Managing Successful Pregnancies in Patients with Chronic Intestinal Failure on Home Parenteral Nutrition: Experience from a UK National Intestinal Failure Unit

Background & Aim: There are minimal reports of pregnancy in the chronic intestinal failure (CIF)/ home parenteral nutrition (HPN) population, with some concern relating to the risk associated with such pregnancies. The aim of this retrospective observational study was to evaluate pregnancy experience and outcomes in patients with CIF requiring HPN in a national UK CIF referral centre.Method: All known pregnancies in patients treated with HPN for CIF between 1982 and 2016 were identified retrospectively from a prospectively maintained database. Maternal and foetal outcomes were collated, along with PN requirements before and during pregnancy.Results: There were 5 pregnancies in 5 mothers in our cohort consisting of over 700 patients, males and females. The median age at conception was 28 years (range 24-33 years). The median duration on HPN prior to pregnancy was 26 months (range 4-85 months). One patient had Crohn’s disease, another had pan-enteric dysmotility and the other three patients had ischaemic complications leading to short bowel syndrome (SBS). All mothers were intensively monitored in an obstetric clinic and a dedicated CIF multi-disciplinary clinic throughout pregnancy. There were 2/5 preterm deliveries. One of the preterm deliveries was associated with spontaneous labour and the other had a planned induction as a result of maternal clinical need. Neonatal complications were seen in both prenates. There were no recorded maternal catheter related line infections during the 5 pregnancies.Conclusion: Successful pregnancy whilst receiving HPN is feasible but requires close, intensive monitoring and dedicated optimisation of PN in order to minimise maternal and foetal complications. All women of child-bearing age on HPN should be counselled about pregnancy.Abbreviations: ALP: alkaline phosphatase; ALT: alanine transaminase; CIF: chronic intestinal failure; HPN: home parenteral nutrition; IBD: inflammatory bowel disease; IF: intestinal failure; IFALD: Intestinal Failure associated liver disease; LFT: liver function test; PN: parenteral nutrition; RDA: Recommended daily allowance; SBS: short bowel syndrome; TPN: total parenteral nutrition.

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Incidence and Outcomes of Home Parenteral Nutrition in Patients With Crohn Disease in Olmsted County, Minnesota

Crohn's & Colitis 360 ◽

10.1093/crocol/otaa083 ◽

2020 ◽

Vol 2 (4) ◽

Author(s):

Zeinab Bakhshi ◽

Siddhant Yadav ◽

Bradley R Salonen ◽

Sara L Bonnes ◽

Jithinraj Edakkanambeth Varayil ◽

...

Keyword(s):

Weight Loss ◽

Parenteral Nutrition ◽

Short Bowel Syndrome ◽

Crohn Disease ◽

Severe Disease ◽

Bloodstream Infections ◽

Home Parenteral Nutrition ◽

Average Weight ◽

Olmsted County ◽

Short Bowel

Abstract Background We sought to estimate the incidence of home parenteral nutrition (HPN) use in a population-based cohort of patients with Crohn disease (CD), and to assess clinical outcomes and complications associated with HPN. Methods We used the Rochester Epidemiology Project (REP) to identify residents of Olmsted County, who were diagnosed with CD between 1970 and 2011, and required HPN. Results Fourteen out of 429 patients (3.3%) with CD received HPN (86% female). Eleven patients (79%) had moderate–severe CD and 12 patients (86%) had fistulizing disease. Thirteen patients (93%) underwent surgery, primarily due to obstruction. Among CD incidence cases, the cumulative incidence of HPN from the date of CD diagnosis was 0% at 1 year, 0.5% at 5 years, 0.8% at 10 years, and 2.4% at 20 years. Indications for HPN included short bowel syndrome in 64%, malnutrition in 29%, and bowel rest in 21%. The median duration of HPN was 2.5 years. There was an average weight gain of 1.2 kg at 6 months, an average weight loss of 1.4 kg at 1 year, and a further weight loss of 2.2 kg at 2 years from the start of HPN. Patients were hospitalized a mean of 5 times after the start of HPN, mainly due to catheter-related bloodstream infections and thrombosis. Conclusions Less than 4% of patients with CD need HPN. Most have moderate to severe disease with short bowel syndrome or malnutrition. Possible reasons for the patients’ weight loss could be noncompliance, and increased metabolic needs because of active disease.

