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Goulet O, Breton A, Coste ME, Dubern B, Ecochard-Dugelay E, Guimber D, Loras-Duclaux I, Abi Nader E, Marinier E, Peretti N, Lambe C. Pediatric Home Parenteral Nutrition in France: A six years national survey. Clin Nutr 2021; 40:5278-5287. [PMID: 34534896 DOI: 10.1016/j.clnu.2021.08.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/31/2021] [Accepted: 08/05/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND AIMS Home Parenteral Nutrition (HPN) is the cornerstone management for children suffering from chronic intestinal failure (CIF). In France, HPN is organized from a network of 7 certified centers located in University Hospitals spread across the national territory. This study aims to review the data involving children on HPN over a 6-years period in France to outline the global and continuous improvement in care. PATIENTS AND METHODS This cross-sectional study included all children enrolled in any of the 7 French HPN certified centers from January 1st, 2014 to December 31st, 2019. Data was recorded from annual databases provided by each center regarding: age at inclusion, indication and duration of HPN, type of intravenous lipid emulsion (ILE), outcome [PN weaning off, transfer to adult center, death, intestinal transplantation (ITx)], rate of catheter-related bloodstream infections (CRSBIs) for 1000 days of HPN, Taurolidine lock procedure (TLP) use and prevalence of cholestasis defined as conjugated bilirubin ≥20 μmol/l. RESULTS The number of patients increased by 43.6% from 268 in 2014 to 385 in 2019. According to the year of follow up, the indications for HPN were short bowel syndrome (SBS) (42.3-46.6%), congenital enteropathies (CE) (18.5-22.8%), chronic intestinal pseudo-obstruction syndrome (CIPOS) (13.0-16.3%), long segment Hirschsprung's disease (LSHD) (9.7-13.3%), Crohn's disease (CD) (1.6-2.6%) and other non-primary digestive diseases (NPDD) such as immune deficiency, cancer or metabolic disease (4.0-9.2%). The median age at discharge on HPN decreased from 11.7 months in 2014 to 8.3 months in 2019 (p < .001). By December 31st, 2019, 44.8% of children had left the HPN program after a median duration ranging between 39.9 and 66.4 months. Among these patients, 192 (74.2%) were weaned off PN (94.7% SBS), 41 (15.8%) were transferred to adult centers for CIPOS (42%), SBS (31%) or CE (27%), 21 died (8.1%) - mostly in relation to cancer or immune deficiency - and 5 were transplanted (1.9%): 4 underwent combined liver-intestine transplantation for LSHD (n = 2), SBS, CE and one multivisceral Tx for CIPOS. The use of a composite fish-oil based ILE increased from 67.4% in 2014 to 88.3% in 2019 (p < 0.001). CRBSIs dropped from 1.04 CRSBIs per 1000 days HPN in 2014 to 0.61 in 2019 (p < 0.001) while meantime, the percentage of children receiving TLP increased from 29.4% to 63.0% (p < 0.001). The prevalence of cholestasis (conjugated bilirubin ≥ 20 μmol/l) was low and stable between 4.1 and 5.9% of children during the study period. CONCLUSION In France, the number of children enrolled in a HPN program continuously increased over a 6 years period. SBS is the leading cause of CIF requiring HPN. The rate of CRBSIs dropped dramatically as the use of TLP increased. Mortality rate was low and mainly in relation to the underlying disease (cancer, immune deficiency). Cholestasis and intestinal Tx remained very rare.
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Affiliation(s)
- Olivier Goulet
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Necker-Enfants Malades University of Paris-UFR Paris Descartes, Certified Center for Home Parenteral Nutrition, Reference Center for Rare Digestive Diseases in Children, Paris, France
| | - Anne Breton
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Purpan University Hospital, Certified Center for Home Parenteral Nutrition, Toulouse, France
| | - Marie-Edith Coste
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, La Timone University Hospital, Certified Center for Home Parenteral Nutrition, Marseille, France
| | - Béatrice Dubern
- Division of Pediatric Nutrition and Gastroenterology, Armand Trousseau University Hospital, Certified Center for Home Parenteral Nutrition, Sorbonne University, Paris, France
| | - Emmanuelle Ecochard-Dugelay
- Division of Pediatric Gastroenterology and Nutrition, Robert Debré University Hospital, Certified Center for Home Parenteral Nutrition, Reference Center for Rare Digestive Diseases in Children Paris, France
| | - Dominique Guimber
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Jeanne de Flandre University Hospital, Certified Center for Home Parenteral Nutrition, Reference Center for Rare Digestive Diseases in Children, Lille, France
| | - Irène Loras-Duclaux
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Pediatric University Hospital, Certified Center for Home Parenteral Nutrition, Reference Center for Rare Digestive Diseases in Children, Lyon, France
| | - Elie Abi Nader
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Necker-Enfants Malades University of Paris-UFR Paris Descartes, Certified Center for Home Parenteral Nutrition, Reference Center for Rare Digestive Diseases in Children, Paris, France
| | - Evelyne Marinier
- Division of Pediatric Gastroenterology and Nutrition, Robert Debré University Hospital, Certified Center for Home Parenteral Nutrition, Reference Center for Rare Digestive Diseases in Children Paris, France
| | - Noel Peretti
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Pediatric University Hospital, Certified Center for Home Parenteral Nutrition, Reference Center for Rare Digestive Diseases in Children, Lyon, France
| | - Cecile Lambe
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Necker-Enfants Malades University of Paris-UFR Paris Descartes, Certified Center for Home Parenteral Nutrition, Reference Center for Rare Digestive Diseases in Children, Paris, France.
