L.V. Marino

L.V. Marino
University Hospital Southampton NHS Foundation Trust · Dietetics/ SLT Department

BSc (Hons), PG Dip Diet, MMed Sci Nutr, PhD

About

74
Publications
7,421
Reads
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606
Citations
Introduction
Additional affiliations
June 2013 - July 2017
University Hospital Southampton NHS Foundation Trust
Position
  • Clinical Academic Paediatric Dietitian (PICU/ Cardiac)/ NIHR ICA Clinical Lectureship
March 2009 - May 2013
Imperial College London
Position
  • Research Dietitian
March 2009 - May 2013
Imperial College London
Position
  • Research Dietitian

Publications

Publications (74)
Article
Full-text available
Introduction With increased survival, children with CHD are reaching adulthood, however, obesity amongst this cohort is an emerging problem. Making every contact count encourages clinicians to utilise contact to elicit behaviour change. The aim of this work was to identify whether the body habitus of children classified as obese was addressed durin...
Article
p>Background: Paediatric Crohn's disease (CD) has been associated with undernutrition. Accurate and accessible measures of body composition would provide data to personalise nutritional therapy. We assessed feasibility of MRI-derived measures of psoas cross-sectional area (PCSA) in paediatric CD and correlated with anthropometric and bioelectrical...
Article
Introduction: the purpose was to explore the experience, information, support needs and decision-making of parents with congenital heart disease (CHD) during the COVID-19 crisis. Materials and methods: a survey study of parents of children with CHD, children and young people, capturing experiences, decision-making, information and support needs d...
Article
Background: The COVID-19 pandemic has had wide-reaching primary and secondary health implications. The UK government implemented a national lockdown to slow the rate of infection at the end of March 2020, lasting until early summer 2020. The results from a UK nationwide survey suggest the majority of inflammatory bowel disease patients were follow...
Article
Full-text available
Background The European Society of Pediatric and Neonatal Intensive Care (ESPNIC) published 32 clinical recommendations around supporting nutrition in critically ill children following an extensive review of the literature online in January 2020. The challenge now is to engage with paediatric intensive care unit teams to implement these into their...
Article
Full-text available
There are reports of children COVID-19 or COVID-19 like symptoms with hyperinflammatory multisystem syndrome, ARDS, gastrointestinal and atypical Kawasaki disease presenting to PICU worldwide temporally associated with COVID-19, for which there are important nutrition support considerations. As a result, the European Society of Pediatric and Neonat...
Preprint
Full-text available
Purpose of the study The purpose was to explore the experience, information, support needs and decision-making of parents with congenital heart disease (CHD) during the COVID-19 crisis. Study design On-line survey design Setting An on-line survey with open/closed questions to explore the experiences of parents of children, as well as children and y...
Chapter
Nutritional management of the critically ill child (CIC) is a very specialist and challenging area in paediatric dietetic practice. In addition to minimising the effects of starvation associated with suboptimal nutrition and preventing nutritional deficiencies and excesses, its goal is to sustain organ function and prevent dysfunction of the cardio...
Article
Full-text available
Background No evidence based recommendations for micronutrient requirements during paediatric critical illness are available, other than those arising from recommended nutrient intakes (RNI) for healthy children and expert opinion. Objectives The objective of this review is to examine the available evidence from micronutrient status in critically...
Article
Full-text available
Background: Nutritional support is considered essential for the outcome of pediatric critical illness. There is a lack of methodologically sound trials to provide evidence-based guidelines leading to diverse practices in PICUs worldwide. Acknowledging these limitations, we aimed to summarize the available literature and provide practical guidance f...
Article
Full-text available
Background: Nutritional support is considered essential for the outcome of pediatric critical illness. There is a lack of methodologically sound trials to provide evidence-based guidelines leading to diverse practices in PICUs worldwide. Acknowledging these limitations, we aimed to summarize the available literature and provide practical guidance f...
Article
Full-text available
Objective: Infants with congenital heart disease (CHD) often experience growth failure prior to surgery, which is associated with increased paediatric-intensive-care unit length of stay (PICU-LOS) and post-operative complications. This study assessed the impact of a pre-operative, consensus-based nutritional pathway (including support from a multi...
