Outcome of home parenteral nutrition in 251 children over a 14-y period: report of a single center

• Published in: The American journal of clinical nutrition 2016-05, Vol.103 (5), p.1327-1336
• Main Authors: Abi Nader, Elie, Lambe, Cécile, Talbotec, Cécile, Pigneur, Bénédicte, Lacaille, Florence, Garnier-Lengliné, Hélène, Petit, Laetitia-Marie, Poisson, Catherine, Rocha, Amélia, Corriol, Odile, Aigrain, Yves, Chardot, Christophe, Ruemmele, Frank M, Colomb-Jung, Virginie, Goulet, Olivier
• Format: Article
• Language: English
• Subjects: Bowel disease; Catheter-Related Infections - epidemiology; Catheters; Digestive system; Female; Follow-Up Studies; France; Humans; Infant; Intestinal Diseases - therapy; Liver Diseases - epidemiology; Male; Parenteral nutrition; Parenteral Nutrition, Home - adverse effects; Pediatrics; Prognosis; Retrospective Studies; Short Bowel Syndrome - therapy; Treatment Outcome
• ISSN: 0002-9165; 1938-3207
• DOI: 10.3945/ajcn.115.121756

Parenteral nutrition (PN) is the main treatment for intestinal failure. We aimed to review the indications for home parenteral nutrition (HPN) in children and describe the outcome over a 14-y period from a single center. We conducted a retrospective study that included all children who were referred to our institution and discharged while receiving HPN between 1 January 2000 and 31 December 2013. The indications for HPN were divided into primary digestive diseases (PDDs) and primary nondigestive diseases (PNDDs). We compared our results to a previous study that was performed in our unit from 1980 to 2000 and included 302 patients. A total of 251 patients were included: 217 (86%) had a PDD. The mean ± SD age at HPN onset was 0.7 ± 0.3 y, with a mean duration of 1.9 ± 0.4 y. The indications for HPN were short bowel syndrome (SBS) (59%), PNDD (14%), congenital enteropathies (10%), chronic intestinal pseudo-obstruction syndromes (9%), inflammatory bowel diseases (5%), and other digestive diseases (3%). By 31 December 2013, 52% of children were weaned off of HPN, 9% of the PDD subgroup had intestinal transplantation, and 10% died mostly because of immune deficiency. The major complications of HPN were catheter-related bloodstream infections (CRBSIs) (1.7/1000 d of PN) and intestinal failure-associated liver disease (IFALD) (51 children; 20% of cohort). An increased rate of CRBSIs was observed compared with our previous study, but we saw a decreasing trend since 2012. No noteworthy deceleration of growth was observed in SBS children 6 mo after weaning off HPN. SBS was the major indication for HPN in our cohort. IFALD and CRBSIs were potentially life-threatening problems. Nevertheless, complication rates were low, and deaths resulted mostly from the underlying disease.