Supporting Children with Intestinal Failure Through Parenteral Nutrition

Roy C. Maynard, M.D., is the Medical Director for PHS. He serves as PHS’s clinical leader, working with the team to provide consultation and advice to ensure quality and effective pediatric home care to patients and their families in their own homes. He also leads implementation of clinical policies, procedures and programs to further enhance the best possible care for each child. He is a Neonatologist and Pediatric Pulmonologist, and served as a staff physician at Children’s Hospitals and Clinics in Minneapolis, Minn.


Intestinal failure is defined as the reduction of gut function below the minimum necessary for the absorption of macronutrients and/or water and electrolytes, causing intravenous supplementation to be required to maintain health and/or growth1. At this point in a patient’s medical care, Pediatric Home Service can provide parenteral nutrition (sometimes called HPN or TPN) in the home to administer this needed infusion. A recent report2 identified – in decreasing order of frequency – the most common causes of intestinal failure in children.

  1. Necrotizing enterocolitis
  2. Gastroschisis
  3. Intestinal atresia
  4. Motility disorders
  5. Volvulus
  6. Trauma/surgical resection
  7. Secretory diarrhea

Coordinated Care for Our Patients

PHS utilizes a comprehensive team approach to take care of children with intestinal failure. Our specialty pharmacy prepares the home parenteral nutrition formulations ordered by the patient’s doctor. Home infusion nurses instruct families in sterile technique for accessing central lines. An infusion nurse is on call 24 hours a day for trouble shooting of infusion pumps/central lines and lab draws. PHS dietitians work closely with the patient’s family and physician to optimize HPN and enteral feedings based on each patient’s clinical status and laboratory results.

A weekly meeting to discuss HPN patients by the Nutrition Support Team at PHS includes pharmacists, infusion nurses, dietitians, and physicians and/or advanced practice nurses caring for children with these potentially life-threatening conditions.

Contributing Data for Excellence

PHS contributions to benchmarking quality measures have included home parenteral nutrition patient outcomes through the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.)  SUSTAIN registry3 as well as tracking central line-associated bloodstream infections (CLABSI).

A well-founded multidisciplinary approach impacts the lives of children with intestinal failure, validating improved outcomes and the capacity to thrive at home.

 

  1. ESPEN endorsed recommendations. Definition and classification of intestinal failure in adults. Pironi, Loris et al. Clinical Nutrition. 2015 April, Volume 34, Issue 2, 171 – 180
  2. Fullerton, B.S., Enteral autonomy, cirrhosis, and long term transplant-free survival in pediatric intestinal failure patients. J Pediatr Surg. 2016 January; 51(1):96-100.
  3. https://www.nutritioncare.org/sustain/

 

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