Are commercially available formulations a possible alternative for home parenteral nutrition for children?

A descriptive cross-sectional study examined the best option for paediatric patients under home parenteral nutrition (PN), comparing standardised parenteral nutrition with individually tailored prescriptions in 24 infants and children.


Currently, guidelines recommend the use of individual prescriptions for home PN in paediatric patients. While the nutrient composition of individualised PN is optimally tailored to each patient’s needs, it usually has a shelf life of only a few days. In contrast, commercially available standardised PN often is stable for up to 24 months at room temperature. With these advantages in stability and availability, commercial standard formulations can play an important role in reducing hospital pharmacy workload and overall costs and may serve as a more flexible option for families with children on home PN.

The aim of the study was to evaluate the possibility of replacing individually tailored prescription with commercially available standard PN in a population of paediatric patients on home PN. This was approached by retrospective comparisons with information from patients with an individualised home PN for a period of 12 months with available commercial standard PN. The comparisons were made between the last individual prescription per patient and standard formulations using the following criteria: non-protein calorie to volume ratio, non-protein calorie to nitrogen ratio, and electrolyte concentration. In addition, data on the diagnosis and indication for home PN, stoma, demographic factors, age of beginning of home PN, number of days and hours on home PN were collected. A total of 24 patients were included with 67% male patients. The median age was 7.5 years and the most common diagnosis short bowel syndrome (58%).

The results showed that a replacement with standard PN was appropriate for 16 patients (67%) with short-term use (<4 weeks) and 10 patients (42%) receiving long-term home PN (>4 weeks). It needs to be acknowledged that most patients on long-term PN with short bowel syndrome have stomas, and their individual prescriptions for home PN are usually very different from available commercial formulations, making it more difficult to find an appropriate commercial solution for their needs.

The study provides evidence that standard PN can be appropriate for paediatric patients receiving PN at home. However, comparisons were limited by the fact that only one prescription per patient was considered, and inter-prescriptions changes could not be taken into account. Given the better stability and availability of commercial standard PN, they may be a more flexible option. The short-term use e.g. for families during holiday season or in settings/periods with restricted access may be of additional advantage.

Yet, further studies are needed to clarify long-term outcomes of standard formulations and to evaluate if there is need to revise guideline recommendations. Making commercial formulations more available is essential to make standard PN use at home a practical and more feasible option.

Paper available at: Journal of Pediatric Gastroenterology and Nutrition

Full list of authors: Ferreira, Mariana; Guerra, Paula; Ferreras, Cristina; Espinheira, Maria do Céu; Trindade, Eunice; Dias, Jorge Amil

DOI: 10.1097/MPG.0000000000003187