Practical management of home parenteral nutrition in infancy.

The child born today with chronic intestinal failure (IF) can expect to survive throughout childhood and into adult life even if dependent on parenteral nutrition (PN) support. The three major aetiologies of chronic IF are short bowel syndrome (SBS), intestinal dysmotility and mucosal disease. SBS is the commonest of these conditions in infancy, most frequently subsequent to resection for necrotising enterocolits (NEC). The focus of IF management is to ensure appropriate weight gain and growth whilst minimising complications (related to underlying disease as well as to PN) and aiming for intestinal autonomy. Strategies to avoid complications and aid PN weaning include early oral/enteral feed introduction, 'cycling' PN as soon as tolerated, limiting lipid infusions and discharging home on overnight PN with formally trained parents. A newer treatment for SBS is GLP-2 analogue. Multidisciplinary care in a specialist intestinal rehabilitation centre with collaboration with local professional support is key to success.