Laboratory Monitoring of Children on Home Parenteral Nutrition: A Prospective Study

Smith, Amber; Feuling, Mary Beth; Larson‐Nath, Catherine; Karls, Catherine; Hoorn, Megan Van; Walia, Cassandra L. S.; Léon, Carly D. G.; Danner, Elaine; Opichka, Pam; Duesing, Lori; Martínez, Alfonso Martín; Goday, Praveen S.

doi:10.1177/0148607116673184

Cited by 10 publications

(6 citation statements)

References 23 publications

(24 reference statements)

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“…Guidelines on micronutrient monitoring in children with IF vary widely and are not specific for weaned patients (12), but usually regular monitoring is recommended since most patients will not have clinical symptoms. In a recent paper, it is suggested that copper, selenium, zinc, vitamin A, E, D, B12, methylmalonic acid, prothrombin time, iron, total iron‐binding capacity, red blood cell count, folate, and carnitine (the latter if <1 year) should be monitored every 6 months in children on HPN (28).…”

Section: Discussionmentioning

confidence: 99%

Growth, Body Composition, and Micronutrient Abnormalities During and After Weaning Off Home Parenteral Nutrition

Neelis¹,

Olieman

Rizopoulos

et al. 2018

J. pediatr. gastroenterol. nutr.

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Section: Discussionmentioning

confidence: 99%

Growth, Body Composition, and Micronutrient Abnormalities During and After Weaning Off Home Parenteral Nutrition

Neelis¹,

Olieman

Rizopoulos

et al. 2018

J. pediatr. gastroenterol. nutr.

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“…And finally, our study participants were limited to adult HPN patients. Although ETE deficiencies and the impact of shortages have also been reported in children, 14,28,29,43,44 thereby suggesting a broader implication of this type of work, our findings cannot be extrapolated to pediatric HPN patients.…”

Section: Discussionmentioning

confidence: 74%

“…Complications including acrodermatitis enteropathica (Zn deficiency), [6][7][8][9][10] anemia and neutropenia (Cu deficiency), [11][12][13][14] reversible or even fatal cardiomyopathy (Se deficiency), [15][16][17][18][19][20][21][22][23][24] and glucose intolerance (Cr deficiency) [25][26][27] were increasingly reported in home PN (HPN) patients through the 1970s and 1980s. Although such cases were less frequently reported in the literature for some time, most likely related to commercially available parenteral products and the capability of more frequent biochemical monitoring, [28][29][30] ETE deficiencies have remained an ongoing issue in long-term HPN patients. 31,32 Recently, ETE deficiency has been brought back to the spotlight as the United States is experiencing waves of critical drug shortages.…”

Section: Introductionmentioning

confidence: 99%

Impact of nationwide essential trace element shortages: A before‐after, single‐center analysis of hospitalized adults receiving home parenteral nutrition therapy

et al. 2021

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Background: Recent data on the prevalence of essential trace element (ETE) deficiencies in home parenteral nutrition (HPN) patients are scarce. We investigated whether ETE deficiencies are still an important issue for HPN patients and whether the prevalence of such deficiencies may be influenced by nationwide drug shortages. Methods:We conducted a single-institution, retrospective analysis from 2006 to 2015 of hospitalized HPN patients who continued PN during and in between hospitalizations. In subgroup analysis, patients were dichotomized as those with HPN duration <1 vs ≥1 year. Zinc (Zn), copper (Cu), and selenium (Se) levels were abstracted for patients over the study period. Prevalence of ETE deficiency was compared using chi-squared test for patients hospitalized during nonshortage vs shortage (2011-2014) periods.Results: Ninety-six patients were included in the analysis. Prevalence of ETE deficiency during nonshortage vs shortage periods was 48% vs 54% (Zn), 15% vs 21% (Cu), and 24% vs 48% (Se; P = .01), respectively. When comparing patients who received HPN <1 year vs ≥1 year, the prevalence of Se deficiency doubled during shortage in both subgroups (24% to 42% vs 26% to 49%); and Cu deficiency tripled during shortage period in the group receiving HPN ≥1 year (5% to 16%). Conclusion:ETE deficiency is prevalent in hospitalized HPN patients and was exacerbated during nationwide shortages of parenteral supplements. Statistical significance may be limited by small sample size. Future studies are needed to determine optimal ETE supplementation strategies for minimizing the impacts of nationwide drug shortages on HPN patients.

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“…Those results were later reproduced by large Canadian retrospective cohort study (32). Based on those results, all children on HPN should be followed‐up by a specialized multidisciplinary team to ensure that parents are well trained before discharge, and that once home appropriate PN prescriptions, clinical assessment, and laboratory tests are undertaken (33,34), with an associated improvement in survival (35,36). The overall prognosis of SBS‐IF is now expected to be good with survival rate exceeding 90% (37).…”

Section: Aim Of Treatmentmentioning

confidence: 99%

Nutrition and Intestinal Rehabilitation of Children With Short Bowel Syndrome: A Position Paper of the ESPGHAN Committee on Nutrition. Part 2: Long-Term Follow-Up on Home Parenteral Nutrition

Norsa,

Goulet,

Alberti

et al. 2023

Journal of Pediatric Gastroenterology &Amp; Nutrition

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Short bowel syndrome (SBS) is the leading cause of intestinal failure (IF) in children. The preferred treatment for IF is parenteral nutrition which may be required until adulthood. The aim of this position paper is to review the available evidence on managing SBS and to provide practical guidance to clinicians dealing with this condition. All members of the Nutrition Committee of the European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) contributed to this position paper. Some renowned experts in the field joined the team to guide with their expertise. A systematic literature search was performed from 2005 to May 2021 using PubMed, MEDLINE, and Cochrane Database of Systematic Reviews. In the absence of evidence, recommendations reflect the expert opinion of the authors. Literature on SBS mainly consists of retrospective single-center experience, thus most of the current papers and recommendations are based on expert opinion. All recommendations were voted on by the expert panel and reached >90% agreement. This second part of the position paper is dedicated to the long-term management of children with SBS-IF. The paper mainly focuses on how to achieve intestinal rehabilitation, treatment of complications, and on possible surgical and medical management to increase intestinal absorption.

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Laboratory Monitoring of Children on Home Parenteral Nutrition: A Prospective Study

Abstract: A structured team approach to laboratory monitoring of home PN patients can simplify PN management, significantly decrease monthly laboratory costs, and lead to fewer laboratory draws while improving micronutrient monitoring and preventing deficiencies.

Cited by 10 publications

References 23 publications

Growth, Body Composition, and Micronutrient Abnormalities During and After Weaning Off Home Parenteral Nutrition

Growth, Body Composition, and Micronutrient Abnormalities During and After Weaning Off Home Parenteral Nutrition

Impact of nationwide essential trace element shortages: A before‐after, single‐center analysis of hospitalized adults receiving home parenteral nutrition therapy

Nutrition and Intestinal Rehabilitation of Children With Short Bowel Syndrome: A Position Paper of the ESPGHAN Committee on Nutrition. Part 2: Long-Term Follow-Up on Home Parenteral Nutrition

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