Article
To improve nutritional outcomes of community dwelling adults with malnutrition we identified three related hypotheses to be tested: i) Southampton Community Prescribing Support Service dietitians achieve 100% compliance with selected standards of the National Institute for Health and Clinical Excellence Clinical Guideline (CG) 32, ii) patient servi...
Article
Introduction Although chylothorax is an uncommon complication following paediatric cardiothoracic surgery, it has significant associated morbidities and increased in-hospital mortality, as well as results in higher costs. A lack of prospective evidence or consensus guidelines for management of chylothorax further hinders optimal management. The aim...
Article
Full-text available
Introduction Infants with CHD often experience growth failure. Ensuring optimal growth before surgery is associated with improved outcomes and has emerged as a significant cause of parental stress. Parents have reported a perceived lack of accessible feeding information for infants with CHD. To address this gap, the aim of this study was to develop...
Book
Full-text available
The Dietetic Pocket Guide has two editions: The version on adults (2017) and the paediatric version (2019). The Dietetic Pocket Guides are is designed to help dietitians working in all care settings and with all patient groups to complete a full dietetic assessment and diagnosis. These guides contain a wealth of relevant information, tests and cri...
Article
Full-text available
Background Enteral feeding is challenging in critically ill infants. Target intakes are often not achieved as a result of fluid restriction, procedural interruptions and perceived enteral feeding intolerance. In those infants perceived to have poor feeding tolerance, the use of a peptide nutrient‐energy dense enteral feed (PEF) may improve nutritio...
Article
Full-text available
Background: Although feeding difficulties are commonly described amongst children with chronic diseases, those admitted to a paediatric intensive care unit (PICU) represent a mix of previously healthy children as well as those with pre-existing diseases. There is, however, a lack of evidence describing the prevalence and type of feeding difficulti...
Article
Full-text available
To improve the postdischarge growth of exclusively breastfed preterm infants, born weighing ≤1.8 kg, by using breast milk fortifier (BMF) supplements postdischarge until 48 weeks’ gestational age. A quality improvement (QI) project involving plan–do–study–act (PDSA) cycles. A tertiary surgical neonatal unit. Preterm infants weighing ≤1.8 kg at birt...
Article
Aim Maintenance enteral nutrition (MEN) is routinely used in Paediatric Crohn's Disease (CD) to prolong remission although there is limited evidence for efficacy and alack of formal guidelines. This study surveyed patients’, parents’ and professional experience with MEN. Methods Two questionnaires were developed to survey experience of MEN; i) Pat...
Article
Breastmilk confers many advantages to infants and mothers as well as promoting the formation of the parental bond (1). International guidance recommends that breastmilk should be the preferred choice of feed for infants, with current guidelines from the World‐Health‐Organisation (WHO) stating infants should be exclusively breastfed for the first 6...
Article
Full-text available
Introduction: Primary ciliary dyskinesia (PCD) is a rare, heterogeneous genetic disorder where impaired mucociliary clearance is caused by dysfunctional motile cilia leading to bronchiectasis. There is limited evidence characterising the nutritional status of children with PCD, although lower body mass index (BMI) z-score has been associated with...
Article
Objective: Growth among infants with CHD is poor, and is multifactorial with multiple contributing factors. Unexplained hypophosphataemia has been reported among infants and children with complex medical needs consuming amino acid infant formula as the sole source of nutrition. The aim of this audit was therefore to review the incidence of hypopho...
Article
Full-text available
Introduction Despite improvements in the medical and surgical management of infants with CHD, growth failure before surgery in many infants continues to be a significant concern. A nutritional pathway was developed, the aim of which was to provide a structured approach to nutritional care for infants with CHD awaiting surgery. Materials and method...
Article
We have previously shown that children with a bioelectrical impedance spectroscopy phase angle at 50° (PA 50°) of <2.7 on postoperative day 2 had a four-fold increase in the risk of prolonged paediatric intensive care length of stay. In this study, we demonstrate a relationship between a baseline measure of phase angle 200/5° and postoperative leng...
