Indications and complications of inpatient parenteral nutrition prescribed to children in a large tertiary referral hospital

Abstract

BackgroundParenteral Nutrition (PN) is prescribed to children with intestinal failure. Although life saving, complications are common. Recommendations for indications and constituents of PN are made in the 2005 guidelines by the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN). The aim of this study was to establish if the indications for prescribing PN in a tertiary children’s hospital were appropriate, and to identify complications encountered. Data were compared to those published by the National Confidential Enquiry into patient outcome and death (NCEPOD) carried out in the United Kingdom in 2010.MethodsChildren and newborns receiving inpatient PN over a 6 months period were entered into the study and data was collected prospectively. The appropriate indications for the use of PN were based on the ESPGHAN guidelines. Recorded complications were divided into metabolic, central venous catheter (CVC) related, hepatobiliary and nutritional.ResultsA total of 303 children (67 newborns) were entered into the study. The main indications for the start of PN were critical illness (66/303), surgery (63/303) and bone marrow transplantation (28/303). The ESPGHAN recommendations were followed in 91.7% (278/303) of cases (95.5% of newborns, 90.7% of children). PN was considered inappropriate in 12/303 patients and equivocal in 13. The mean PN duration was 18 days (1–160) and the incidence of complications correlated to the length of PN prescribed. Metabolic, hepatobiliary and CVC related complications affected 74.6, 24.4, 16.4% of newborns and 76.7, 37.7 and 24.6% of children respectively.In relation to the appropriate indications for the start of PN our results mirrored those reported by the NCEPOD audit (92.4% of newborns and 88.6% children). However, the incidence of metabolic disturbances was higher in our cohort (74.6% vs 30.4% in children, 76.7% vs 14.3% in newborns) but CVC related complications lower amongst our newborns (16,4% vs 25%).ConclusionsAlthough the indications for inpatient PN in children is mostly justified, there is still a proportion who is receiving PN unnecessarily. PN related complications remain common. There is a need for better education amongst health professionals prescribing PN and access to nutritional support teams to reduce unwanted side effects.

Alimentação parenteral: principais complicações decorrentes de seu uso / Parenteral nutrition: main complications resulting from it's use

“…Brazilian Journal of Health Review, Curitiba, v. 5, n. 3,p.10089-10098, may./jun., 2022 O STRONG kids tem como itens de avaliação: presença de doença de alto risco ou previsão de cirurgia de grande porte; perda de massa muscular e adiposa através de avaliação clínica subjetiva; diminuição da ingesta alimentar e perdas nutricionais (diarreia e vômitos); perda ou não ganho de peso (em menores de um ano de idade). É um método com sensibilidade elevada, menor percentual de especificidade, concordância intra-avaliador substancial, além de facilidade de uso na prática clínica (14).…”

An Overview on Different L-Thyroxine (l-T4) Formulations and Factors Potentially Influencing the Treatment of Congenital Hypothyroidism During the First 3 Years of Life

“…Parenteral Nutrition (PN) is used when normal and enteral feeding are impossible ( 181 ). Some reports show that long-term PN is a risk factor for low iodine and/or selenium levels, causing hypothyroidism, which in some cases is severe, stressing the importance of dosing of these elements and evaluating THs ( 182 , 183 ).…”

Soporte Nutricional en El Paciente Pediátrico Crítico

“…Las indicaciones de NP son: Paciente en el cual el tracto gastrointestinal no pueda ser utilizado, paciente pediátrico que requiera ayuno absoluto igual o superior de 5 días o antes si es un niño desnutrido, en aquellos en los que no sea posible la vía enteral, con una ingesta inferior al 50% de sus necesidades durante los 7 días o antes en el desnutrido. Su administración debe ser por vía central exclusiva, de preferencia catéteres epicutáneos y si no es posible catéter venoso central sólo para este fin 21 .…”

“…La NP debe mantenerse hasta que se consiga una adecuada transición a la NE, es decir, cuando dichos aportes alcancen 2/3 de los requerimientos nutricionales estimados [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] .…”