Growth, Body Composition and Micronutrient Abnormalities During and After Weaning Off Home Parenteral Nutrition

Objectives: To assess growth, body composition and micronutrient abnormalities in children with intestinal failure (IF) over time, both during and after weaning off parenteral nutrition (PN). Methods: Retrospective study in children on home PN between 2001 and 2015. Weight-for-age (WFA) and height-for-age (HFA) SD scores (SDS) were calculated, as well as fat mass (FM) and fat free mass (FFM) SDS obtained by DEXA. The course of growth parameters and body composition was analyzed with linear mixed models. All micronutrient measurements during the study period were obtained. Results: Fifty-two patients were included with a median follow-up of 3.4 years. Seventy-one % weaned off after a median PN duration of 0.9 years. One year after the start of PN, 28 patients were still PN-dependent with median WFA-SDS of -0.66 and median HFA-SDS of -0.96, both significantly lower than zero. Catch-up growth was achieved during PN, but HFA-SDS decreased after weaning (p = 0.0001). At a median age of 6.2 years, median %FM SDS was 0.30 and FFM SDS was -1.21, the latter significantly lower than zero. Frequent micronutrient abnormalities during PN were vitamin A (90%), zinc (87%) and iron (76%) and after weaning vitamin A (94%), E (61%) and 25-OH vitamin D (59%). Conclusion: Children with IF demonstrate abnormal growth and body composition and frequent micronutrient abnormalities. Longitudinal evaluation showed that catch-up growth occurs during PN, but height SDS decreases after weaning. This underlines the need for close monitoring, also after reaching enteral autonomy. Address correspondence and reprint requests to Jessie Hulst, PhD, MD, Department of Pediatric Gastroenterology, Erasmus Medical Center – Sophia Children's Hospital, Room Sp3435, PO BOX 2060, 3000 CB Rotterdam, the Netherlands (e-mail: j.hulst@erasmusmc.nl) Received 16 April, 2018 Accepted 23 June, 2018 Conflicts of interest and source of funding: none declared Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (www.jpgn.org). © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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