, and compensate. The ease of the transition depends not only on bowel length, but the site of the resection, the presence of the colon and ileocecal valve (ICV), and the continuity of the bowel. Therefore, a multidisciplinary and multimodal (nutritional, surgical, and pharmacological) treatment program provides for the best outcomes in intestinal rehabilitation for children.
27	Past Chair's Farewell Marsha R. Stieber, MSA, RD, CNSD Welcome, DNS members, to summer and to a new program year for ADA and for DNS. It is almost unimaginable that the past year as DNS Chair has whizzed by so quickly—and my head is still spinning from the experience! It was a tremendously wonderful journey, and that was due solely to you.

All material appearing in SUPPORT LINE is covered by copyright and may be photocopied or otherwise reproduced for noncommercial scientific or educational purposes only, provided the source is acknowledged. Written consent from the managing editor is required for any other purpose.

Viewpoints and statements in these materials do not necessarily reflect the policies and/or official positions of The American Dietetic Association or DNS.

SUPPORT LINE (ISSN 1067-3768) is published bi-monthly. $60 for individual non-member subscriptions, $120 for institutions per year (plus postage surcharges for international subscriptions). Newsletter subscriptions are available to interested parties who are ineligible for ADA membership. Published by Dietitians in Nutrition Support, a dietetic practice group of The American Dietetic Association (ADA), 120 S. Riverside Plaza, Suite 2000, Chicago, IL 60606. Send requests for subscriptions to Jamie Diamond, MS, RD, CNSD, 3850 Galt Ocean Drive, Apt. 2009, Fort Lauderdale, FL 33308. For address changes: Please submit name and address changes directly to the Membership Team of the American Dietetic Association using the address change card in the Journal of the American Dietetic Association. SUPPORT LINE is indexed in the Cumulative Index to Nursing and Allied Health Literature.

FOR THIS ISSUE:

Editor

Susan Roberts, MS, RD, LD, CNSD
3911 Kramar Court
Arlington, TX 76016
214/820-6751

Managing Editor

Deborah K. Kuhlman
921 N. Western Avenue
Park Ridge, IL 60068
847/692-3407

Associate Editors

Therese Austin, MS, RD, CNSD

Kathy Logan,, MS, RD, CNSD

Associate Editor, Continuing Education:

Neha Parekh, MS, RD, CNSD

Associate Editor, Writer's Mentoring:

Marcia Kalista-Richards, MPH, RD, CNSD

Contributing Editor, Inquire Here:

Gail Cresci, MS, RD, CNSD

Membership/Subscriptions:

Jamie Diamond, MMS, PA-C, RD

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