Prepubertal growth in children with long-term parenteral nutrition

Area of Science:

• Pediatric Gastroenterology
• Nutritional Support
• Growth and Development

Background:

• Children requiring long-term parenteral nutrition (PN) face challenges in achieving optimal growth.
• Cyclic nocturnal home PN is a common method for providing nutritional support to these children.
• Assessing growth patterns in this population is essential for optimizing clinical management.

Purpose of the Study:

• To retrospectively analyze growth patterns in children receiving long-term cyclic nocturnal home PN.
• To identify factors influencing growth, specifically focusing on PN supply adequacy.
• To provide recommendations for optimizing PN regimens to support healthy growth in children.

Main Methods:

• Retrospective analysis of growth data (height and weight) in 16 children over at least 8 years before puberty.
• Categorization of growth periods into regular (height gain >50th percentile) and slow (height gain ≤25th percentile).
• Comparison of PN nitrogen and energy intake during regular versus slow growth periods.

Main Results:

• Only 4 out of 16 children achieved consistent regular prepubertal growth.
• 12 children experienced alternating periods of regular and slow growth.
• Significantly higher PN nitrogen and energy supplies were observed during periods of regular growth compared to slow growth.

Conclusions:

• Inadequate PN supplies, especially nitrogen, are strongly associated with slowed growth and negative nitrogen balance in children on long-term PN.
• Weight gain acceleration can occur concurrently with height gain deceleration.
• Early adjustment of PN supply, particularly nitrogen, is recommended when growth deviates from the individual's curve.