Complicaciones asociadas al tratamiento en niños con nutrición parenteral domiciliaria

Abstract

When it is not possible to achieve an adequate nutritional status via the enteral route as a consequence of intestinal failure, the only way to maintain a satisfactory nutritional situation is through parenteral nutrition (PN). Nevertheless, its long-term use may lead to serious complications. Objective: to determine the incidence rate of complications associated with home parenteral nutrition (HPN) during the period 1993-2005. Materials and methods: the retrospective analysis of the medical histories of the 22 patients (13 girls and 9 boys) who received HPN during that period. Results: the total duration of the programme was 4,324 days, with an average duration per patient of 196 days. In the case of 19 children the venous access was a tunnelled catheter and in the case of 3 children a subcutaneous reservoir. We found a total of 23 complications, with an average of 1.95 per patient and year. The rate of infectious complications was 3 for every 1,000 days of HPN (11 bacteraemias and 2 exit site infections). Mechanical complications accounted for 1.8 episodes for every 1,000 days. On 5 of the occasions when the catheter broke it was possible to repair it using the repair kit. There were no episodes of venous thrombosis. Only two patients developed severe hepatic complications, and one of those patients required an hepatointestinal transplantation. None of the complications resulted in death. Only on two occasions was a catheter exchange required, in one case as a result of accidental loss and in the other as a result of the occlusion of the catheter. Four children are currently still on the HPN programme. Conclusions: the HPN is a safe technique with a low complication rate and, therefore, continues to be a valid alternative to an intestinal transplantation. The most common complications were those caused by infections.