Prepubertal Growth in Children with Long-Term Parenteral Nutrition

Abstract

In children who depend on long-term parenteral nutrition (PN), a major goal is to obtain optimal growth. The aim of this retrospective study was to analyze growth in children on long-term cyclic nocturnal home PN, over at least 8 years before puberty. Nine boys and 7 girls were studied. Their mean age at the time of study was 11 years with a mean PN duration of 10.5 (8.6–16.4) years. Diseases were short bowel syndrome (5), intractable diarrhea (4), chronic intestinal pseudo-obstruction (4) and long segment Hirschsprung’s disease (3). In each child, periods of at least 2 years were analyzed: either periods of regular growth (R: height gain >50th percentile), or slow growth (S: height gain ≤25th percentile). Results were expressed as mean ± SD. Comparisons were performed using either Student’s test for unpaired data or Wilcoxon’s test for paired data. PN provided a mean of 224 ± 80 mg nitrogen/kg/day and 43 ± 14 kcal/kg/day equivalent to 50% of recommended supplies. At the time of study, the population presented with weight (W) = –0.7 ± 0.8 SD and height (H) = –1.5 ± 1.3 SD. The difference between W and expected W for H (W/H) was significant (p < 0.002). W/H ratio was 105 ± 11%. For the total PN duration, weight gain was +0.2 ± 1.5 SD and height loss was –0.75 ± 1.4 SD. An excess weight gain occurred in parallel with the deflection of height gain. Of the 16 children, regular prepubertal growth was achieved in 4 only. The other 12 showed alternate periods of R and S. In 8 of them, 26.5 years of R and 33.5 years of S were compared, each child being his own control. PN nitrogen and energy supplies were significantly higher during R periods than during S periods. In the absence of any disease or treatment explaining the failure to thrive, inadequate PN supplies, especially in terms of nitrogen supply, are thought to be responsible for a negative nitrogen balance and slowed growth. In case of any deflection away from the individual growth curve, it is recommended to adjust the PN supply early, especially nitrogen supply.

Necrotizing Enterocolitis and Central Line Associated Blood Stream Infection Are Predictors of Growth Outcomes in Infants with Short Bowel Syndrome

“…This somewhat paradoxical finding is likely because additional nutrition support was provided to the smallest infants in an effort to fuel catch-up growth. In contrast to existing literature, 8,25,26 we did not find that weaning from PN was associated with of worsening growth patterns, but we note that our follow-up period was limited to the first 12 months of life.…”

“…8,25,26 There has been less attention on growth patterns during the immediate time after the intestinal injury. This is a critical period to study, because undesirable effects on somatic growth may have lasting effect.…”

Comparison of Short Bowel Syndrome Acquired Early in Life and During Adolescence

“…Possible explanations to this finding could be that adolescents are closer to their maximum height because of obvious age differences, and that they had more years with a normal intestinal function when compared with the PG. This finding is consistent with long-term follow-up studies, where they found that neonatal SBS might affect the final height of the individual (5,14).…”

“…Several studies have studied growth assessment of children with SBS and concluded that it is possible to achieve a normal growth under adequate nutritional support (1)(2)(3)(4)(5).…”

Nutrición parenteral domiciliaria en pacientes pediátricos con insuficiencia intestinal

“…Llama la atención el compromiso de talla que se identificó en el 53,3% de los pacientes, independiente del lugar de tratamiento. Esto podría deberse a un aporte inadecuado de nutrientes en las etapas iniciales de la patología o en momentos de crecimiento acelerado, o bien podría ser el resultado de suspensiones transitorias del soporte nutricional debido a pérdidas de acceso venoso por períodos variables en el transcurso de la enfermedad 24 .…”