{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T21:18:52Z","timestamp":1793999932374,"version":"4.8.0"},"reference-count":6,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2025,5,1]],"date-time":"2025-05-01T00:00:00Z","timestamp":1746057600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,5,1]],"date-time":"2025-05-01T00:00:00Z","timestamp":1746057600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Investigative Medicine High Impact Case Reports"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:p>There has been a multivitamin infusion (MVI) shortage for the last decade, generating increasing concerns for the neonatal population. This study evaluated a cohort of 4 total parenteral nutrition (TPN)-dependent neonates who presented within a 6-month period with abnormal biochemistry in a complex and unusual pattern. All exhibited findings were suggestive of multiple inherited metabolic disorders (IMD), particularly multiple acyl-CoA dehydrogenase deficiency and maple syrup urine disease. Given the rarity of having 2 IMDs, communication with the primary team was initiated and revealed inadequate MVI in the administered TPN. All biochemical abnormalities could be explained by thiamine (B1), riboflavin (B2), pyridoxine (B6), and\/or biotin (B7) deficiency. MVI-deficient TPN as the single unifying etiology is further supported by normal newborn screening (NBS) and resolution of biochemical abnormalities with MVI administration in all neonates. Awareness of this problem is critical to avoid unnecessary testing and initiate prompt treatment with vitamins.<\/jats:p>","DOI":"10.1177\/23247096251339303","type":"journal-article","created":{"date-parts":[[2025,5,21]],"date-time":"2025-05-21T03:20:52Z","timestamp":1747797652000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["The Clinical and Biochemical Impact of the Multivitamin Shortage on Neonatal Patients"],"prefix":"10.1177","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-0638-3528","authenticated-orcid":false,"given":"Reva","family":"Frankel","sequence":"first","affiliation":[{"name":"Stanford University, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Courtney","family":"Verscaj","sequence":"additional","affiliation":[{"name":"Stanford University, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6227-7895","authenticated-orcid":false,"given":"Christina G.","family":"Tise","sequence":"additional","affiliation":[{"name":"Stanford University, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristina","family":"Cusmano-Ozog","sequence":"additional","affiliation":[{"name":"Stanford University, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,5,21]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1542\/pir.2017-0283"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ymgme.2022.07.018"},{"issue":"27","key":"e_1_3_2_4_2","first-page":"100738","article-title":"Maternal vitamin deficiency mimicking multiple acyl-CoA dehydrogenase deficiency on newborn screening","volume":"6","author":"Gramer G","year":"2021","unstructured":"Gramer G, Hoffmann GF, Hennermann JB. Maternal vitamin deficiency mimicking multiple acyl-CoA dehydrogenase deficiency on newborn screening. Mol Genet Metab Rep. 2021;6(27):100738.","journal-title":"Mol Genet Metab Rep"},{"key":"e_1_3_2_5_2","unstructured":"ASPEN [Internet]. Parenteral Nutrition Product Shortages. 2023. Accessed June 24 2023. https:\/\/www.nutritioncare.org\/Guidelines_and_Clinical_Resources\/Parenteral_Nutrition_Product_Shortages\/"},{"key":"e_1_3_2_6_2","unstructured":"ASPEN [Internet]. 2021 Parenteral Nutrition Multivitamin Product Shortage Considerations. 2021. Accessed June 24 2023. https:\/\/www.nutritioncare.org\/Guidelines_and_Clinical_Resources\/Product_Shortages\/2021_Parenteral_Nutrition_Multivitamin_Product_Shortage_Considerations\/\/"},{"issue":"1","key":"e_1_3_2_7_2","article-title":"Misdiagnosis of total parental nutrition-related riboflavin deficiency: three case reports of diagnostic error","volume":"13","author":"Shafer GJ","year":"2023","unstructured":"Shafer GJ, Abdenur JE, Dhar V, et al Misdiagnosis of total parental nutrition-related riboflavin deficiency: three case reports of diagnostic error. AJP Rep. 2023;13(1):e11-e16.","journal-title":"AJP Rep"}],"container-title":["Journal of Investigative Medicine High Impact Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/23247096251339303","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/23247096251339303","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/23247096251339303","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T08:04:26Z","timestamp":1777449866000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/23247096251339303"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5]]},"references-count":6,"alternative-id":["10.1177\/23247096251339303"],"URL":"https:\/\/doi.org\/10.1177\/23247096251339303","relation":{},"ISSN":["2324-7096","2324-7096"],"issn-type":[{"value":"2324-7096","type":"print"},{"value":"2324-7096","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5]]},"article-number":"23247096251339303"}}