engleski

Organisation of nutritional care team and home parenteral nutrition in theory and practice

Parenteral nutrition (PN) provides the energy and all essential nutrients to meet patients' ongoing baseline needs, replenish reserves and, in children, to promote growth and development. PN is used when gastrointestinal tract can not be used effectively or safely, when enteral feedings can not provide adequate energy and nutrients to the patient. Home artificial nutrition, especially PN, is an expensive technology but is life-saving in many patients. Cost-benefit studies have demonstrated that home nutrition is about 70% more cost-effective than hospital-based therapy but the complications of these tehniques, including psychological consequences, have to be carefully assesed and prevented. The most suitable way to provide a PN support service and to standardize the management of patients is through a multidisciplinary nutritional care team. Short bowell syndrome is the commonest reason for long-term PN in children. Long-term prognosis of the patient depends on the prognosis of underlying disease, the possibility of concurrent enteral nutrition, nutritional care team experience, caregivers' experience, complications and on meticulous catheter care protocols. It is important to use the gut whenever possible, even if the enteral route provides nutrients which are nutritionally insignificant because they are likely to have an important trophic effect upon the gut and reduce the incidence of cholestasis.

home parenteral nutrition; children; nutritional care team

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