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Abi Nader E, Lambe C, Talbotec C, Pigneur B, Lacaille F, Garnier-Lengliné H, Petit LM, Poisson C, Rocha A, Corriol O, Aigrain Y, Chardot C, Ruemmele FM, Colomb-Jung V, Goulet O. Outcome of home parenteral nutrition in 251 children over a 14-y period: report of a single center. Am J Clin Nutr 2016; 103:1327-36. [PMID: 27030532 DOI: 10.3945/ajcn.115.121756] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 03/01/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Parenteral nutrition (PN) is the main treatment for intestinal failure. OBJECTIVE We aimed to review the indications for home parenteral nutrition (HPN) in children and describe the outcome over a 14-y period from a single center. DESIGN We conducted a retrospective study that included all children who were referred to our institution and discharged while receiving HPN between 1 January 2000 and 31 December 2013. The indications for HPN were divided into primary digestive diseases (PDDs) and primary nondigestive diseases (PNDDs). We compared our results to a previous study that was performed in our unit from 1980 to 2000 and included 302 patients. RESULTS A total of 251 patients were included: 217 (86%) had a PDD. The mean ± SD age at HPN onset was 0.7 ± 0.3 y, with a mean duration of 1.9 ± 0.4 y. The indications for HPN were short bowel syndrome (SBS) (59%), PNDD (14%), congenital enteropathies (10%), chronic intestinal pseudo-obstruction syndromes (9%), inflammatory bowel diseases (5%), and other digestive diseases (3%). By 31 December 2013, 52% of children were weaned off of HPN, 9% of the PDD subgroup had intestinal transplantation, and 10% died mostly because of immune deficiency. The major complications of HPN were catheter-related bloodstream infections (CRBSIs) (1.7/1000 d of PN) and intestinal failure-associated liver disease (IFALD) (51 children; 20% of cohort). An increased rate of CRBSIs was observed compared with our previous study, but we saw a decreasing trend since 2012. No noteworthy deceleration of growth was observed in SBS children 6 mo after weaning off HPN. CONCLUSIONS SBS was the major indication for HPN in our cohort. IFALD and CRBSIs were potentially life-threatening problems. Nevertheless, complication rates were low, and deaths resulted mostly from the underlying disease.
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Affiliation(s)
- Elie Abi Nader
- Departments of Pediatric Gastroenterology, Hepatology and Nutrition, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Cécile Lambe
- Departments of Pediatric Gastroenterology, Hepatology and Nutrition
| | - Cécile Talbotec
- Departments of Pediatric Gastroenterology, Hepatology and Nutrition
| | | | | | | | | | | | - Amélia Rocha
- Departments of Pediatric Gastroenterology, Hepatology and Nutrition
| | - Odile Corriol
- Pharmacy, and Paris Descartes University, Paris, France; and
| | - Yves Aigrain
- Pediatric Surgery and Transplantation, Necker Enfants Malades University Hospital, Certified Center for Home Parenteral Nutrition, National Reference Center for Rare Digestive Diseases in Children, APHP, Paris, France; Paris Descartes University, Paris, France; and
| | - Christophe Chardot
- Pediatric Surgery and Transplantation, Necker Enfants Malades University Hospital, Certified Center for Home Parenteral Nutrition, National Reference Center for Rare Digestive Diseases in Children, APHP, Paris, France; Paris Descartes University, Paris, France; and
| | - Frank M Ruemmele
- Departments of Pediatric Gastroenterology, Hepatology and Nutrition, Paris Descartes University, Paris, France; and
| | | | - Olivier Goulet
- Departments of Pediatric Gastroenterology, Hepatology and Nutrition, Paris Descartes University, Paris, France; and
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