Home parenteral nutrition in children: The Polish experience

Background: Home parenteral nutrition has become routine for management of intestinal failure in patients. In Poland the main obstacle to widespread u se of home parenteral nutrition is the lack of interest of commercial compa nies in delivering feedings and ancillaries to patients. Methods: Twenty-five home parenteral nutrition patients aged from 4 months to more than 13 years were reviewed. The mother or both parents were traine d in home parenteral nutrition techniques for 4 to 6 weeks and compounded t he nutrients themselves at home. Results: The mean duration of home parenteral nutrition was 10,117 patient days. Hospital stays of patients receiving par enteral feedings were signif icantly shorter than the duration of administration of home parenteral nutr ition (p < 0.001). Eleven children are continuing the home parenteral nutri tion program. Eighty-three catheters were used in these patients. The rate of catheter occlusion decreased within the observation period, and in 1997 not one case of occlusion was observed. In 1997 only three catheters were r emoved during 7.8 patient years, and the overall incidence of catheter-rela ted complications was 0.38 per patient year. The overall occurrence of sept icemia was one case in 516 days and of catheter infection was one in 459 da ys. In 1997 a catheter was infected on average of once every 1419 days. The re was significant improvement in the z score for weight during therapy. Th e average monthly cost of nutrients and ancillary items was approximately $ 1200 (4200 Polish zlotys [PLN]), These costs are 1.6 to 3 times lower than those recorded in other studies. Conclusion: Home parenteral nutrition in children with nutrients mixed by c aregivers in the home setting is a safe and appropriate method of treatment that can be used in countries where home parenteral nutrition solutions ar e not manufactured or where commercial home parenteral nutrition is not eco nomically feasible.