Pediatric Home Parenteral Nutrition: Indications and Short‐Term Outcomes in a Large National Sample of Commercially Insured Children and Adolescents

Abstract

Background To support families managing the complex requirements of home parenteral nutrition (HPN) in pediatric patients, health professionals need information about HPN indications and complications. Nationally representative information is limited. Methods A retrospective cohort analysis of the Truven Health MarketScan Commercial Claims and Encounters Database was performed and identified 683 patients aged ≤18 years receiving HPN during dates of service from January 2013 through September 2015. Baseline diagnoses were measured in the 30 days before the first observed HPN claim (preindex). Indications for older (aged 13–18 years) and younger (aged ≤12 years) children were compared. Hospital and emergency department (ED) utilization rates were measured for 30 postindex days. Results Gastrointestinal diagnoses and/or symptoms affected more than three‐quarters of patients. Short bowel syndrome was more common in younger than in older patients (24% vs 7%, respectively), and colitis was less common (13% vs 33%; both P < .01). Cancer was common in both age groups (22%–23%). Additional diagnoses indicating complex medical conditions were observed in a minority of patients: sepsis (9%), convulsions/epilepsy (7%), encephalopathy (3%), and immune deficiency (3%). From the preindex to postindex periods, rates of inpatient hospitalization declined from 78% to 41%, but hospital ED visits increased from 10% to 14%. In both periods, >95% of hospital and ED use was disease related. Conclusion In a nationally representative sample of commercially insured pediatric patients treated with HPN, complex medical conditions were common. Findings highlight the importance of American Society for Parenteral and Enteral Nutrition recommendations for team‐based care.

Home Parenteral Nutrition for Children: What Are the Factors Indicating Dependence and Mortality?

“…The prevalence of home PN (HPN) in children has doubled from 2012 to 2019 in the United Kingdom [ 1 ]. Various indications of home total PN (TPN) for children are mentioned, including colitis, inflammatory bowel disease, intestinal obstruction, motility disorder, malnutrition, and malignancy [ 2 ]. These observations differ from those of adult patient groups with HPN support.…”

Could Commercial Formulations Replace Individualized Prescription in Pediatric Home Parenteral Nutrition?

“…H ome parenteral nutrition (PN) is the best option for children dependent on long-term PN. It provides an alternative to lengthy hospitalization and allows for independent living in a familiar environment and school attendance, with psychosocial benefits for both child and family (1)(2)(3)(4)(5). Additionally, it has higher cost-effectiveness and is associated with a lower risk of complications (2,(4)(5)(6).…”

“…Standard PN formulations have been shown to improve patient safety, minimizing compounding errors and microbiological contamination, as well as optimizing resource efficiency, decreasing pharmacy workload and associated costs (1,5,(8)(9)(10). Although a wide variety of standard formulations for adults are commercially available, these are not optimal for children as their nutritional requirements differ significantly depending on age, weight, underlying disease, nutritional and hydration status and environmental factors (5,11).…”