Parenteral Nutrition

Objectives: To assess renal function in pediatric intestinal failure (IF) patients on long term home parenteral nutrition (HPN). Methods: Children who received HPN for a minimum of 3 years between 2007 and 2017 were identified from the IF clinic of a large tertiary referral center. Estimated glomerular filtration rate (eGFR) was calculated using the Schwartz formula at discharge on HPN, after 6 months, 1, 2, and 3 years. Results: Twenty five patients (40% male) fulfilled the inclusion criteria. The indications for HPN were due to an underlying motility disorder in 56% (14/25), enteropathy in 24% (6/25), and short bowel syndrome in 20% (5/25). At the start of HPN 80% (20/25) had a normal eGFR. Four children (17%) had an abnormal eGFR. In the group of patients with normal eGFR at the start of HPN 30% (6/20) had at least one episode of decreased eGFR in the following 3 years, however there was no significant decline in eGFR at the end of the 3 year study period. Overall there was no statistically significant deterioration of eGFR in the study population ( p = 0.7898). Conclusion: In our cohort of children on long term HPN no significant decline of eGFR could be demonstrated within 3 years of starting PN.

show abstract

“…The number of adults and children receiving this life saving therapy has since grown dramatically (12).…”

Section: Discussionmentioning

confidence: 99%

Renal Function in Children on Long Term Home Parenteral Nutrition

2019

View full text Add to dashboard Cite

show abstract

“…On the other hand, a nasogastric tube was placed for all the neonates intraoperatively in order to provide early postoperative enteral nutrition which can reduce the use of parenteral nutrition, thus, reducing the incidence of parenteral nutrition-related complications. [29] Additionally, 2 cases with anastomotic leaks in this study were provided conservative management with enteral nutrition using nasogastric tube, which played an important role in promoting the natural healing of the leaks.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of primary gastric transposition for long-gap esophageal atresia in neonates

Zeng

Liu²,

Ma³

et al. 2017

Medicine

View full text Add to dashboard Cite

Background:Gastric transposition is a relatively novel method of esophageal replacement. The purpose of this retrospective study was to assess the outcomes of long-gap esophageal atresia (LGEA) treated with esophageal replacement using primary gastric transposition in neonates.Methods:Between March 2008 and May 2015, 14 newborns with LGEA were treated in our hospital. They were all found to have gaps of over 3 cm at the time of the surgery and were diagnosed with LGEA. Primary gastric transposition was performed. They also underwent a gastric drainage procedure by pyloromyotomy. The nasogastric tube was removed if no anastomotic fistula was present and oral feeding was initiated. After initial recovery and discharge, the patients were evaluated with outpatient follow-ups or telephone follow-ups from 1 month after the surgery.Results:The mean age of the neonates at the time of the surgery was 32 hours (range, 4–96 h). The mean birth weight was 2550 g (range, 2100–3500 g). There were 2 deaths in this series of patients due to respiratory failure or withdrawal of treatment by the parents, with a mortality rate of 14.3%. Seven of the neonates developed unilateral or bilateral severe pneumonia. Early anastomotic leak occurred in 3 cases and anastomotic strictures occurred in 4 cases. These 4 neonates were able to eat a fairly normal diet after esophageal balloon dilation. Gastroesophageal reflux occurred in 7 of 12 cases. Feeding multiple small meals and postural support for positioning and feeding were instructed for these 7 cases. Subsequently, the symptoms alleviated and they had no additional surgical therapy. None of the neonates had delayed gastric emptying or gastric retention.Conclusion:Primary gastric transposition may be a rewarding reconstructive option in the treatment of LGEA.

show abstract

“…Given the limited number of anatomic sites available for central venous catheter (CVC) placement in these children, preserving long-term venous access is critically important. Although CVC are lifelines for these children, CVC complications, including catheter-related blood stream infection (CRBSI), occlusion and line breakage are associated with increased morbidity and mortality (1)(2)(3)(4). The pediatric IF population has high rates of CRBSI with a reported incidence ranging from 4.74 to 10.6 per 1000 catheter days (5)(6)(7)(8).…”

Section: What Is Newmentioning

confidence: 99%

Mechanical Complications in Central Lines Using Taurolidine Versus Ethanol Lock Therapy in Children With Intestinal Failure

Strauss

Boctor

Silverman

et al. 2022

J. pediatr. gastroenterol. nutr.

View full text Add to dashboard Cite

Objectives: Ethanol lock therapy (ELT) is effective in reducing rates of catheter-related-bloodstream infections (CRBSI) in the pediatric intestinal failure (IF) population; however, ELT may increase the risk of line occlusion and breakage, significantly impacting preservation of vascular access. During a period of ethanol shortage, Health Canada temporarily approved the use of taurolidine lock therapy (TLT) in pediatric iF patients previously utilizing ELT. This provided a unique opportunity to directly compare rates of central venous catheter (CVC) complications, including CRBSi, breaks, occlusions, repairs and replacements in patients who utilized both ELT and TLT. Methods: A retrospective study of pediatric IF patients managed by three Western Canadian intestinal rehabilitation programs was performed. Event rates in patients who used both ELT and TLT during the study period were compared using Poisson regression analysis. Results: In 13 patients with 10,187 catheter days (CDs), TLT (vs ELT) had lower rates of CVC breaks (1.11 vs 5.19/1000 CDs, P < 0.001), occlusions (0.83 vs 4.06/1000 CDs, P ¼ 0.01) and repairs (1.94 vs 5.64/1000 CDs, P ¼ 0.01). There was no difference in CRBSI rates (0.83 vs 2.03/1000 CDs, P ¼ 0.25) or rates of CVC replacements due to mechanical events (0.28 vs 1.81/1000 CDs, P ¼ 0.08). Conclusions: Although there was no difference in CRBSI rates, TLT was associated with lower rates of mechanical complications compared to ELT in this study. Taurolidine may be a suitable alternative to ethanol in preventing CRBSI and may be associated with improved preservation of central lines in children with IF.

show abstract

Parenteral Nutrition

Cited by 17 publications

References 54 publications

Renal Function in Children on Long Term Home Parenteral Nutrition

Renal Function in Children on Long Term Home Parenteral Nutrition

Outcomes of primary gastric transposition for long-gap esophageal atresia in neonates

Mechanical Complications in Central Lines Using Taurolidine Versus Ethanol Lock Therapy in Children With Intestinal Failure

Contact Info

Product

Resources

About