Choi Shin Jie, Lee Kyung Jae, Choi Jong Sub, Yang Hye Ran, Moon Jin Soo, Chang Ju Young, Ko Jae Sung
Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea.
Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea.
Pediatr Gastroenterol Hepatol Nutr. 2016 Mar;19(1):44-53. doi: 10.5223/pghn.2016.19.1.44. Epub 2016 Mar 22.
Parenteral nutrition (PN) not only provides nutritional support but also plays a crucial role in the treatment of children with intestinal failure. The aim of this study was to evaluate the clinical significance and clinical outcomes of long-term PN.
Retrospective cohort study was conducted using the medical records of patients treated at Seoul National University Children's Hospital. This study included 19 patients who received PN for over six months. Most patients received home PN.
The indications for PN included short bowel syndrome, chronic intestinal pseudo-obstruction, and intractable diarrhea of infancy. The median age of PN initiation was 1.3 years, and the median treatment duration was 2.9 years. Two patients were weaned from PN; 14 continued to receive PN with enteral feedings; and 3 patients died. The overall survival rates at 2 and 5 years were 93.3% and 84.0%, respectively. The incidence of catheter-related bloodstream infections was 2.7/1,000 catheter-days and was associated with younger age at PN initiation and lower initial height Z-score. Six patients developed catheter-related central vein thrombosis, with an incidence of 0.25/1,000 catheter-days. Eleven patients experienced PN-associated liver disease (PNALD), and one patient underwent multi-visceral transplant. The patients with PNALD exhibited lower final heights and body weight Z-scores. All patients experienced micronutrient deficiencies transiently while receiving PN.
PN is an important and safe treatment for pediatric intestinal failure. PNALD was linked to final anthropometric poor outcomes. Micronutrient deficiencies were common. Anthropometric measurements and micronutrient levels must be monitored for successful PN completion.
肠外营养（PN）不仅提供营养支持，而且在治疗肠衰竭儿童中起着关键作用。本研究的目的是评估长期PN的临床意义和临床结局。
采用首尔国立大学儿童医院治疗的患者病历进行回顾性队列研究。本研究纳入了19例接受PN超过6个月的患者。大多数患者接受家庭PN。
PN的适应证包括短肠综合征、慢性肠假性梗阻和婴儿难治性腹泻。开始PN的中位年龄为1.3岁，中位治疗持续时间为2.9年。2例患者停止了PN；14例继续接受PN并同时进行肠内喂养；3例患者死亡。2年和5年的总生存率分别为93.3%和84.0%。导管相关血流感染的发生率为2.7/1000导管日，与开始PN时年龄较小和初始身高Z评分较低有关。6例患者发生导管相关中心静脉血栓形成，发生率为0.25/1000导管日。11例患者发生PN相关肝病（PNALD），1例患者接受了多脏器移植。发生PNALD的患者最终身高和体重Z评分较低。所有患者在接受PN期间均短暂出现微量营养素缺乏。
PN是治疗小儿肠衰竭的一种重要且安全的方法。PNALD与最终人体测量学不良结局有关。微量营养素缺乏很常见。为了成功完成PN，必须监测人体测量指标和微量营养素水平。
