Use of parenteral nutrition in pediatric general and surgical wards : indications and complications

Parenteral nutrition (PN) is used to treat children that cannot fully feed by oral or enteral route. The aim of our retrospective study was to evaluate the current clinical practice concerning the use of PN in our Pediatric and Surgical Wards. From 2012 to 2016 we found that 21 patients admitted to the General Pediatric Ward and 292 patients admitted to the Surgical Pediatric Ward required PN. On the General Pediatric Ward, indications for PN were 38% (8/21) inflammatory bowel disease, 19% (4/21) malnutrition in patients with anatomical malformations, 14.2% (3/21) tetraplegic patients with complications (2 sepsis, 1 intolerance to enteral nutrition), 9.5% (2/21) metabolic diseases (mitochondrial disease, HMG-coA reductase deficit). On the Surgical Ward PN was used in the following cases: 44.2 % (129/292) lower gastrointestinal tract complications (intussusceptions, bowel obstructions, Hirschprung’s disease, appendicitis and peritonitis), in 15.7% (46/292) ano-rectal malformations, 11.9% (25/292) upper gastrointestinal tract indications (gastroschisis, onphalocele, duodenal and pyloric stenosis), 9.6% (28/292) oncologic indications (neuroblastoma, abdominal mass), 8.6% (25/292) fundoplication and gastrostomy placement, uro-genital indications, 1, 4% (4/292) other diagnosis. PN was in all cases administered via a central line: internal giugular vein or a Broviac line. Mean duration of PN was 11, 46 + 17,37 days for general Paediatric Ward, 9,6 + 10,9 days for the Surgical Ward. The main PN related complications were catheter related 2,2 % (obstruction and infection) and metabolic complications 1,6 % (electrolyte and glycaemic alterations), cholestasis 0.9%. PN has been safely used for a wide range of indications and with a low rate of complications.