Home Parenteral Nutrition in Chronic Intestinal Diseases

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Abstract
Nine children and adolescents with chronic intestinal diseases and growth failure were treated with home parenteral nutrition (HPN) for 7-63 months. All patients improved their growth velocities on HPN, with an average height gain of 9 cm. The mean growth velocity in six patients with Crohn''s disease increased more than fivefold (from 0.67 .+-. 0.4 cm/year to 3.8 .+-. 1.09 cm/year), and they gained a mean of 11.4 .+-. 3.4 kg/year. The three patients without Crohn''s disease [intestinal pseudo-obstruction (two), severe short bowel (one)] increased growth velocity from an average of 2.9 .+-. 1.1 cm to 6.1 .+-. 1.34 cm/year and gained a mean of 10 .+-. 2.84 kg/year. Patients without Crohn''s disease grew faster on HPN than age comparable patients with Crohn''s disease. Also, the two patients with Crohn''s disease who were younger and had their disease for a short period (< 3 years) grew better than older patients with Crohn''s disease who had their disease for a mean of 8 .+-. 1.3 years. All patients improved clinically, and three with Crohn''s disease achieved complete remission. Five of the nine patients had psychosocial adjustment problems while on HPN. In conclusion, HPN is a relatively safe and effective means to stimulate growth in children and adolescents who cannot meet nutritional needs by the enteral route.