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Use of home parenteral nutrition in severely neurologically impaired children
  1. Francisco Ribeiro-Mourão1,2,
  2. Sophie Bertaud3,
  3. Joe Brierley4,
  4. Renee McCulloch5,
  5. Jutta Köglmeier2,
  6. Susan M Hill2
  1. 1Pediatrics Department, Alto Minho Local Health Unit EPE, Viana do Castelo, Portugal
  2. 2Department of Paediatric Gastroenterology, Great Ormond Street Hospital for Children, London, UK
  3. 3Louis Dundas Centre for Children’s Palliative Care, Great Ormond Street Hospital for Children, London, UK
  4. 4Paediatric Bioethics Centre, Great Ormond Street Hospital for Children, London, UK
  5. 5Louis Dundas Centre for Children's Palliative Care, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
  1. Correspondence to Dr Susan M Hill, Department of Paediatric Gastroenterology, Great Ormond Street Hospital for Children, London WC1N 3JH, UK; susan.hill{at}gosh.nhs.uk

Abstract

Objective To review the outcome of children with severe neurological impairment (NI) and intestinal failure (IF) referred to our specialist multidisciplinary IF rehabilitation service and to discuss implications.

Design Case report series, descriptive analysis.

Setting IF rehabilitation programme at a tertiary children’s hospital in the UK.

Patients Children with severe NI referred to our IF rehabilitation programme from 2009 to 2019.

Main outcome measures Demographic and social data, diagnosis, clinical condition, use of home parenteral nutrition (HPN), complications, ethics review outcome and advance care plans.

Results Six patients with severe NI were referred to our IF rehabilitation service. Consent for publication was obtained from five families. After thorough medical review and clinical ethics committee assessment, three children started HPN, one had intravenous fluids in addition to enteral feed as tolerated and one intravenous fluids only. The HPN children survived 3–7.08 years (median 4.42 years) on treatment. Objective gastrointestinal signs, for example, bleeding improved without excessive HPN-related complications. Symptomatic improvement was less clear. Analgesia was reduced in three of the five children. All cases had detailed symptom management and advance care plans regularly updated.

Conclusions HPN can play a role in relieving gastrointestinal signs/symptoms in children with severe NI and IF. HPN can be conceptualised as part of good palliative care if judged to be in the child’s best interests. However, given its risks and that HPN has the potential to become inappropriately life-sustaining, a thorough ethics review and evaluation should be performed before it is initiated, withheld or withdrawn in children with severe NI.

  • palliative care
  • ethics
  • gastroenterology
  • neurology

Data availability statement

Data sharing not applicable as no datasets generated and/or analysed for this study.

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Data availability statement

Data sharing not applicable as no datasets generated and/or analysed for this study.

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Footnotes

  • Contributors FR-M, JK and SMH contributed to conception or design of the work. FR-M and SB contributed to data collection. FR-M, SB, JB, RM, JK and SMH contributed to data analysis and interpretation. FR-M, JB and SMH contributed to drafting the article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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