Article
Purpose of review: The development of nutritional screening tools has done much to raise the profile of nutrition and encourage healthcare practitioners to consider how to identify children at nutritional risk. However, the next challenge is to ensure nutritional screening accurately identifies those who have immediate and ongoing risk and therefo...
Article
Full-text available
Background & aims: Critically ill adults have increased nutrition risk. Prior to procedures patients are often fasted, leading to nutritional deficits. The use of fasting guidelines may therefore help reduce deficits from accumulating. The aim of this work was to determine the impact on nutrition support delivery following the implementation of fa...
Chapter
In this chapter, undernutrition is used as the over-arching term for both faltering growth and malnutrition as defined by the World Health Organization (WHO). The causes for undernutrition in children with chronic disease are multifactorial and linked to increased macronutrient and micronutrient requirements, altered metabolism, increased nutrient...
Article
Introduction There has been an increased emphasis on the nutritional care of children in hospital with the recognition that those admitted to hospital, particularly with chronic conditions, are at significant nutrition risk. However, although nutrition risk screening tools (NRST) are widely used in acute hospital settings compliance with their use...
Article
Aim: Paediatric Crohn's disease (CD) is associated with growth delay and poor nutritional status. Maintenance enteral nutrition (MEN) supplementation is a potential adjunct to improve growth/prolong remission. Methods: Newly-diagnosed CD patients were identified. Anthropometry, treatments and outcomes were collected for 12 months following diagn...
Article
Background & aims Fats in the form of lipid emulsions (LEs) are an integral part of intravenous nutrition. The fatty acid composition of different LEs varies. The exact composition of a LE may influence cell and tissue function and clinical outcome. Currently, it is not clear which LE might be best for paediatric patients. We conducted a systematic...
Article
Full-text available
Objective: Children with congenital heart disease (CHD) are often growth restricted (low weight- and/or height-for-age) which may increase risk of poor post operative resilience. Bioelectrical impedance spectroscopy (BIS) has been used to determine body composition in different clinical settings and has been shown to mark differences in nutritiona...
Conference Paper
Background Vitamin A is known to be an important micronutrient for immune competence, retinal cell and lung development. Preterm infants are recognised as having reduced Vitamin A stores and therefore being at greater risk of deficiency and its consequences. Aims To assess adequacy of vitamin A supplementation via parenteral nutrition (PN) for pre...
Article
Introduction Multiple nutritional risk assessment tools are available, but there are limited data on their application in the acute setting. We explored the validity of two tools in a tertiary Children's Hospital's acute unit and the cohort's nutritional status using WHO definitions. Methods Prospective study n=300 (median 38 months; 44.6% female;...
Article
Full-text available
It is thought that 178 million children are underweight worldwide, and 20 million suffer from severe acute malnutrition each year, which carries a higher mortality. Growth parameters below a nominal cut-off indicate acute or chronic malnutrition, which are used as indicators for commencing therapeutic nutritional intervention in individuals and pop...
Article
Introduction Exclusive enteral nutrition (EEN) is the primary therapy for induction of remission and growth restoration in newly diagnosed children with Crohns Disease (CD). Patients who failed to go into clinical remission were offered steroids with partial enteral nutrition (PEN) alongside diet or steroids alone. The aim of this retrospective stu...
Article
Introduction Several studies suggest that maintenance enteral nutrition (MEN) post induction in Crohns Disease (CD) may have a role in prolonging remission. This retrospective study compares growth outcomes and relapse rate in CD patients supplemented with MEN versus an unsupplemented group. Methods Data including anthropometry, treatment type and...
Article
CHD is associated with poor growth, delayed motor and language skills development, and increased length of hospital stay; 28.2% of infants were stunted, with z-scores<-2. The severity of surgery score was not associated with an increased length of stay, suggesting that a low weight-for-age z-score at the time of surgery may impact on length of stay...
Article
Objective: Glutamine has been shown to promote the release of heat shock protein 70 (HSP70) both within experimental in vitro models of sepsis and in adults with septic shock. This study aimed to investigate the effects of 2 mM glutamine and an inhibitor of HSP70 (KNK437) on the release of HSP70 and inflammatory mediators in healthy adult voluntee...
