Introduction: To analyse longitudinal changes in micronutrient blood levels in all patients already established for >12 months on parenteral nutrition (PN) treatment in our home intestinal failure (IF) rehabilitation service.

Methods: Laboratory reports of blood micronutrient levels and concurrent CRP levels in children with IF established on PN >12 months prior to 2013 were reviewed in 2013, 2015 and 2017. Peditrace ® or additrace® supplement was routinely included in PN and doses adjusted according to blood levels with additional enteral supplements if appropriate. Results were categorised as deficient (> 10% below normal range) or normal, based on mean of 2 values (one value only for vitamin D) obtained over 6-months in each time period, 2013, 2015 and 2017. The study was approved as an audit. Two tailed Fisher’s exact test was used to calculate p values.

Results: 30 patients(16 male) diagnosed with motility disorders in 12(40%), short bowel syndrome (SBS) in 7(23%), mucosal disorders in 11(37%). Five children weaned off PN, 2 transitioned to adult care and 1 died(due to underlying disease). IV lipids including vitlipid ® were added to PN 2 or 3 nights/week in 27, four nights in 2 and not given to one child. Please see results table for levels obtained in each time period (samples not obtained if patient no longer on PN or blood sample insufficient for analysis). There was a similar incidence of each micronutrient deficiency in the different diagnoses.

*<30 patients as patients no longer on PN or results not available due to insufficient sample

Table showing prevalence of micronutrient deficiencies in long term home PN patients

Conclusions: The majority of children with chronic IF on home PN had some micronutrient deficiencies with increasing incidence of normal levels with time. Two or 3 nights/week appeared sufficient for maintaining fat soluble vitamin levels. There were significantly less cases of low copper and vitamin A levels with time. Our results emphasise the importance of routine monitoring of micronutrients and the need to prescribe home PN according to individual requirements.

peditrace® commercially available preparation of micronutrients

additrace® commercially available preparation of micronutrients

vitlipid® commercially available preparation of lipids