title: Weaning Off Prognosis Factors of Home Parenteral Nutrition for Children With Primary Digestive Disease.
abstract: OBJECTIVE
  The aim of the present study was to describe the indications for home parenteral nutrition (HPN) in children with primary digestive diseases and to identify factors associated with weaning off.
  
  
  METHODS
  All the children initially discharged on HPN between January 1, 2000, and December 31, 2009, for chronic intestinal failure (IF) were included. The associations between clinical factors and weaning off of HPN were assessed using a multivariable Cox regression model.
  
  
  RESULTS
  Among the 151 children (boys = 58%) included in this study, 98 (65%) presented with short bowel syndrome (SBS), 17 (11%) with digestive neuromuscular disorders, 14 (9%) with mucosal diseases, 13 (9%) with inflammatory bowel disease, and 9 (6%) with other primary digestive diseases. The probability of survival was ∼100%. At the end of the follow-up, the probability for weaning off of HPN was 0.73 (95% confidence interval 0.54-0.84) but varied according to the underlying cause of IF (for example, SBS and inflammatory bowel disease had a better prognosis). The median time until weaning off was 21 months (95% confidence interval 18-38 months). Unfavourable prognostic factors for weaning off of HPN included a bowel remnant of <40 cm, the presence of <50% of the colon, and daily lipid intakes >1.5 g · kg · day. Underlying disease was also associated with weaning off.
  
  
  CONCLUSIONS
  HPN is a safe therapeutic option for children with chronic IF requiring long-term nutritional management. Prognostic factors for weaning off of HPN were identified, and they highlight the relevance of SBS anatomy and parenteral nutrition caloric intake. The outcome of children on HPN was primarily dependent on the underlying disease.
authors.affiliation: *Unité de Gastro-Entérologie Pédiatrique, Département de l'Enfant et de l'Adolescent, Hôpitaux Universitaires de Geneve, Geneva, Switzerland †Unité de Recherche Clinique/Centre d'Investigation Clinique Paris Descartes Necker, Hôpital Necker-Enfants Malades, Paris, France ‡University Children's Hospital, Pediatric Pulmonology Research Group, Basel, Switzerland §Unité de Gastroentérologie, Hépatologie et Nutrition Pédiatriques ||Pharmacie, Hôpital Necker-Enfants Malades, Paris, France.
authors.forename: Laetitia-Marie
authors.initials: LM
authors.lastname: Petit
authors.forename: Delphine
authors.initials: D
authors.lastname: Girard
authors.forename: Solene
authors.initials: S
authors.lastname: Ganousse-Mazeron
authors.forename: Cécile
authors.initials: C
authors.lastname: Talbotec
authors.forename: Benedicte
authors.initials: B
authors.lastname: Pigneur
authors.forename: Caroline
authors.initials: C
authors.lastname: Elie
authors.forename: Odile
authors.initials: O
authors.lastname: Corriol
authors.forename: Catherine
authors.initials: C
authors.lastname: Poisson
authors.forename: Olivier
authors.initials: O
authors.lastname: Goulet
authors.forename: Virginie
authors.initials: V
authors.lastname: Colomb
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004066:Digestive System Diseases / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D016331:Parenteral Nutrition, Home / Q000379:methods*; D011379:Prognosis; D012044:Regression Analysis; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D028761:Withholding Treatment / Q000706:statistics & numerical data*; D055815:Young Adult