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Published on: September 20, 2019
Outcomes of the First 54 Pediatric Patients on Long-Term Home Parenteral Nutrition from a Single Brazilian Center
Helena A S Goldani1,2, Marilia R Ceza1, Liege L Godoy3
1From the Pediatric Gastroenterology Unit, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil.
Insights
This study shows that multidisciplinary pediatric intestinal rehabilitation programs using home parenteral nutrition (HPN) are safe and feasible in Brazil. These programs improve patient outcomes, with a 90% 5-year survival rate and 27.7% achieving enteral autonomy.
Area of Science:
- Pediatric Gastroenterology
- Clinical Nutrition
- Public Health
Background:
- Limited data exists on multidisciplinary home parenteral nutrition (HPN) programs in Latin America.
- This study addresses this gap by evaluating the first pediatric intestinal rehabilitation program for HPN in Brazil.
Purpose of the Study:
- To describe the outcomes of a multidisciplinary pediatric intestinal rehabilitation program for patients requiring home parenteral nutrition (HPN).
- To assess the feasibility and safety of HPN in a Brazilian public tertiary hospital setting.
Main Methods:
- Retrospective review of pediatric patients (0-18 years) with intestinal failure (IF) requiring parenteral nutrition (PN) for over 60 days.
- Data collected between January 2014 and December 2020.
Main Results:
- Fifty-four patients were discharged on HPN; 15 achieved enteral autonomy, and 4 died.
- The 5-year survival rate was 90%, with 27.7% achieving enteral autonomy.
- High rates of catheter-related thrombosis (66.7%) and a low bloodstream infection rate (0.39/1000 catheter-days) were observed. Intestinal failure-associated liver disease (IFALD) affected 24% of patients, but none who achieved enteral autonomy developed IFALD.
Conclusions:
- Multidisciplinary pediatric intestinal rehabilitation programs with HPN are feasible and safe within the Brazilian public health system.
- These programs demonstrate significant improvements in anthropometric parameters and survival rates for pediatric patients with intestinal failure.
Objectives:
Data on multidisciplinary programs dedicated to home parenteral nutrition (HPN) in Latin America are limited. This study describes the results of the first multidisciplinary pediatric intestinal rehabilitation program for HPN at a public tertiary hospital in Brazil.
Methods:
We retrospectively reviewed patients aged 0-18 years with intestinal failure (IF) who required parenteral nutrition (PN) for >60 days between January/2014 and December/2020.
Results:
Fifty-four patients were discharged on HPN (15 achieved enteral autonomy, 34 continued on HPN at the end of the study, 1 underwent intestinal transplantation, and 4 died). The median (IQR) age at the study endpoint of patients who achieved enteral autonomy was 14.1 (9.7-19) versus 34.7 (20.4-53.9) months in those who did not achieve enteral autonomy. Overall prevalence of catheter-related thrombosis was 66.7% and catheter-related bloodstream infection rate was 0.39/1000 catheter-days. Intestinal failure-associated liver disease (IFALD) was present in 24% of all patients; none of the patients who achieved enteral autonomy had IFALD. All patients showed significant improvement in anthropometric parameters during the HPN period. The sociodemographic characteristics of the patients' family members were mothers less than 20 years old (7.5%), schooling time more than 10 years (55.5%), and household income between 1 and 3 times the minimum wage (64.8%). The 5-year survival rate for HPN is 90%, and 27.7% of patients achieve enteral autonomy.
Conclusion:
The treatment of pediatric patients with IF followed by a multidisciplinary pediatric intestinal rehabilitation program with HPN is feasible and safe in the Brazilian public health system.
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