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Published on: September 20, 2019
Prevalence of home parenteral nutrition in children
Anthony E Wiskin1, Rachel Russell2, Andrew R Barclay3
1Department of Paediatric Gastroenterology, Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol, BS2 8BJ, UK.
Insights
Home parenteral nutrition (HPN) in UK pediatrics has grown significantly. This study found long-term HPN in children is safe, with good survival rates and a low need for intestinal transplants.
Area of Science:
- Pediatric Gastroenterology
- Clinical Nutrition
- Public Health
Background:
- Home parenteral nutrition (HPN) use in UK pediatrics has risen sharply in the past two decades.
- Defining HPN prevalence has been difficult, despite perceived improvements in outcomes and acceptance of long-term parenteral nutrition (PN).
- Increasing complexity and acceptance of HPN may strain pediatric gastroenterology services.
Purpose of the Study:
- To determine the prevalence of HPN in children within the UK.
- To investigate patient outcomes for those receiving HPN.
- To analyze trends in HPN utilization and patient demographics.
Main Methods:
- Utilized a national database to collect data on children receiving HPN.
- Analyzed prevalence data from 2015 onwards, comparing with previous reports.
- Examined key outcomes including mortality and intestinal transplantation rates.
Main Results:
- From 2015, 525 children were recorded; <5% mortality and 1% intestinal transplant rates.
- In 2019, 389 children received HPN, a prevalence of 30 per million children, nearly double that of 2012.
- Short bowel syndrome remains the primary diagnosis, but a poorly defined group with multisystem disease has increased tenfold.
Conclusions:
- Long-term HPN in childhood is a safe treatment modality.
- Associated with favorable survival rates in pediatric patients.
- Carries a low risk of requiring intestinal transplantation.
Background:
Use of HPN in paediatrics in the UK has increased rapidly over the last 20 years but the prevalence of HPN has been challenging to define. Clinicians in the UK have noted an evolving complexity of cases and perceive improved outcomes and increased acceptability of long-term PN. These factors combined have the potential to increase the burden on existing paediatric gastroenterology services in the UK.
Methods:
A national database was interrogated to define the prevalence of HPN in children in the UK and to explore outcomes for patients receiving HPN.
Results:
Since 2015, 525 children were notified to the database; of these patients, mortality was <5% and intestinal transplant occurred in 1%. In 2019, 389 children received HPN in the UK; this is nearly double the number last reported in 2012 and is a prevalence of 30 per million children. Short bowel syndrome is the largest category of these patients. However, a poorly defined group including those with multisystem disease has increased 10 fold since 2012 and is now the second largest category.
Conclusions:
Long term HPN in childhood is safe and associated with good survival and low risk of the need for intestinal transplantation.
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