Hostname: page-component-78c5997874-fbnjt Total loading time: 0 Render date: 2024-11-10T14:42:11.322Z Has data issue: false hasContentIssue false
  • English
  • Français

Managing children and adolescents on parenteral nutrition: challenges for the nutritional support team

Published online by Cambridge University Press:  07 March 2007

Tracey Johnson  and
Elaine Sexton
Tracey Johnson*
Affiliation:
Department of Dietetics, Birmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, UK
Elaine Sexton
Affiliation:
Department of Nutritional Care, Birmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, UK
*
*Corresponding author: Tracey Johnson, fax +44 121 333 8021, email tracey.johnson@bch.nhs.uk
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

Managing infants, children and adolescents, ranging from premature infants to 18-year-old adolescents, on parenteral nutrition (PN) is a challenge. The ability of children to withstand starvation is limited and, unlike adults, children require nutrition for growth. PN in children is often required secondary to a congenital bowel problem rather than because of an acquired condition. Conditions requiring PN include motility disorders, congenital disorders of the intestinal epithelium and short-bowel syndrome (SBS). Intestinal failure may be temporary and children with SBS may be weaned from PN. However, other children require permanent PN. There are no comprehensive guidelines for the nutritional requirements of children and adolescents requiring PN. Practice in individual centres is based on clinical experience rather than clinical trials. Requirements are assessed on an individual basis according to age, nutritional status and clinical condition. These requirements need regular review to ensure that they remain appropriate for the changing age and weight of the child. Assessments of intakes use different methods, e.g. reference tables and predictive equations. Complications of PN include infection, accidental damage to, or removal of, the line and cholestatic liver disease. Home parenteral nutrition (HPN) is associated with fewer line infections and allows continuation of nutritional support in a more normal environment, encouraging normal development and participation in family activities. However, having a child at home on HPN is associated with physical and psychological stresses. A feeling of depression, loneliness and social isolation is common amongst children and their families. Home-care services are essential to supporting children at home and should be tailored to, and sensitive to, the individual needs of each family.

Keywords

Parenteral nutritionIntestinal failureChildren and adolescents
Type
BAPEN Symposium 1 on ‘Nutritional support in children and adolescents’
Information
Proceedings of the Nutrition Society , Volume 65 , Issue 3 , August 2006 , pp. 217 - 221
Copyright
Copyright © The Nutrition Society 2006

