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[Home parenteral nutrition in children: practical modalities]
I Loras-Duclaux1, A Lachaux, C Le Gall
1Service de gastroentérologie et nutrition pédiatriques, hôpital Edouard-Herriot, Lyon, France.
Summary
Home parenteral nutrition (PN) enables long-term treatment for chronic digestive diseases and in oncology, hematology, and renutrition before transplantation. Parental involvement and technical advances make home PN feasible for over three months, with infections being the most common complication.
Area of Science:
- Clinical Nutrition
- Pediatric Gastroenterology
- Home Healthcare
Context:
- Parenteral nutrition (PN) is a critical intervention for patients with non-functional digestive tracts.
- Indications for PN span chronic digestive diseases, oncology, hematology, and pre-transplantation renutrition.
- Advancements in technology have enabled sophisticated PN to be administered at home.
Purpose:
- To review indications for home parenteral nutrition (home PN) based on disease, socio-cultural factors, and proximity to PN centers.
- To examine the technical aspects of home PN, including vascular access, catheter selection, nutritional components, and parental training.
- To discuss complications, primarily infections, and briefly report on outcomes and quality of life for children receiving home PN.
Summary:
- Home PN is indicated for treatments exceeding three months when the digestive tract is unusable or at rest.
- Successful home PN requires active parental involvement, appropriate technical management (vascular access, catheter, nutrition), and logistical support.
- Complications of home PN mirror those of prolonged PN, with infection being the most frequent concern.
Impact:
- Home PN offers a viable alternative for long-term nutritional support, improving patient management outside traditional hospital settings.
- Effective parental training and robust logistical support are crucial for the success and safety of home PN programs.
- Understanding and mitigating complications, particularly infections, is essential for optimizing outcomes and quality of life in pediatric patients receiving home PN.