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. 1978 Sep;188(3):394–403. doi: 10.1097/00000658-197809000-00015

Home parenteral nutrition: results in 34 pediatric patients.

C T Strobel, W J Byrne, E W Fonkalsrud, M E Ament
PMCID: PMC1396993  PMID: 99097

Abstract

Although home parenteral nutrition (HPN) has been used successfully for adult patients, no extensive experience with children has been reported. During the past three years, we have managed 34 patients, ages 1 1/2 months to 20 1/2 years, on a HPN program for periods ranging from 23 to 786 days. Silastic Broviac catheters were inserted into the superior vena cava through the jugular or cephalic veins or into the inferior vena cava through the saphenous vein. The catheters were brought out onto the chest or lower abdominal wall through a subcutaneous tunnel. Solutions were infused over a 10--14-hour period each day, using a volumetric pump system. All patients improved their nutritional status. Twenty-three of 29 on the program for more than two months showed an increase in height. All patients evidenced a significant decrease in symptomatology. All resumed per group activities while on HPN and were able to continue their education or work. At present 24 patients including 15 with Crohn's disease no longer receive HPN. Administration of HPN through a Broviac catheter is a safe, successful technique for maintaining an optimal nutritional status in children with severe digestive disorders, and permits resumption of a more normal daily lifestyle. Following HPN, bowel adaptation and initiation of full oral alimentation become possible in many patients.

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Selected References

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  1. Broviac J. W., Cole J. J., Scribner B. H. A silicone rubber atrial catheter for prolonged parenteral alimentation. Surg Gynecol Obstet. 1973 Apr;136(4):602–606. [PubMed] [Google Scholar]
  2. Broviac J. W., Scribner B. H. Prolonged parenteral nutrition in the home. Surg Gynecol Obstet. 1974 Jul;139(1):24–28. [PubMed] [Google Scholar]
  3. Byrne W. J., Halpin T. C., Asch M. J., Fonkalsrud E. W., Ament M. E. Home total parenteral nutrition: an alternative approach to the management of children with severe chronic small bowel disease. J Pediatr Surg. 1977 Jun;12(3):359–366. doi: 10.1016/0022-3468(77)90011-2. [DOI] [PubMed] [Google Scholar]
  4. Dudrick S. J., Ruberg R. L. Principles and practice of parenteral nutrition. Gastroenterology. 1971 Dec;61(6):901–910. [PubMed] [Google Scholar]
  5. Dunlap W. M., James G. W., 3rd, Hume D. M. Anemia and neutropenia caused by copper deficiency. Ann Intern Med. 1974 Apr;80(4):470–476. doi: 10.7326/0003-4819-80-4-470. [DOI] [PubMed] [Google Scholar]
  6. Fleming C. R., McGill D. B., Berkner S. Home parenteral nutrition as primary therapy in patients with extensive Crohn's disease of the small bowel and malnutrition. Gastroenterology. 1977 Nov;73(5):1077–1081. [PubMed] [Google Scholar]
  7. Jeejeebhoy K. N., Langer B., Tsallas G., Chu R. C., Kuksis A., Anderson G. H. Total parenteral nutrition at home: studies in patients surviving 4 months to 5 years. Gastroenterology. 1976 Dec;71(6):943–953. [PubMed] [Google Scholar]
  8. Jeejeebhoy K. N., Zohrab W. J., Langer B., Phillips M. J., Kuksis A., Anderson G. H. Total parenteral nutrition at home for 23 months, without complication, and with good rehabilitation. A study of technical and metabolic features. Gastroenterology. 1973 Nov;65(5):811–820. [PubMed] [Google Scholar]
  9. Patel D., Anderson G. H., Jeejeebhoy K. N. Amino acid adequacy of parenteral casein hydrolysate and oral cottage cheese in patients with gastrointestinal disease as measured by nitrogen balance and blood aminogram. Gastroenterology. 1973 Sep;65(3):427–437. [PubMed] [Google Scholar]
  10. Press M., Hartop P. J., Prottey C. Correction of essential fatty-acid deficiency in man by the cutaneous application of sunflower-seed oil. Lancet. 1974 Apr 6;1(7858):597–598. doi: 10.1016/s0140-6736(74)92653-1. [DOI] [PubMed] [Google Scholar]
  11. Rault R. M., Scribner B. H. Treatment of Crohn's disease with home parenteral nutrition. Gastroenterology. 1977 Jun;72(6):1249–1252. [PubMed] [Google Scholar]
  12. Riella M. C., Broviac J. W., Wells M., Scribner B. H. Essential fatty acid deficiency in human adults during total parenteral nutrition. Ann Intern Med. 1975 Dec;83(6):786–789. doi: 10.7326/0003-4819-83-6-786. [DOI] [PubMed] [Google Scholar]
  13. Riella M. C., Scribner B. H. Five years' experience with a right atrial catheter for prolonged parenteral nutrition at home. Surg Gynecol Obstet. 1976 Aug;143(2):205–208. [PubMed] [Google Scholar]
  14. Scribner B. H., Cole J. J., Christopher T. G., Vizzo J. E., Atkins R. C., Blagg C. R. Long-term total parenteral nutrition. The concept of an artificial gut. JAMA. 1970 Apr 20;212(3):457–463. [PubMed] [Google Scholar]
  15. Shils M. E. A program for total parenteral nutrition at home. Am J Clin Nutr. 1975 Dec;28(12):1429–1435. doi: 10.1093/ajcn/28.12.1429. [DOI] [PubMed] [Google Scholar]
  16. Welch G. W., McKeel D. W., Jr, Silverstein P., Walker H. L. The role of catheter composition in the development of thrombophlebitis. Surg Gynecol Obstet. 1974 Mar;138(3):421–424. [PubMed] [Google Scholar]
  17. Whitehead R. G., Coward W. A., Lunn P. G. Serum-albumin concentration and the onset of kwashiorkor. Lancet. 1973 Jan 13;1(7794):63–66. doi: 10.1016/s0140-6736(73)90465-0. [DOI] [PubMed] [Google Scholar]

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