Home parenteral nutrition in infants

Česká verze

Authors: B. Obermannová; B. Jírová; F. Fencl; K. Zárubová
Authors place of work: Pediatrická klinika 2. lékařské fakulty Univerzity Karlovy a Fakultní nemocnice v Motole, Praha
Published in the journal: Čes-slov Neonat 2025; 31 (2): 65-72.
Category: Původní práce

Summary

Objective: To provide an evidence-based, practice-oriented overview of home parenteral nutrition (HPN) in infants. Methods: Narrative synthesis of recent international guidelines and contemporary clinical studies/meta-analyses (notably on lipid emulsions and taurolidine locks), complemented by practical intestinal rehabilitation strategies in infancy.

Main findings: Timely identification of candidates for HPN and their management within specialized and experienced centers facilitate a safe transition to home care. A tunneled single-lumen silicone catheter dedicated to parenteral nutrition with standardized line-care bundles is preferred. After metabolic stabilization, cyclic (overnight) infusion reduces hepatic burden and improves family comfort. Typical nutritional targets include: energy ~85–105 kcal/kg/day, amino acids 2–3 g/kg/day, glucose infusion rate ~10–12 mg/kg/min during the cycle, and lipids 1–3 g/kg/day with monitoring of serum triglyceride levels. Multicomponent lipid emulsions are favored in infants at risk of cholestasis, while taurolidine locks effectively reduce the risk of recurrent catheter-related bloodstream infections. Structured clinical and laboratory monitoring mitigates risk of intestinal failure–associated liver disease (IFALD), central line infections, thrombosis, refeeding syndrome, bone demineralization, and micronutrient deficiencies (notably iodine and vitamin D).

Conclusions: When delivered within a standardized, multidisciplinary care program, HPN in infants is safe and effective. This approach allows, in most cases, for growth to be maintained at home and for a stepwise transition to enteral autonomy.

Keywords:

infant – cholestasis – intestinal failure – home parenteral nutrition – catheter-related bloodstream infections – lipid emulsions – intravenous

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