Newsletter

[ Vol. 13 No. 1 ] (January - April 2012 )
Pediatric home parenteral nutrition-Taiwan experience

Yen-Hsuan Ni,^1,3Der-Yirng Hsieh,³Hong-Shiee Lai^2,3
1Department of Pediatrics, National Taiwan University Hospital (Taiwan)
²Department of Surgery, National Taiwan University Hospital (Taiwan)
³Nutrition Support Team, National Taiwan University Hospital (Taiwan)

Home parenteral nutrition (HPN) program started in 1989 in Taiwan. Few medical centers (e.g., National Taiwan University Hospital) are able to provide HPN on a routine base for pediatric patients. From 1989 to 2011, we have 64 (M:F= 41:23) pediatric patients enrolled into HPN program. Less than half of the patients (29/64) started their HPN below one-year of age, while 20 started HPN at the age of 1-6 and the remaining 15 children used HPN after the age of 6. The indications for HPN were congenital or acquired short bowel syndrome (n=41) and functional intestinal obstruction (n=23). Among the 23 functional dysmotility patients, we had three cases of Crohn’s disease. Parenteral nutrition was administered through a central line, either with a Hickman or a Port-A catheter. Caretakers were trained by the special nurses in hospital for two weeks before they went home. The family had to come to the hospital weekly to for one-week ration of HPN. The special nurses would do a telephone visit every month. The program of HPN was mostly 12 hours in the nighttime. Oral intake was generally encouraged unless otherwise indicated. The mean duration of HPN use is 552. 2 day. Among the 64 children, 36 (56.3%) could finally terminate HPN use and completely resume enteral feeding; 10 (15.6%) were still maintained on HPN; 18 children (28.1%) expired. About two thirds of the patients could achieve an acceptable increase of body weight after the institution of HPN. Catheter-related infection, and mechanic failures of the catheter (including occlusion, dislodgement, and leakage) were the two main complications for HPN. Staphylococcus aureus and fungus were the two most common infectious agents. In conclusion, HPN program does help the children who could not be fed adequately through enteral route. More than half of the patients benefited from HPN and converted to an adequate enteral feeding. The infection control is undoubtedly the challenge for HPN.

From  
The 14^th Congress of Parenteral and Enteral Nutrition Society of Asia
“From Nutrition Support to Nutrition Therapy”
October 14-16, 2011, Taipei, Taiwan 
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