Nutrition Interventions for Children with Special Health Care Needs

Chapter 11
Section 2 - Problem-Based Nutrition Interventions
Community Monitoring of the patient
on home parenteral Nutrition
Kathryn L. Hunt, RD, CD
Parenteral nutrition (PN) is needed when the patient’s gastrointestinal tract will not
sustain life or when a child is unable to tolerate enteral feedings for a significant
period of time. PN may be administered for weeks or months, as may be required
for children with nutritional depletion from certain diseases, or for years, as may
be required for children with severe short bowel syndrome (1). However severe
or significant the need, PN is now an accepted form of therapy with life-saving
capacities for pediatric patients. Indications for home parenteral nutrition for
pediatric patients are listed below.
• Short bowel syndrome
• Intestinal motility disorders (e.g., pseudo-obstruction)
• Inflammatory bowel disease (e.g., Crohn’s disease, ulcerative colitis)
• Hypermetabolic states (e.g., severe burns and trauma)
• Acute and chronic pancreatitis
• Special circumstances (e.g., hepatic failure, cancer, congenital villous atrophy)
• Unexplained intestinal malabsorption syndromes
The goal of the health care team in managing the pediatric patient on PN is to
provide a solution of carbohydrate, protein, and fat that will achieve a positive
nitrogen balance for growth, increase the patient’s weight, and improve clinical
outcome. The solution should also contain appropriate amounts of electrolytes,
vitamins, minerals, and trace elements to maintain balance within the patient’s body
and prevent nutrient deficiencies (2). Despite its life-saving capacities, PN has risks
and potential consequences, including liver damage from overfeeding, biliary sludge
from absence of enteral nutrition, and catheter-related sepsis (3). To minimize
these risks and to prevent other complications, the patient receiving PN should be
transitioned to enteral feeding at the earliest opportunity (4). This requires close
monitoring and regular re-evaluation by the health care team.
In general, PN regimens (including solution composition) are established in the
hospital, where the patient’s metabolic response and tolerance can be monitored
closely (5). After discharge, it is important to continue to monitor response to PN
Nutrition Interventions for Children With Special Health Care Needs 129