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Nutrition Support Adequacy in Children with Biliary Atresia After Liver Transplant
Nicole Knebusch1,2,3, Manpreet Virk1,2, Moreshwar S Desai1,2
1Division of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA.
Insights
Pediatric liver transplant recipients with biliary atresia achieved adequate nutrition support in the first week post-transplant. Infants received significantly higher energy and protein intake compared to older children, highlighting age-specific nutritional needs.
Area of Science:
- Pediatric Gastroenterology
- Transplant Surgery
- Clinical Nutrition
Background:
- Biliary atresia is a complex condition requiring liver transplantation in children.
- Post-transplant nutrition support is crucial but challenging due to pre-existing factors.
- Optimizing nutrition in pediatric liver transplant recipients is essential for recovery.
Purpose of the Study:
- To evaluate the adequacy of energy and protein intake in pediatric liver transplant patients with biliary atresia.
- To assess nutrition support during the first week in the Pediatric Intensive Care Unit (PICU).
- To identify factors influencing nutrition adequacy in this vulnerable population.
Main Methods:
- Retrospective cohort study of 138 pediatric patients with biliary atresia post-liver transplant.
- Analysis of nutrition adequacy (enteral and parenteral) during the first week of PICU admission.
- Comparison of nutrition goals achieved between infants and older children.
Main Results:
- Combined enteral and parenteral nutrition achieved 98% energy and 101% protein adequacy by week one.
- Infants (<1 year) showed significantly higher nutrition adequacy (136% calories, 157% protein) than older children.
- Older children (>1 year) received 0% of targeted nutrition goals.
Conclusions:
- Pediatric liver transplant patients with biliary atresia can achieve adequate nutrition support with combined methods.
- Age is a critical factor, with infants demonstrating superior nutrition delivery compared to older children.
- Tailored strategies are necessary to address the distinct nutritional requirements of pediatric liver transplant recipients.
Abstract:
Background: The nutrition support of children with biliary atresia after liver transplant is affected by multiple factors, and a connection between these factors and conditions present before transplant can potentially make the nutrition support more challenging. We aim to assess the adequacy of nutrition support, specifically energy and protein, during the first week of admission to the Pediatric Intensive Care Unit (PICU) in children after liver transplant secondary to biliary atresia. Methods: We performed a retrospective cohort study of 138 patients [13.9 median (9-33.4) IQR months; 62% female] with a diagnosis of biliary atresia admitted to the PICU after liver transplantation at Texas Children's Hospital over a 14-year study period. We obtained nutrition adequacy of enteral and parenteral nutrition support for the first week after transplant during their PICU admission. Results: Goal adequacy was reached at the end of the first week of admission when combined enteral and parenteral nutrition support was provided (median 98% for energy and 101% for protein). Infants achieved significantly higher adequacies than older children during the first week (136% < 1 year vs. 0% > 1 year, p < 0.001 for calories, and 157% < 1 year vs. 0% > 1 year for protein; p < 0.01). Conclusions: These findings highlight the complex nutritional challenges faced by this population, and strategies are needed to meet the unique needs of children after liver transplantation.
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