Monitoring of long‐term parenteral nutrition in children with intestinal failure

Abstract

Pediatric intestinal failure (IF) is a rare and complex condition associated with significant morbidity and mortality. It is defined as the reduction of gut mass or function below the minimal needed for absorption of nutrients and fluid to sustain life and growth. Since the advent of specialized multidisciplinary intestinal rehabilitation centers, IF management has considerably evolved in the last years, but serious complications of long‐term parenteral nutrition (PN) can occur. Main complications include intestinal failure‐associated liver disease, growth failure, body composition imbalance, central venous access complications, micronutrient deficiencies and toxicities, metabolic bone disease, small intestinal bacterial overgrowth, and renal disease. With improvement in survival rates of patients over the last 20 years, emphasis should be on limiting IF‐related comorbidities and improving quality of life. Close monitoring is pivotal to ensuring quality of care of these patients. The care of children with chronic IF should involve a comprehensive monitoring plan with flexibility for individualization according to specific patient needs. Monitoring of children on long‐term PN varies significantly across units and is mainly based on experience, although few guidelines exist. This narrative review summarizes the current knowledge and practices related to monitoring of children with IF. The authors also share their 20‐year experience at the Royal Children's Hospital in Melbourne Australia on this topic.

Children with Intestinal Failure Maintain Their Renal Function on Long-Term Parenteral Nutrition

“…Although this study presents favorable outcomes in a pediatric IF population, it emphasizes the importance of tight monitoring and follow-up. Monitoring of renal complications is advisable as an integral part of long-term management of children on home PN treatment, including frequent blood and urine tests, periodic blood pressure assessment, renal sonography and pediatric nephrology consultation [13]. This surveillance is warranted especially in children with permanent IF, as renal injury in early life may predispose to kidney disease in adulthood [12], and the high rate of proteinuria and calciuria in our cohort suggest that the preserved renal function may not last into adulthood.…”

The Role of a Nutrition Support Team in the Management of Intestinal Failure Patients

“…This nutrition assessment should incorporate aspects influencing intake, absorption, and expenditure, such as sex and age, the anatomy of the intestine (i.e., remaining bowel length, enterostomies, presence of ileocecal valve), and weight, height, and body composition. For visual representation see Figure 1, a more detailed description of the individual components is provided in Table 2 [14][15][16][17][18][19][20][21][22][23][24][25]. The assessment should be repeated regularly to evaluate the effectiveness of a nutrition intervention and to prevent patients from becoming dehydrated and undernourished with associated electrolyte abnormalities and weight loss.…”

“…Screening of electrolytes, vitamins, and trace elements should be performed at baseline and monitored thereafter. Electrolytes should be monitored every 1-3 months or more frequently when indicated (e.g., in the case of recent PN composition change or increased gastro-intestinal losses); vitamins and trace elements should be monitored every 6-12 months [21,22].…”

Guía clínica para el manejo de la falla intestinal secundaria a síndrome de intestino corto en pediatría.

“…El control de los marcadores bioquímicos del metabolismo óseo incluye el dosaje de 25-OH-vitamina D, fosfatasa alcalina, fosfato y calcio plasmático trimestralmente y calcio urinario con hormona paratiroidea una vez al año. 43,82 Se recomienda una revisión anual por un endocrinólogo pediátrico para evaluar la salud ósea en estos pacientes para abordar los casos complejos. El impacto de la enfermedad ósea en la calidad de vida y en la actividad física puede ser importante en algunos pacientes.…”