Comparision of Complications along with Outcome between patients requiring Total Parenteral Nutrition & Enteral nutrition in a Paediatric Intensive Care Unit–A hospital based observational study

Dr. Pratik Kumar Dey; Dr Naresh Chandra Acharya; Dr. Dillip Kumar Dash; Dr.Jasashree Choudhary; Dr M.D. Mohanty

Volume : VIII, Issue : IV, April - 2019

Comparision of Complications along with Outcome between patients requiring Total Parenteral Nutrition & Enteral nutrition in a Paediatric Intensive Care Unit–A hospital based observational study

Dr. Pratik Kumar Dey, Dr Naresh Chandra Acharya, Dr. Dillip Kumar Dash, Dr. Jasashree Choudhary, Dr M. D. Mohanty

Abstract :

INTRODUCTION: The concept of Total Parenteral Nutrition started during the late 1930s when positive nitrogen balance was maintained in children by use of protein hydrosylates. In 1966, an animal model of short bowel syndrome was created at the University of Pennsylvania. Beagle puppies were given PN via a central line and shown to have normal rates of growth PN and had normal rates of growth as compared to the puppies on the right who did not have a central line. Then in 1970, protein hydrosylates were replaced by crystalline amino acid solutions resulting fewer allergic reactions. In 1980 & 81, infant specific & pediatric specific crystalline solutions were introduced. Finally in 1988, the guidelines for TPN were introduced. [1]The recent technological advancements in Paediatric Critical Care has resulted in a more sophisticated care for children and adolescents, making these Intensive care units prepared to treat cases of high complexity. However, the technology available has not been sufficient enough in improving the quality of patient care and higher ability to predict life expectancy becomes an issue that could increase the suffering and prolong death process [2]. Material &Methods: This was a prospective observational study to evaluate the outcome of patients admitted to the paediatric intensive care unit (PICU) of IMS & SUM hospital who required TPN as per ESPHAGN recommendation versus those not requiring the same. STUDY PERIOD: 2years.PLACE OF STUDY: This study was conducted in the Paediatric Intensive Care Unit of the Department of Paediatrics in the Institute of Medical Sciences and SUM Hospital (IMS & SH) which is a tertiary care centre in Odisha. The total admissions to the PICU was 278 during the study period .After excluding 53 cases, 225 cases were studied in detail .All the patients admitted to the PICU fulfilling the inclusion criteria were the participants. All the paediatric patients between 1 month to14years admitted to PICU, meeting the criteria were included in the study. Out of 225 cases, 59 were given TPN as per ESPHAGN recommendations. All the necessary investigations required as per our PICU protocol were done along with other necessary investigations .New complications that develops before or after TPN were noted and taken care accordingly .All cases were followed till discharge or death. Patients requiring TPN as per guidelines were assessed at regular intervals with different biochemical & other parameters both before & after the initiation of TPN. Results: Out of total 278 admissions to the PICU during the study period, 53 cases (30 admitted for Post–Operative stabilisation, 12 participants left against medical advice (LAMA) and 11 died within 8 hours of admission) were excluded from the study. The association between various study variables and the outcome was analysed and a p value of < 0.05 was considered as statistically significant. Majority of the study population were within the age group of 5 to 10 years. Males outnumbered the female participants in each sub group. The causes of illness were grouped as per the primary system involved. Respiratory system (n = 89) constituted the major cause of illness at the time admission, followed by CNS (n = 45), Infections (n = 22), GI (4). The others included CVS (n = 7), Haematological (n = 20), Renal (n = 11) and Others (n = 27). The highest mortality rate (28.91%) was observed in the cases that received enteral nutrition (EN) while the cases which received TPN had an excellent recovery rate of 87.3%.TPN had significant association with good outcome (p–value–0.001).Out of the total 225 cases, 59 needed TPN, out of which 51 patients survived.The mortality rate in cases requiring Total Parenteral Nutrition was significantly less as compared to cases which received enteral nutrition(13.96% vs 28.91%).Few Complication among TPN cases were also significantly lower compared to the Enteral cases i.e Hypoglycaemia(3% vs 7%), Hyponatremia(31.7 vs 38.3),Hypokalemia(30.2 vs 40.6),Hypoalbuminemia(13.5 vs 18.1) respectively to name a few. Conclusion: The present study was done in a tertiary care referral hospital to evaluate the complications & outcome of patients between those requiring TPN against those not requiring it in a paediatric intensive care unit. A total of 225 cases were studied and analyzed. The overall mortality was 19.6%. Our study demonstrated that, nutritional intervention in the form of TPN has many advantages like low mortality, minimal morbidity, better weight gain, lesser metabolic abnormalities & reduced PICU stay.