Poor Prognostic Factors in Patients with Parenteral Nutrition-Dependent Pediatric Intestinal Failure.
Poor Prognostic Factors in Patients with Parenteral Nutrition-Dependent Pediatric Intestinal Failure.
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DOI：
10.5223/pghn.2016.19.1.44
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发表时间：
2016-03
期刊：
影响因子：
--
通讯作者：
Ko JS
中科院分区：
文献类型：
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作者：
Choi SJ;Lee KJ;Choi JS;Yang HR;Moon JS;Chang JY;Ko JS
肠外营养（PN）不仅提供营养支持，而且在儿童肠衰竭的治疗中起着至关重要的作用。本研究的目的是评估长期PN的临床意义和临床结果。回顾性队列研究采用在首尔国立大学儿童医院治疗的患者的医疗记录。本研究包括19例接受PN治疗超过6个月的患者。大多数患者接受家庭PN治疗。PN的适应症包括短肠综合征、慢性假性肠梗阻、婴儿期难治性腹泻。PN起始的中位年龄为1.3岁，中位治疗时间为2.9年。2例患者脱离PN；14名继续接受肠内喂养的PN；3名患者死亡。2年和5年总生存率分别为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PN起始年龄较小和初始身高Z-score较低有关。6例患者发生导管相关性中心静脉血栓形成，发生率为0.25/ 1000导管日。11例患者经历了pn相关性肝病（PNALD）， 1例患者接受了多脏器移植。PNALD患者表现出较低的最终身高和体重z分数。所有患者在接受PN治疗时均出现短暂的微量营养素缺乏。PN是治疗小儿肠衰竭的一种重要且安全的治疗方法。PNALD与最终的人体测量不良结果有关。微量营养素缺乏很常见。人体测量和微量营养素水平必须监测成功完成PN。
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.