Evaluation of non-infectious complications in children receiving parenteral nutrition

BackgroundParenteral nutrition may lead to inevitable complications.AimsTo determine the indications, metabolic and mechanical complications of parenteral nutrition in children.MethodsOne hundred fifty-eight children (91 males; 57.8%) who received 179 episodes of individualized parenteral nutrition for >= 5 days within 2 years were analyzed. Indications and duration of parenteral nutrition, effect on growth, and metabolic and central venous catheter-related non-infectious complications were evaluated.ResultsParenteral nutrition was administered in 179 different episodes (109 males; 60.9%), and the median age during these episodes was 64.0 (14.0-129.0) months. The most common indications were hematological malignancies, gastrointestinal surgery, and hematopoietic stem cell transplantation. Most of the electrolyte imbalances occurred in the first 3 days. Hypophosphatemia (44.7%), hypomagnesemia (43.0%), hypokalemia (43.0%), hyponatremia (40.8%), and hypertriglyceridemia (38.2%) were the most common metabolic complications. Liver transaminases elevated in 32/145 (22.1%) episodes and bilirubin in 30/149 (21.0%). Ursodeoxycholic acid treatment was added to 25 patients with hypertransaminasemia and/or hyperbilirubinemia. Transaminase levels improved in 16 (64%) and bilirubin levels in 15 (60%) patients receiving ursodeoxycholic acid. Catheter thrombosis was seen in 4.5% of the episodes. The targeted energy could be given more efficiently via central catheters rather than peripheral venous accesses. Patients' bodyweights increased in 39.1% of the episodes.ConclusionsClose monitoring of electrolyte levels, especially in the first 3 days, is crucial to prevent complications of parenteral nutrition. When individualized PN preparations are used for metabolically unstable patients, it can be easier to maintain the blood glucose, lipids, and electrolyte levels within the normal range.

Automated summary

This study analyzed 158 children who received 179 episodes of individualized parenteral nutrition. The most common indications were hematological malignancies, gastrointestinal surgery, and hematopoietic stem cell transplantation. The most common metabolic complications included electrolyte imbalances and elevated liver enzymes. Central venous catheters were more efficient for providing targeted energy. Maintaining blood glucose, lipids, and electrolyte levels within the normal range is crucial for individualized parenteral nutrition.