Introduction: Data on multidisciplinary programs dedicated to the care of intestinal failure (IF) patients on home parenteral nutrition (HPN) in middle-income countries from Latin America are scarce. This study described the results of the first Pediatric Multidisciplinary Intestinal Rehabilitation Program with HPN in the public Health System from a public tertiary hospital in Brazil.

Methods: We conducted a retrospective study that included all children who were referred to our institution with IF from 1-January-2014 to 31-January-2019. Inclusion criterion was the use of parenteral nutrition (PN) for at least 2 months while in stable condition. We assessed the medical records of patients who were discharged while receiving HPN and those who were not discharged and received PN whilst in hospital. All patients who were not discharged on HPN had psychological or social impairments or did not reach a stable clinical condition. The following outcomes were analyzed: total PN period (HPN or PN in hospital period), full PN weaning off and causes of death.

Results: 49 patients were included, median age at onset of long-term PN was 4 months old (17 days-16 years). 15 (30.6%) were girls and 38 (77.6%) had short bowel syndrome, of whom 10 had remnant intestine <20cm. IF causes were: intestinal atresia 18(36.7%); volvulus 9(18.4%); gastroschisis 7(14.3%); necrotizing enterocolitis 6(12.2%); Hirschsprung’s disease 2(4.1%); pseudo-obstruction syndrome 2(4.1%); other causes 5(10.2%). 35(71.4%) were discharged receiving HPN, of whom 9 weaned off HPN, 23 are currently on HPN (1 patient is on waiting list for multivisceral transplant) and 3 died [1 catheter-related bloodstream infection (CRBSI), 1 loss of venous access, and 1 intestinal failure associated liver disease]. Median period of HPN was 13.9 months (10 days–4.5 years). From the 14 patients who were not discharged from hospital, 7 weaned off PN, 2 are still receiving PN, and 5 died (3 loss of venous access and 2 CRBSI). Total weaning off PN rate was 32.7%. 5-year survival rate of all patients was 81.4% whereas 5-year survival on HPN was 90.4% (Kaplan-Meier).

Conclusion: Treatment of patients with IF by a multidisciplinary rehabilitation program with HPN is feasible and safe in the public health system in Brazil. The high survival rate supported the use of HPN as the primary treatment for IF.