Characteristics and outcomes of home parenteral nutrition among children with severe neurological impairment

To describe the characteristics, secular trends, and outcomes of home parenteral nutrition (HPN) use among children with severe neurological impairment (SNI) and non‐primary digestive disorders from 2010 to 2023 and compare outcomes to children with primary digestive disorders on HPN. A retrospective review of all children with SNI and non‐primary digestive disorders, where HPN was initiated between January 2010 and September 2023 at a tertiary care pediatric hospital. The Mann–Kendall trend test was used to assess trends in HPN initiation. We compared acute care service utilization in the year prior and following HPN initiation. Mortality and ability to achieve enteral autonomy outcomes were compared to those of children with HPN and primary digestive disorders. Of the 205 included children with HPN, 18 children had SNI and non‐primary digestive disorders, 187 children had primary digestive disorders. There was an increase in HPN initiation among children with SNI and non‐primary digestive disorders (p= 0.002) between 2010 and 2020. Among children with SNI and non‐primary digestive disorders, HPN‐related complications (line‐associated infection/thrombus, nephrolithiasis, cholelithiasis) occurred in 72%. There was no change in acute care utilization in the year prior versus year following HPN initiation. Compared with the primary digestive disorders group, children with SNI and non‐primary digestive disorders were less likely to achieve enteral autonomy (p< 0.0001); however, no significant differences in mortality were observed (22% vs. 8%, p= 0.09). HPN is increasingly being used among SNI children with non‐primary digestive disorders. Compared to children with primary digestive disorders on HPN, those with SNI are less likely to achieve enteral autonomy. Home parenteral nutrition (HPN) can be considered among children with severe neurological impairment (SNI) and non‐primary digestive disorders who do not tolerate enteral feeding.The decision to initiate HPN in children with SNI and non‐primary digestive disorders is challenging due to absence of definitive etiologies for gastrointestinal symptoms and the known HPN‐related complications and psychosocial burden. Home parenteral nutrition (HPN) can be considered among children with severe neurological impairment (SNI) and non‐primary digestive disorders who do not tolerate enteral feeding. The decision to initiate HPN in children with SNI and non‐primary digestive disorders is challenging due to absence of definitive etiologies for gastrointestinal symptoms and the known HPN‐related complications and psychosocial burden. The use of HPN among children with SNI and non‐primary digestive disorders is increasing over time.Children with SNI and non‐primary digestive disorders are less likely to achieve enteral autonomy compared to children with primary digestive disorders on HPN; however, mortality rates are similar. The use of HPN among children with SNI and non‐primary digestive disorders is increasing over time. Children with SNI and non‐primary digestive disorders are less likely to achieve enteral autonomy compared to children with primary digestive disorders on HPN; however, mortality rates are similar.