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Long-term growth and development in children after home parental nutrition
B L Leonberg1, E Chuang, P Eicher
1Department of Clinical Nutrition, The Children's Hospital of Philadelphia, Pennsylvania 19104-4399, USA.
Insights
Children needing long-term parenteral nutrition (PN) may face growth and nutritional issues later. Continued monitoring of diet, growth, and nutrition is crucial for these children.
Area of Science:
- Pediatric Nutrition
- Growth and Development
- Parenteral Nutrition
Background:
- Long-term parenteral nutrition (PN) is a life-sustaining therapy for children with intestinal failure.
- The long-term effects of PN cessation on growth and development remain incompletely understood.
- Assessing outcomes after PN discontinuation is vital for optimizing pediatric care.
Purpose of the Study:
- To evaluate growth, body composition, and nutritional status in children after prolonged PN cessation.
- To identify potential long-term health risks associated with prior PN dependence.
- To inform guidelines for post-PN follow-up and monitoring.
Main Methods:
- Prospective documentation of growth parameters, body composition, and nutritional markers.
- Assessment of developmental status, including psychomotor and swallowing function.
- Analysis of serum vitamin levels, fecal fat excretion, and bone mineral density.
Main Results:
- All nine children exhibited at least one abnormality post-PN.
- Low height-for-age, low percent ideal body weight, and low total body fat were observed.
- Abnormalities in vitamin A levels, fecal fat, and bone mineral density were noted in several subjects.
Conclusions:
- Children requiring prolonged PN are at risk for persistent growth and nutritional abnormalities.
- Long-term monitoring of dietary intake, growth, and nutritional status is essential.
- Early identification and management of these issues can improve long-term outcomes.
Abstract:
Growth and development after the cessation of prolonged parenteral nutrition (PN) has not been fully evaluated. Growth, body composition, and nutritional and developmental status were documented in nine children (five boys, four girls) 2 to 6 years old (mean 4.9 +/- 1.0 years) who had previously received long-term PN (mean 14.6 +/- 11.4 months). PN had been discontinued in all subjects for at least 6 months (mean 3.4 +/- 1.4 years); they were receiving oral feedings only. One subject had a significantly low height-for-age, and another had a low percent ideal body weight; five subjects had low total body fat. Serum vitamin A was low in six subjects. Seventy-two-hour fecal fat analysis was abnormal in two of eight subjects. Abnormal bone mineral density was present in four of nine subjects. Psychomotor development was normal in all nine subjects. Two had functional difficulties in swallowing. One or more abnormalities were present in all nine subjects. These findings suggest that children who require prolonged PN in early life are at risk for abnormalities in growth and nutritional status in later childhood; they require long-term dietary, growth, and nutritional monitoring.