Outcome of children receiving home parenteral nutrition: An audit of practice

Abstract

Introduction: Parenteral nutrition (PN) is life-saving for patients with intestinal failure. The process of intestinal rehabilitation, however, may be prolonged, so patients are sometimes discharged while this occurs. However, there is limited information on outcomes of children receiving long-term PN and no regional data. Our aim was to review our experience of children discharged from our center with home PN. Methods: We undertook a retrospective review of all children discharged from a tertiary pediatric hospital on PN. Indication for PN, type of lipids, complications, duration of PN, and outcomes were noted. Results: A total of 46 children were discharged on home PN between 2002 and 2017. Of these, 54% (25/46) had short bowel syndrome (SBS), of which gastroschisis was most common (n = 15), followed by acquired SBS (n = 5). Other PN indications included dysmotility (n = 9), feed intolerance (n = 9), and gastrointestinal mucosal disease (n = 3). Eleven children remain on PN (median time on PN, 5.25 [2.53-13.71] years): five with SBS, five with motility disorder, and one with auto-immune enterop-athy. There were eight deaths (17%); four were from complications of PN, with the rest from progression of their primary disease. Intestinal failure-associated liver disease (IFALD) resulted in three deaths, and one died from central line sepsis. All patients who died from IFALD had been on soy-based lipid emulsions. No deaths from PN complications have occurred since 2010. Overall, 83% of patients discharged on home PN remain alive. Surviving children with SBS who transitioned off PN generally did so after a median of 1.21 (0.12-6.81) years. Conclusion: A good prognosis is expected for children discharged on home PN. Most children, especially those with SBS, are likely to be able to come off PN in time.L6244310032018-10-23 <br />