CLINICAL NUTRITION (1990) 9: 65-71 &T Longmen Gmup UK Ltd 1990 zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA Home Parenteral Nutrition in Children: 8 Years of Experience with zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA 112 Patients zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQP C. Ricout, A. M. Gorski, 0. Goulet, S. de Potter, 0. Corriol, M. Postaire, C. Nihoul- Fekete, D. Jan, Y. Revillon, S. Lortat-Jacob and D. Pellerin Centre of home parenteral nutrition, HBpital des Enfants-Malades, 149, rue de Shres, 75743 Paris, France. (Reprint requests to C.R.) zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA ABSTRACT It is essential that children on prolonged parenteral nutrition for anatomical or functional loss of small bowel should enjoy a quality of life which is as normal as possible. Their return home is a major factor in this. Over the past 8 years, 112 children were able to remain at home on cyclic parenteral nutrition. Forty-nine of them are no longer on home parenteral nutrition (HPN), 45 are still on HPN, and 18 have died. Growth and quality of life were good in most cases. Most of the complications were from infection, 1 septicaemia per 594 days on HPN. In the light of these results, HPN seems to zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA be the best option for children requiring prolonged parenteral nutrition, although it can only be considered within the framework of a specialized centre, which ensures patient follow-up, and provides the logistical support required for this high-technology treatment. INTRODUCTION The main challenge in caring for children who are totally or partially dependent on parenteral nutrition (PN) for many months or years is to ensure that they enjoy the best possible quality of life. Cyclical infusions [l] and their return home [2, 31 help to fulfil these objectives. This report reviews our experience over the past 8 years with home parenteral nutrition (HPN). PATIENTS AND METHODS Patients Between 1981 and 1988, 112 children (66 boys and 46 girls) were fed parenterally at home. Fifty-nine were aged between 3 and 24 months, 25 between 2 and 10 years and a further 8 between 10 and 18 years. Most of them (102) were French, 5 were from the Antilles, and 5 were from North Africa, but all their families were living in France. Thirty-three were living in the greater Paris area and 79 in the provinces. Many of the heads of household (41%) held management positions. Five families were single-parent. Indications for HPN (Table 1) Forty-four children had short bowels; 36 cases were of perinatal origin, with an average length of 54cm (23- 150 cm), the ileo-cecal valve being intact in 10 cases; 8 cases were of later origin. Seventeen children had a severe form of Crohn’s disease: acute exacerbation (11 Table 1 Home parenteral nutrition indications in 112 chil- dren Short bowel syndrome Crohn’s disease Chronic intestinal pseudo obstruction Abnormal intestinal motility Protracted diarrhoea Immune deficiency Others *deaths. 44 (2*) 17 14 (3*) 10 (2*) 8 8 (4*) 11 (7*) cases), intestinal fistula (5 cases), extensive small bowel resection (1 case). Prior treatment failed in 10 cases- corticosteroid therapy (9 cases), constant rate enteral nutrition (1 case). Fourteen children had chronic intes- tinal pseudo-obstruction with neuronal form (6 cases), muscular form (6 cases) or unidentified (2 cases). Three had associated uropathy. Ten children had abnormal intestinal motility, 5 from Hirschsprung’s disease, with distended small bowel despite an enterostomy in the healthy region: the others had motor abnormalities secondary to plastic peritonitis and/or prolonged small bowel disturbances from peritoneal dialysis (2 cases), repeated surgical intervention (2 cases), necrotizing enterocolitis (1 case). Eight children had intractable severe diarrhoea with persistent villous atrophy, and failure of all oral feeding attempts after an interval of over 2 years. Two of them also had associated symp- toms of autoimmune disease. Eight children had immune deficiencies associated with severe intestinal disorders, and 4 were awaiting bone marrow uans- plants. 65