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Low-dose growth hormone in adult home parenteral nutrition–dependent short bowel syndrome patients: A positive study

Gastroenterology ◽

10.1053/gast.2003.50057 ◽

2003 ◽

Vol 124 (2) ◽

pp. 293-302 ◽

Cited By ~ 168

Author(s):

David Seguy ◽

Kouroche Vahedi ◽

Nathalie Kapel ◽

Jean–Claude Souberbielle ◽

Bernard Messing

Keyword(s):

Growth Hormone ◽

Parenteral Nutrition ◽

Short Bowel Syndrome ◽

Low Dose ◽

Home Parenteral Nutrition ◽

Short Bowel ◽

Positive Study

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HOME PARENTERAL NUTRITION FOR CHRONIC SHORT BOWEL SYNDROME

The Medical Journal of Australia ◽

10.5694/j.1326-5377.1979.tb125742.x ◽

1979 ◽

Vol 2 (6) ◽

pp. 317-319 ◽

Cited By ~ 13

Author(s):

G. Ramsey Stewart

Keyword(s):

Parenteral Nutrition ◽

Short Bowel Syndrome ◽

Home Parenteral Nutrition ◽

Short Bowel

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Survival of Patients With Short‐Bowel Syndrome on Home Parenteral Nutrition: A Prospective Cohort Study

Journal of Parenteral and Enteral Nutrition ◽

10.1002/jpen.1984 ◽

2020 ◽

Author(s):

Jessica Noelting ◽

Leah Gramlich ◽

Scott Whittaker ◽

David Armstrong ◽

Errol Marliss ◽

...

Keyword(s):

Cohort Study ◽

Parenteral Nutrition ◽

Short Bowel Syndrome ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Home Parenteral Nutrition ◽

Short Bowel

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Short bowel syndrome in infancy: recent advances and practical management

Frontline Gastroenterology ◽

10.1136/flgastro-2020-101457 ◽

2020 ◽

pp. flgastro-2020-101457

Author(s):

Elena Cernat ◽

Chloe Corlett ◽

Natalia Iglesias ◽

Nkem Onyeador ◽

Julie Steele ◽

...

Keyword(s):

Parenteral Nutrition ◽

Short Bowel Syndrome ◽

Intestinal Adaptation ◽

Intestinal Failure ◽

Rare Condition ◽

Oral Feeding ◽

Short Bowel ◽

Intestinal Continuity ◽

Gastrointestinal Reconstruction ◽

Lipid Reduction

Short bowel syndrome (SBS) is a rare condition characterised by extensive loss of intestinal mass secondary to congenital or acquired disease. The outcomes are determined by dependency on parenteral nutrition (PN), its possible complications and factors that influence intestinal adaptation. In order to achieve the best results, patients should be managed by a specialised multidisciplinary team with the aims of promoting growth and development, stimulating intestinal adaptation and preventing possible complications. This involves timely surgical management aimed at rescuing maximum bowel length and eventually re-establishing intestinal continuity where appropriate. A combination of enteral and parenteral nutrition needs to be targeted towards maintaining a balance between fulfilling the nutritional and metabolic needs of the child while preventing or at least minimising potential complications. Enteral nutrition and establishment of oral feeding play a fundamental role in stimulating bowel adaptation and promoting enteral autonomy. Other measures to promote enteral autonomy include the chyme recycling in patients where bowel is not in continuity, autologous gastrointestinal reconstruction and pharmacological treatments, including promising new therapies like teduglutide. Strategies such as lipid reduction, changing the type of lipid emulsion and cycling PN are associated with a reduction in the rates of intestinal failure–associated liver disease. Even though vast improvements have been made in the surgical and medical management of SBS, there is still lack of consensus in many aspects and collaboration is essential.

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