Prepubertal growth in children with long-term parenteral nutrition.
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 < or =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.
Colomb
V
V
Pediatric Gastroenterology and Nutrition, Necker-Enfants Malades Hospital, Paris, France. virginie.colomb@nck.ap-hop-paris.fr
Dabbas
M
M
Goulet
O
O
Talbotec
C
C
Corriol
O
O
Ricour
C
C
D000293:Adolescent; D001827:Body Height; D002648:Child; D002908:Chronic Disease; D003967:Diarrhea / Q000503:physiopathology / Q000628:therapy; D005260:Female; D006128:Growth; D006627:Hirschsprung Disease / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D007418:Intestinal Pseudo-Obstruction / Q000503:physiopathology / Q000628:therapy; D008297:Male; D010288:Parenteral Nutrition; D011627:Puberty; D012778:Short Bowel Syndrome / Q000503:physiopathology / Q000628:therapy; D013997:Time Factors; D015430:Weight Gain