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Home parenteral nutrition in children: the Polish experience
J Ksiazyk1, M Lyszkowska, J Kierkus
1The Children's Memorial Health Institute, Warsaw, Poland.
Insights
Home parenteral nutrition (HPN) mixed by parents is safe for children with intestinal failure. This approach is cost-effective and feasible in countries lacking commercial HPN services.
Area of Science:
- Pediatrics
- Clinical Nutrition
- Gastroenterology
Background:
- Home parenteral nutrition (HPN) is crucial for managing intestinal failure.
- Commercial HPN services are limited in Poland due to lack of industry interest.
- This study addresses the feasibility of HPN with caregiver-prepared nutrients.
Purpose of the Study:
- To evaluate the safety and efficacy of home parenteral nutrition (HPN) where nutrients are compounded by parents.
- To assess the outcomes and complications associated with caregiver-prepared HPN in pediatric patients.
- To determine the cost-effectiveness of this HPN model.
Main Methods:
- Retrospective review of 25 pediatric patients receiving HPN.
- Parental training for nutrient compounding and administration over 4-6 weeks.
- Analysis of patient data including duration of therapy, catheter complications, infections, and nutritional status.
Main Results:
- Mean duration of HPN was 10,117 patient days.
- Significantly shorter hospital stays were observed for HPN patients (p < 0.001).
- Catheter-related complications and septicemia rates were low, with significant improvement in weight z-scores. Monthly costs were substantially lower than reported in other studies.
Conclusions:
- Caregiver-compounded home parenteral nutrition (HPN) is a safe and effective treatment for pediatric intestinal failure.
- This model is viable in regions without commercial HPN manufacturing or where it's economically unfeasible.
- HPN managed at home by parents offers a cost-effective alternative.
Background:
Home parenteral nutrition has become routine for management of intestinal failure in patients. In Poland the main obstacle to widespread use of home parenteral nutrition is the lack of interest of commercial companies in delivering feedings and ancillaries to patients.
Methods:
Twenty-five home parenteral nutrition patients aged from 4 months to more than 13 years were reviewed. The mother or both parents were trained in home parenteral nutrition techniques for 4 to 6 weeks and compounded the nutrients themselves at home.
Results:
The mean duration of home parenteral nutrition was 10,117 patient days. Hospital stays of patients receiving parenteral feedings were significantly shorter than the duration of administration of home parenteral nutrition (p < 0.001). Eleven children are continuing the home parenteral nutrition program. Eighty-three catheters were used in these patients. The rate of catheter occlusion decreased within the observation period, and in 1997 not one case of occlusion was observed. In 1997 only three catheters were removed during 7.8 patient years, and the overall incidence of catheter-related complications was 0.38 per patient year. The overall occurrence of septicemia was one case in 516 days and of catheter infection was one in 459 days. In 1997 a catheter was infected on average of once every 1419 days. There was significant improvement in the z score for weight during therapy. The average monthly cost of nutrients and ancillary items was approximately $1200 (4200 Polish zlotys [PLN]). These costs are 1.6 to 3 times lower than those recorded in other studies.
Conclusion:
Home parenteral nutrition in children with nutrients mixed by caregivers in the home setting is a safe and appropriate method of treatment that can be used in countries where home parenteral nutrition solutions are not manufactured or where commercial home parenteral nutrition is not economically feasible.