Article
Poor growth is a common complication in infants with congenital heart disease. There has been much focus on low birth weight as having increased risk of adverse outcomes following neonatal heart surgery. In this study, we examined whether preoperative nutritional status, measured by admission weight-for-age z score, was associated with postoperativ...
Chapter
Glutamine serves as a primary fuel for rapidly dividing cells, such as in the gut and immune system, and is used as a source of nitrogen to refill the citric acid cycle. During critical illness, the demand for glutamine may exceed that which can be mobilised from muscle stores. Clinical data over the past 20 years have provided evidence that glutam...
Article
Objective: Glutamine has been shown to promote heat shock protein 70 (HSP70) release both within experimental in vitro models of sepsis (2-10 mM) and in adults post trauma (0.5 g/kg), although the efficacy varies and is dependent on the model used. The effect of glutamine supplementation on HSP70 release in children is less clear. Therefore, the a...
Chapter
Nutritional management of critically ill children (CIC) is a very specialist and challenging area in paediatric practice. A knowledge of metabolic changes and fuel utilisation during physiological stress can assist dietitians in commencing nutritional support at the appropriate time and suggesting a suitable feeding route and feed composition. Crit...
Article
Heat shock proteins are classified into six main families, of which HSP70 is the best studied. HSP70 is postulated to modulate the immune/inflammatory response in critical illness. Glutamine promotes HSP70 release, however, little is known about the relationship between glutamine and HSP70 in paediatric critical illness. We therefore aimed to descr...
Article
Background & aims Ready to use (RTU) infant formulas became available for use in South African hospitals in 2005. However, a major barrier to use these formulae has been the perceived high product cost compared to the product cost of powdered infant formula (PIF). The aim of this cost comparative analysis was to determine the entire cost of these t...
Article
Full-text available
Burn injuries evoke a systemic metabolic response with profound effects on organ function, susceptibility to infection, wound healing, growth and development, and mortality. Children are especially vulnerable to nutritional deficiencies owing to their limited energy reserves. We evaluated the feeding practice in a paediatric burns unit. All childre...
Article
The relationship between infant feeding patterns and the later development of food allergies has been the focus of much debate and research over the last decade. National recommendations have been made by many countries on how to feed infants to reduce the risk of food allergy but due to the lack of firm evidence the recommendations differ widely....
Article
Full-text available
The study arose as part of a best-practice nutrition model regarding the introduction of ready-to-use (RTU) infant feeds in place of powdered infant feeds (PIFs) as a standard formula for infants under the age of 1 year who are unable to be breastfed. Internationally and locally there is grave concern regarding the safety and efficacy of mixing PIF...
Article
To determine the prevalence of malnutrition in hospitalised paediatric patients at Red Cross War Memorial Children's Hospital. A 1-day cross-sectional survey was completed in all medical and surgical wards and some specialist outpatient clinics. A total of 227 children participated in the study. Thirty-five per cent of patients were moderately maln...
Article
To compare the efficacy of blind transpyloric placement using a specifically designed nasojejunal tube (NJT) versus a standard nasogastric tube (NGT) in severe head injury (SHI). This was a randomised trial conducted in a neurosurgical intensive care unit. Fourteen patients were enrolled with a Glasgow Coma Score (GCS) less than 8 (mean 6.8 SEM+/-0...
Article
To determine the effect of 8-hourly administration of 10 mg intravenous metoclopramide, over a 48-h period on gastric emptying in severe head injury (SHI), 22 patients were prospectively randomized (Glasgow Coma Score of 3-8) to receive 2 ml of intravenous metoclopramide or 2 ml of 5% saline 8-hourly for 48 h. Baseline and serial blood paracetamol...
Article
Full-text available
Over the last 20 years studies focusing on malnutrition have helped to define the benefits of nutrition intervention. Malnutrition remains a widespread and largely unrecognised problem. 1-2 Malnutrition may be defined as a nutrition disorder resulting from reduced nutrient intake or impaired metabolism. There is currently no 'gold standard' or sing...

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