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Weaning Off Prognosis Factors of Home Parenteral Nutrition for Children With Primary Digestive Disease
Laetitia-Marie Petit1, Delphine Girard, Solene Ganousse-Mazeron
1*Unité de Gastro-Entérologie Pédiatrique, Département de l'Enfant et de l'Adolescent, Hôpitaux Universitaires de Geneve, Geneva, Switzerland †Unité de Recherche Clinique/Centre d'Investigation Clinique Paris Descartes Necker, Hôpital Necker-Enfants Malades, Paris, France ‡University Children's Hospital, Pediatric Pulmonology Research Group, Basel, Switzerland §Unité de Gastroentérologie, Hépatologie et Nutrition Pédiatriques ||Pharmacie, Hôpital Necker-Enfants Malades, Paris, France.
Insights
Home parenteral nutrition (HPN) is a safe option for children with chronic intestinal failure (IF). Factors like underlying disease and remnant bowel length influence weaning off HPN.
Area of Science:
- Pediatric Gastroenterology
- Clinical Nutrition
- Intestinal Failure Management
Background:
- Home parenteral nutrition (HPN) is crucial for managing chronic intestinal failure (IF) in children.
- Understanding indications and outcomes is vital for optimizing pediatric care.
Purpose of the Study:
- To detail indications for HPN in pediatric primary digestive diseases.
- To identify factors predicting successful weaning from HPN.
Main Methods:
- Retrospective cohort study of 151 children discharged on HPN (2000-2009).
- Multivariable Cox regression analyzed associations between clinical factors and HPN weaning.
Main Results:
- Survival probability was ~100%.
- Weaning probability was 0.73, varying by IF cause (e.g., better prognosis for SBS, IBD).
- Unfavorable factors included <40 cm bowel remnant, <50% colon presence, and >1.5 g/kg/day lipid intake.
Conclusions:
- HPN is a safe long-term therapy for pediatric chronic IF.
- SBS anatomy and caloric intake are key prognostic factors for weaning.
- Underlying disease significantly impacts HPN outcomes in children.
Objectives:
The aim of the present study was to describe the indications for home parenteral nutrition (HPN) in children with primary digestive diseases and to identify factors associated with weaning off.
Methods:
All the children initially discharged on HPN between January 1, 2000, and December 31, 2009, for chronic intestinal failure (IF) were included. The associations between clinical factors and weaning off of HPN were assessed using a multivariable Cox regression model.
Results:
Among the 151 children (boys = 58%) included in this study, 98 (65%) presented with short bowel syndrome (SBS), 17 (11%) with digestive neuromuscular disorders, 14 (9%) with mucosal diseases, 13 (9%) with inflammatory bowel disease, and 9 (6%) with other primary digestive diseases. The probability of survival was ∼100%. At the end of the follow-up, the probability for weaning off of HPN was 0.73 (95% confidence interval 0.54-0.84) but varied according to the underlying cause of IF (for example, SBS and inflammatory bowel disease had a better prognosis). The median time until weaning off was 21 months (95% confidence interval 18-38 months). Unfavourable prognostic factors for weaning off of HPN included a bowel remnant of <40 cm, the presence of <50% of the colon, and daily lipid intakes >1.5 g · kg · day. Underlying disease was also associated with weaning off.
Conclusions:
HPN is a safe therapeutic option for children with chronic IF requiring long-term nutritional management. Prognostic factors for weaning off of HPN were identified, and they highlight the relevance of SBS anatomy and parenteral nutrition caloric intake. The outcome of children on HPN was primarily dependent on the underlying disease.
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