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Published on: September 20, 2019
Paediatric parenteral nutrition: current issues
1Department of Paediatric Gastroenterology and Nutrition, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
Insights
Parenteral nutrition (PN) has been crucial for infants with intestinal failure, especially preterm infants. Updated guidelines address persistent challenges like sepsis and liver disease, aiming to improve PN best practices.
Area of Science:
- Pediatric Gastroenterology
- Neonatology
- Nutritional Support
Background:
- Parenteral nutrition (PN) significantly improved outcomes for pediatric patients with intestinal failure.
- PN adoption in preterm infants, necessitated by immature gastrointestinal function, led to this group becoming the largest recipients.
- Despite advancements, complications such as central venous catheter-related sepsis, thrombosis, liver disease, bone disease, and metabolic disturbances persist.
Purpose of the Study:
- To summarize key elements of the updated European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) guidelines on parenteral nutrition.
- To highlight changes and advancements in PN best practices since the 2005 guidelines.
- To address persistent challenges in PN for pediatric and preterm populations.
Main Methods:
- Review of scientific literature and clinical experience.
- Development of evidence-based recommendations by ESPGHAN and collaborating organizations.
- Comparison of updated 2018 guidelines with the initial 2005 guidelines.
Main Results:
- Guidelines have evolved based on scientific knowledge and clinical experience over 10+ years.
- Focus on reducing risks associated with PN, though challenges remain.
- Updated recommendations aim to promote best practices in PN for vulnerable pediatric populations.
Conclusions:
- Parenteral nutrition remains a vital support for infants and children with intestinal failure.
- Continuous updates to guidelines are necessary to manage and mitigate PN-associated complications.
- The 2018 guidelines represent an advancement in optimizing PN strategies, building upon decades of experience.
Abstract:
Parenteral nutrition transformed the prognosis for infants and children with intestinal failure. Soon after its introduction into clinical care 50 years ago, parenteral nutrition was also rapidly adopted for use in the preterm infant, where immaturity of gastrointestinal motor function precluded enteral feeding. Preterm infants subsequently became the single largest group of patients to be fed in this way. Although the development of scientific knowledge and the lessons of clinical experience have reduced the risk of complications, some of the problems and difficulties associated with this form of nutritional support remain challenging. These include central venous catheter-related sepsis, thrombosis, liver disease, bone disease and metabolic disturbance. In an initiative to promote best practice, guidelines on parenteral nutrition were first published by the European Society for Paediatric Gastroenterology, Hepatology and Nutrition and collaborating organisations in 2005. These were constructed following a thorough review of the scientific literature, allowing a series of evidence-based recommendations to be made. The exercise was repeated just over 10 years later and updated guidelines published in 2018. This review summarises key elements from the new guideline, with a focus on what has changed since 2005.
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