HOME
Return to Table of Contents
ADMISSION INDICATIONS AND OUTCOMES OF PEDIATRIC PATIENTS ON A HOME ENTERAL NUTRITION PROGRAM: A DESCRIPTIVE COHORT STUDY
MN Hoque, L Gramlich
Objective: The goal of this study is to describe the indications for home enteral nutrition (HEN) in the pediatric population, the duration of therapy, and outcomes of discharged patients from the program. This will serve as a baseline framework to create evidenced based medicine in this area.
BACKGROUND: HEN is a life sustaining therapy for people who are unable to meet nutrient needs by oral intake, who have a functional gastrointestinal tract, and are able to remain at home. The population of pediatric patients utilizing HEN has not been well described in the literature. We identified only 3 studies describing HEN programs in the pediatric population. Daveluy et. al. report on 416 patients on HEN in France over an 11 year period. We report a descriptive cohort study of 340 pediatric patients discharged over a 2 year period from the Pediatric Northern Alberta HEN support program (PNAHENSP). This is a provincially funded program that provides support to all pediatric patients in northern Alberta on HEN. At any one time there are over 400 clients in the program from a population of 2 million people. This program provides a commercial enteral nutrition product, expertise, and supplies, via an interdisciplinary team to patients on HEN and their families.
Research Design and METHODS: A retrospective chart review of all patients discharged from the PNAHENSP between 01/01/05 and 12/31/06 to detail indications for HEN, length of time on program, and reason for discharge from program. Data was collected and statistically analyzed.
RESULTS: Over the two year period 340 pediatric patients were discharged from the PNAHENSP (146 in 2005 and 194 in 2006). Diagnostic categories for HEN included: immune (2%), neuromuscular (11%), weight loss (4%), congenital (19%), genetic (1%), gastrointestinal (1%), cardiac (13%), cancer (7%), and other disorders including failure to thrive (42%). Average duration of HEN therapy in all patients was 19.1 months. 72% of patients were transitioned to oral intake, 15% of patients died, 3% of patients were discharged to the adult HEN program, 6% of patients moved, and 2% were lost to follow-up.
CONCLUSIONS: HEN is a life sustaining intervention that provides a bridge to oral intake in the majority of patients. Interdisciplinary HEN programs are vital to providing appropriate nutritional therapy to patients able to receive care in their home. There is a large body of evidence that identifies interdisciplinary teams as an important factor in the success of home based programs.