Long-term parenteral nutrition

Abstract

Intestinal failure (IF) is a term applied when intestinal function becomes insufficient to allow adequate absorption of fluid, electrolytes, or nutrients required for normal growth and survival. The development of parenteral nutrition (PN) as a treatment modality has greatly improved the outcome for children with IF and has contributed to improved outcomes in neonates and children from intensive care settings. Home parenteral nutrition (HPN) is central to the care of patients when IF is expected to last for more than 3–6 months. Normal growth and long-term survival is now expected for most children and young people on HPN when only 10 years ago, the prognosis for survival was poor. Adolescents with IF now successfully transfer to adult services, many of which will have been dependent on PN since early infancy. This article reviews the current indications for PN and the recent advances in PN that have contributed to better outcomes. A guideline on Paediatric Parenteral Nutrition of the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and the European Society for Clinical Nutrition and Metabolism (ESPEN) supported by the European Society of Paediatric Research (ESPR) was published in 2010. This has been recently updated (ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition, 2018) with up-to-date evidence for health professionals working with infants, children and adolescents receiving PN. This update includes details the use of Taurolock™ to prevent central venous catheter (CVC) related sepsis, and the role of new multicomponent lipid emulsions. Recommendations have been given with regard to the use of in-line filtration and photoprotection of PN fluids and advice on energy, fluid, electrolyte, macro-and micronutrient intake has been updated.