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[Long-term TPN for short bowel syndrome]
S Yokoyama1, T Fujimoto, T Mitomi
1Department of Surgery, Tokai University, School of Medicine, Isehara, Japan.
Insights
Total parenteral nutrition (TPN) in infants with extremely short bowel is crucial but carries risks like catheter sepsis and liver dysfunction. Early oral feeding alongside TPN can mitigate complications.
Area of Science:
- Pediatric Gastroenterology
- Neonatal Intensive Care
Context:
- Total parenteral nutrition (TPN) is a life-sustaining treatment for infants with extremely short bowel.
- Management of these infants presents significant challenges, including high risks of complications.
Purpose:
- To evaluate the role and safety of TPN in managing infants with extremely short bowel.
- To assess TPN-related complications, including catheter sepsis and hepatic dysfunction.
Summary:
- The study included 163 children receiving TPN, with 7 cases of short bowel syndrome.
- Mortality rate was 3% (5/163), primarily due to catheter sepsis.
- Broviac catheters showed significantly fewer complications than conventional Silastic catheters (p<0.01).
- Hepatic dysfunction was a notable complication, often resolving with the initiation of enteral feeding.
- Early oral feeding, supported by TPN, is recommended to manage fluid loss and improve outcomes.
- Rare complications like copper deficiency and urolithiasis were also reported.
Impact:
- Highlights the critical role of TPN in extremely short bowel syndrome while underscoring the need for vigilant monitoring.
- Demonstrates the superiority of Broviac catheters in reducing central venous catheter-related sepsis.
- Emphasizes the importance of early enteral nutrition alongside TPN for managing short bowel syndrome and associated complications.
Abstract:
One hundred and sixty three children who received total parenteral nutrition (TPN), including 7 cases of short bowel syndrome, were studied to evaluate the role of TPN in the management of infants with extremely short bowel. Three of the seven were died of sepsis related with central venous catheter (CV catheter) during the period of malabsorption when TPN was necessary. Two children of other diseases were died of catheter sepsis, 5 out of 163 in total, making the mortality late of TPN 3%. Incidence of CV catheter related complications was significantly less frequent in Broviac catheter when compared with conventional Silastic catheter (p less than 0.01). Another significant complication of TPN in cases of short bowel syndrome was hepatic dysfunction. Cholestatic liver dysfunction seemed to be cleared when enteral feeding was started even with TPN going on. Oral feeding should be started in the early postoperative period with concomitant TPN covering the fluid loss. A case of copper deficiency with high output jejunostomy and a case of urolithiasis with hyperoxaluria complicated with short bowel were reported.