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Published on: September 20, 2019
Clinical improvement following home parenteral nutrition in pediatric patients with intestinal failure
Yi-Ching Tung1, Yen-Hsuan Ni, Hong-Shiee Lai
1Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei.
Insights
Home parenteral nutrition (HPN) supports pediatric intestinal failure patients, showing growth improvements. Metabolic issues are usually temporary, but managing infections during HPN is crucial for successful outcomes.
Area of Science:
- Pediatric Gastroenterology
- Intestinal Failure Management
- Parenteral Nutrition Therapy
Background:
- Home parenteral nutrition (HPN) is increasingly vital for pediatric intestinal failure.
- Understanding long-term outcomes in this population is essential.
Purpose of the Study:
- To evaluate long-term growth, prognosis, and complications in Taiwanese pediatric patients with intestinal failure receiving HPN.
- To compare outcomes between patients with short bowel syndrome and those with bowel motility disorders.
Main Methods:
- Retrospective analysis of 27 pediatric patients on long-term HPN (1987-2002).
- Patients grouped by diagnosis: short bowel syndrome vs. bowel motility disorder.
- Comparison of growth, prognosis, and complications (cholestasis, hypoglycemia, hyperglycemia, infections).
Main Results:
- HPN initiated earlier for short bowel syndrome (median 5 months) vs. motility disorders (1.9 years).
- Weight and height z-scores improved; cholestatic liver disease (52%) and hyperglycemia (33%) were common but often transient.
- Central venous infection incidence was 3.0/1000 HPN days, with Staphylococcus and Candida as primary pathogens.
Conclusions:
- HPN serves as a successful bridge to enteral nutrition in pediatric intestinal failure.
- Metabolic disturbances and cholestasis are typically transient.
- Vigilant infection control is paramount during HPN therapy.
Background/Purpose:
Home parenteral nutrition (HPN) is being increasingly used to treat children with intestinal failure. This study evaluated the long-term growth, outcome and complications in Taiwanese pediatric patients with intestinal failure who were treated with HPN.
Methods:
This retrospective study included 27 consecutive pediatric patients with intestinal failure who received long-term HPN between 1987 and 2002. These patients were categorized into two groups according to whether they had short bowel syndrome or a bowel motility disorder. Growth, prognosis and complications, including cholestasis, hypoglycemia, hyperglycemia and infections were compared between the two groups.
Results:
The median age of starting HPN was significantly younger in patients with short bowel syndrome (5 months) than in patients with motility disorders (1.9 years). The median duration of HPN treatment in the overall group was 13.5 months (range, 2.1-113.1 months); weight and height increased 1.7 +/- 2.3 and 1.0 +/- 1.6 in z score, respectively. The most common complications were cholestatic liver disease (52%), hypoglycemia (15%) and hyperglycemia (33%). All patients maintained stable serum glucose levels at follow-up. Cholestatic liver disease developed after 2.3 +/- 2.0 months of total HPN in 13 patients, which subsided after 9.7 +/- 6.9 months in 11 patients, while two patients died. The mean incidence of central venous infection was 3.0 +/- 3.3 per 1000 HPN days. The most common pathogens were Staphylococcus spp. (50%) and Candida spp. (30.6%).
Conclusion:
HPN treatment can successfully provide a bridge to enteral nutrition in pediatric patients with intestinal failure. The metabolic disturbances and cholestasis are usually transient, but infection control is important throughout the period of HPN treatment.
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