Adv Pediatr Surg.  2022 Dec;28(2):55-64. 10.13029/aps.2022.28.2.55.

Complications in and Treatment of Pediatric Patients Receiving Long-Term Parenteral Nutrition

• Ha S
• Kwon H
• Namgoong JM

• KMID: 2538290
• DOI: http://doi.org/10.13029/aps.2022.28.2.55

Abstract

Purpose
Although total parenteral nutrition (TPN) is essential for patients with intestinal failure, intensive monitoring and management are required to provide sufficient nutrition and prevent complications. The adverse effects of prolonged TPN >5 years were evaluated in pediatric patients, and preventative methods and treatments were analyzed.
Methods
Pediatric surgery patients at a single center who had received parenteral nutrition (PN) for more than 5 years at a single center were analyzed retrospectively. Adverse effects and treatments were determined by review of their medical records. Complications were defined as catheter-related, metabolic, or nutritional.
Results
Seven patients receiving long-term PN had short bowel syndrome (SBS), including two each with necrotizing enterocolitis, congenital atresia, and pseudo-obstruction, and one with Hirschsprung’s disease. Six patients had a mean 6.4 ± 4.4 line infections (median: 6, range: 3–15). Central venous catheters were replaced a mean 7.3 ± 4.5 times (median: 8.5, range: 1–12). None of these patients had bilirubin concentrations above 2 mg/mL, and none experienced acute or chronic kidney injuries. Six children received vitamin D supplements, and one experienced rickets. Laboratory tests revealed a temporary lack of zinc or selenium, but no associated clinical symptoms. None had a vitamin B12 or folate deficiency. All seven patients were hospitalized for electrolyte imbalance a median 2.5 times (range: 1–17); all recovered with hydration and TPN. At the time of this writing, all seven patients remained alive, with below-average growth, and two were treated with growth hormones.
Conclusion
Appropriate catheter insertion, guardian education and management, as well as active responses to complications, are important-required to safely maintain long-term parenteral nutrition.

Keyword

Parenteral nutrition; Complications; Pediatric