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Managing children and adolescents on parenteral nutrition: Challenges for the nutritional support team
Tracey Johnson1, Elaine Sexton
1Department of Nutritional Care, Birmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, UK. tracey.johnson@bch.nhs.uk
Insights
Parenteral nutrition (PN) for pediatric patients, including infants and adolescents, presents unique challenges due to growth needs. Comprehensive guidelines are lacking, with practices varying and complications like liver disease a concern.
Area of Science:
- Pediatric Gastroenterology
- Clinical Nutrition
- Intestinal Rehabilitation
Background:
- Parenteral nutrition (PN) management in pediatric patients (infants to adolescents) is complex, differing significantly from adult care due to essential growth requirements.
- Pediatric PN is often necessitated by congenital conditions like short-bowel syndrome (SBS) rather than acquired diseases.
- Current pediatric PN practices lack comprehensive guidelines, relying on individual clinical experience and assessments rather than robust clinical trials.
Purpose of the Study:
- To highlight the challenges and considerations in providing parenteral nutrition for infants, children, and adolescents.
- To underscore the absence of standardized guidelines for pediatric PN requirements and assessment methods.
- To discuss complications associated with PN and the implications of home parenteral nutrition (HPN).
Main Methods:
- Review of existing challenges and practices in pediatric parenteral nutrition.
- Analysis of nutritional requirements and assessment methods for growing children on PN.
- Discussion of complications and psychosocial aspects of home parenteral nutrition (HPN).
Main Results:
- Pediatric patients require nutrition for growth, making PN management distinct from adults.
- Nutritional requirements are individualized and need regular reassessment based on age and clinical status.
- Complications include infections and cholestatic liver disease; HPN offers benefits but poses psychosocial challenges for families.
Conclusions:
- There is a critical need for evidence-based, comprehensive guidelines for pediatric parenteral nutrition.
- Individualized assessment and regular review of nutritional needs are paramount for pediatric patients on PN.
- Home parenteral nutrition (HPN) requires robust home-care services sensitive to the unique physical and psychological needs of children and their families.
Abstract:
Managing infants, children and adolescents, ranging from premature infants to 18-year-old adolescents, on parenteral nutrition (PN) is a challenge. The ability of children to withstand starvation is limited and, unlike adults, children require nutrition for growth. PN in children is often required secondary to a congenital bowel problem rather than because of an acquired condition. Conditions requiring PN include motility disorders, congenital disorders of the intestinal epithelium and short-bowel syndrome (SBS). Intestinal failure may be temporary and children with SBS may be weaned from PN. However, other children require permanent PN. There are no comprehensive guidelines for the nutritional requirements of children and adolescents requiring PN. Practice in individual centres is based on clinical experience rather than clinical trials. Requirements are assessed on an individual basis according to age, nutritional status and clinical condition. These requirements need regular review to ensure that they remain appropriate for the changing age and weight of the child. Assessments of intakes use different methods, e.g. reference tables and predictive equations. Complications of PN include infection, accidental damage to, or removal of, the line and cholestatic liver disease. Home parenteral nutrition (HPN) is associated with fewer line infections and allows continuation of nutritional support in a more normal environment, encouraging normal development and participation in family activities. However, having a child at home on HPN is associated with physical and psychological stresses. A feeling of depression, loneliness and social isolation is common amongst children and their families. Home-care services are essential to supporting children at home and should be tailored to, and sensitive to, the individual needs of each family.
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