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      Prepubertal Growth in Children with Long-Term Parenteral Nutrition

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          In children who depend on long-term parenteral nutrition (PN), a major goal is to obtain optimal growth. The aim of this retrospective study was to analyze growth in children on long-term cyclic nocturnal home PN, over at least 8 years before puberty. Nine boys and 7 girls were studied. Their mean age at the time of study was 11 years with a mean PN duration of 10.5 (8.6–16.4) years. Diseases were short bowel syndrome (5), intractable diarrhea (4), chronic intestinal pseudo-obstruction (4) and long segment Hirschsprung’s disease (3). In each child, periods of at least 2 years were analyzed: either periods of regular growth (R: height gain >50th percentile), or slow growth (S: height gain ≤25th percentile). Results were expressed as mean ± SD. Comparisons were performed using either Student’s test for unpaired data or Wilcoxon’s test for paired data. PN provided a mean of 224 ± 80 mg nitrogen/kg/day and 43 ± 14 kcal/kg/day equivalent to 50% of recommended supplies. At the time of study, the population presented with weight (W) = –0.7 ± 0.8 SD and height (H) = –1.5 ± 1.3 SD. The difference between W and expected W for H (W/H) was significant (p < 0.002). W/H ratio was 105 ± 11%. For the total PN duration, weight gain was +0.2 ± 1.5 SD and height loss was –0.75 ± 1.4 SD. An excess weight gain occurred in parallel with the deflection of height gain. Of the 16 children, regular prepubertal growth was achieved in 4 only. The other 12 showed alternate periods of R and S. In 8 of them, 26.5 years of R and 33.5 years of S were compared, each child being his own control. PN nitrogen and energy supplies were significantly higher during R periods than during S periods. In the absence of any disease or treatment explaining the failure to thrive, inadequate PN supplies, especially in terms of nitrogen supply, are thought to be responsible for a negative nitrogen balance and slowed growth. In case of any deflection away from the individual growth curve, it is recommended to adjust the PN supply early, especially nitrogen supply.

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          Central venous catheter-related infections in children on long-term home parenteral nutrition: incidence and risk factors.

          This study aimed to assess the incidence and etiology of central venous catheter (CVC) infections in children on home parenteral nutrition (HPN). 207 CVC-years were studied retrospectively in 47 children on HPN, aged 8.1+/-5.0 years. 125 CVC were used (means: 2.6 CVC/patient and 21 months utilization/CVC). Half of the hospitalizations (162) were due to proven CVC-related infections. The mean infection incidence was 2. 1/1000 HPN days. The total population divided in two groups below and above this value: group one including 24 children, incidence 2.1 per 1000 days (mean: 4.3). No differences were found between the two groups in terms of underlying disease, presence of ostomies, age at the time of HPN onset, or micro-organisms responsible. The only differences (p<0.05) were the mean duration of HPN (longer in group one) and the delay between HPN onset and the first infection (longer in group one). This study does not highlight any risk factors for CVC infection. However, early CVC infections after HPN onset appear to predict a bad prognosis. Copyright 2000 Harcourt Publishers Ltd.

            Author and article information

            Horm Res Paediatr
            Hormone Research in Paediatrics
            S. Karger AG
            September 2002
            17 November 2004
            : 58
            : Suppl 1
            : 2-6
            Pediatric Gastroenterology and Nutrition, Necker-Enfants Malades Hospital, Paris, France
            64760 Horm Res 2002;58(suppl 1):2–6
            © 2002 S. Karger AG, Basel

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            Page count
            Figures: 2, Tables: 3, References: 26, Pages: 5


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