References

Agostini, C, Axelson, I, Colomb, V, Goulet, O, Koletsko, B, Michaelsen, K, Puntis, J, Rigo, J, Shamir, R, Szajewska, H & Turck, D (2005) The need for nutritional support teams in paediatric units: a commentary by the ESPGHAN Committee on Nutrition. Journal of Paediatric Gastroenterology and Nutrition 41 8–11.Google Scholar
Andorsky, J, Lund, DP, Lillehei, CW, Jaksic, T, Di Canzio, J, Richardson, D, Collier, S, Lo, C & Duggan, C (2001) Nutritional and other postoperative management of neonates with short bowel syndrome correlates with clinical outcomes. Journal of Paediatrics 139 27–33.CrossRefGoogle ScholarPubMed
Beath, SV, Booth, IW & Murphy, MS (1995) Nutritional care and candidates for small bowel transplantation. Archives of Disease in Childhood 73 348–350.CrossRefGoogle ScholarPubMed
Bisset, WM, Stapleford, P, Long, S, Chamberlain, A, Sobel, B & Miller, P (1992) HPN in chronic intestinal failure. Archives of Disease in Childhood 6 109–114.CrossRefGoogle Scholar
Carlsson, G, Hakansson, A, Rubensson, F & Finkey, Y (1997) Home parenteral nutrition in children in Sweden. Paediatric Nursing 23 272–274.Google ScholarPubMed
Department of Health (1991) Dietary Reference Values for Food, Energy and Nutrients for the United Kingdom. Report on Health and Social Subjects no. 41. London: H. M. Stationery Office.Google Scholar
Food and Agriculture Organization/World Health Organization/United Nations University (1985) Energy and Protein Requirements. WHO Technical Report Series no. 724. Geneva: WHO.Google Scholar
Food and Agriculture Organization/World Health Organization/United Nations University (2004) Human Energy Requirements. Report of Joint FAO/WHO/UNU Expert Consultation. FAO Food and Nutrition Technical Report Series no. 1. Rome: FAO.Google Scholar
Goulet, O, Ruemmele, F, Lacaille, F & Colomb, V (2004) Irreversible intestinal failure. Journal of Paediatric Gastroenterology and Nutrition 38 250–269.Google ScholarPubMed
Helfrick, FW & Abelson, NM (1944) Intravenous feeding of a complete diet in a child: a report of a case. Journal of Paediatrics 25 400–403.CrossRefGoogle Scholar
Holden, CE (1991) Home parenteral nutrition. Paediatric Nursing 3 13–17.CrossRefGoogle Scholar
Holden, CE, Brook, G, Wills, J, Paul, L & Sexton, E (1996) Home parenteral nutrition: present management, future options. British Journal of Community Health Nursing 1 347–353.CrossRefGoogle Scholar
Holden, CE, Johnson, T & Caney, D (2000) Nutritional support for children in the community. Part 2, Parenteral nutrition. In Nutrition and Child Health, pp. 197–209. [Holden, CE and MacDonald, A, editors]. London: Bailliere Tindall.Google Scholar
Koletzko, B, Goulet, O, Hunt, J, Krohn, K & Shamir, R, for the Parenteral Nutrition Guidelines Working Group (2005) Guidelines on paediatric parenteral nutrition of the European Society of Paediatric Gastroeneterology, Hepatology and Nutrition (ESPGHAN) and the European Society for Clinical Nutrition and Metabolism (ESPEN), supported by the European Society of Paediatric Research (ESPR). Journal of Paediatric Gastroenterology and Nutrition 41, Suppl. 2 81–84.CrossRefGoogle Scholar
Meehan, JJ & Georgeson, KE (1997) Prevention of liver failure in parenteral nutrition dependent children with short bowel syndrome. Journal of Pediatric Surgery 32 473–475.CrossRefGoogle ScholarPubMed
Merritt, RJ (1986) Cholestasis associated with total parenteral nutrition. Journal of Pediatric Gastroenterology and Nutrition 5 9–22.Google ScholarPubMed
Puntis, JWL & Booth, IW (1990) The place of nutritional care team in paediatric practice. Intestinal Therapy and Clinical Monitoring 11 132–136.Google Scholar
Puntis, JWL, Holden, C, Smallman, S, Finkel, Y, George, RH & Booth, IW (1991) Staff training: a key factor in reducing catheter sepsis. Archives of Disease in Childhood 66 335–337.CrossRefGoogle ScholarPubMed
Puntis, JWL (2002) Paediatric parenteral nutrition. In Artificial Nutrition Support in Clinical Practice, 2nd ed., pp. 461–484. [Payne-James, J, Grimble, GK and Silk, DBA, editors]. London: Greenwich Medical Media Ltd.Google Scholar
Rollins, H (2005) Transition of enterally fed young people to adult service. Clinical Nutrition Update 10 9–11.Google Scholar
Royal College of Nursing (2004) Adolescent Transition Care: Guidance for Nursing Staff. London: RCN.Google Scholar
Royal College of Paediatrics and Child Health (2003) Bridging the gaps: Health care for adolescents. www.rcpch.ac.uk (accessed April 2005).Google Scholar
Schofield, WN (1985) Predicting basal metabolic rate – new standards and review of previous work. Human Nutrition Clinical Nutrition 39C, Suppl. 1 5–41Google Scholar
Sexton, E, Holden, CE & Abel, G (2000) A team approach to nutritional support. In Nutrition and Child Health, pp. 197–209. [Holden, CE and MacDonald, A, editors]. London: Bailliere Tindall.Google Scholar
Sexton, E, Holden, C & Coad, J (2005) A review of homecare packages developed for home parenteral nutrition patients and their families. British Journal of Nursing 14 1028–1032.Google Scholar
Sizer, T (1996) Standards and Guidelines for Nutritional Support of Patients in Hospital Maidenhead, Berks.: BAPEN.Google Scholar
Sondheimer, J, Asturias, E & Cadnapaphornchai, M (1998) Infection and cholestasis in neonates with intestinal resection and long term parenteral nutrition. Journal of Paediatric Gastroenterology and Nutrition 27 131–137.Google ScholarPubMed
Vanderhoof, JA & Matya, SM (1999) Enteral and parenteral nutrition in patients with short-bowel syndrome. European Journal of Paediatric Surgery 9 214–219.CrossRefGoogle ScholarPubMed