[Short bowel syndrome in children--treatment with home parenteral nutrition]

In 1979 the author first utilized the method of home parenteral nutrition in a child in Brazil. The purpose of this paper is to present the experience, during the last 23 years, of treatment of children with short bowel utilizing home parenteral nutrition.

Nineteen children with short bowel syndrome (resection of more than 75% of total intestinal length) were initially treated in the hospital and then nutrition therapy was continued at home. Total duration of nutrition therapy ranged from 4 months to 4 years and a half, while periods of home nutrition therapy ranged from 1 week to 4 years (median 8 months). Complete nutrition mixtures containing amino acids, glucose, lipid emulsion, electrolytes, vitamins and micro-elements were administered through Broviac or Hickman central venous catheters. Solutions were infused during the day or the night according to preference of the parents.

In all cases weight gain, growth and development similar to normal children under oral nutrition were verified. Catheter occlusion, liver dysfunction and sepsis related to the catheter were the most frequent complications. Seven children (37%) are alive and treatment free. Twelve children died (ten of them with resection of the entire small bowel and cecum), 11 due to parenteral nutrition complications (nine due to catheter sepsis and two due to massive pulmonary embolization) and one child died with neurological complications after a combined liver and small bowel transplantation.

Home parenteral nutrition is sometimes the only therapeutic choice for children with short bowel syndrome and promotes a maximal level of comfort to the patient and to the parents. Furthermore it reduces the period of hospitalization, while adaptation of the remaining small bowel occurs with maintenance of the nutritional status by oral route.