Dramatic changes in home-based enteral nutrition practices in children during an 11-year period

Objectives: Experience with pediatric home-based enteral nutrition (HEN), in particular series including children only, has been reported only rarely. We investigated the evolution of pediatric HEN activity during an 11-year period. Methods: All patients aged 17 years or younger who started HEN between January 1990 and December 2000 were included in this retrospective study. Results: The annual number of patients treated with HEN increased dramatically from 16 in 1990 to 200 in 2000, with more than 65 new patients every year since 1999 (P < 0.0001). The mean age at the commencement of HEN decreased from 6.2 +/- 1.4 (SEM) to 4.8 0.7 years (P = 0.006). The use of nasogastric tubes decreased from 63% in 1990 to 35% in 1998 (P = 0.009), and the use of gastrostomy increased from 50% to 60% from 1994 onward. The proportion of patients with digestive diseases commencing HEN in each year decreased from more than 40% before 1996 to less than 32% in 2000 (P = 0.009). Commercially manufactured pediatric diets were used increasingly (P = 0.0006). Conclusions: The evolution of HEN was marked by changes in the population treated and the modes of treatment after the emergence of gastrostomy and commercial diets. This justified the creation of a multidisciplinary, pediatric artificial nutrition unit.