Clinical outcomes in pediatric home parenteral nutrition
Abstract:
Background & aims: To examine whether socioeconomic characteristics of families influence caregiver training and clinical outcomes among children discharged on home parenteral nutrition (HPN), focusing on central line-associated bloodstream infection (CLABSI) and 30-day readmission.
Methods: Retrospective cohort (Oct/2018-Jan/2023) at a pediatric intestinal rehabilitation program. Primary caregivers completed a structured, nurse-led curriculum with competency checklists. Socioeconomic variables included caregiver age and education, household income, housing, and family composition. Outcomes were number of sessions to complete training (≤22 vs >22), 30-day readmission, and CLABSI (events per 1000 catheter-days). Recurrent infections were modeled using Andersen-Gill with robust variance.
Results: Thirty-five children (median age at admission 7 months) were followed for a median of 665 days. Caregivers were predominantly mothers (97.1%), with a median age of 31 (26.5; 36) years; 60% had completed high school and the median family income was 1.63 (1.15; 3.20) Brazilian minimum wages (approximately $290.00 USD). Caregiver age was inversely associated with CLABSI (HR 0.96; 95% CI 0.92-0.99). Families with ≥2 children (HR 2.70; 95% CI 1.26-5.82) and those living in provided housing (HR 4.24; 95% CI 1.87-9.58) had higher CLABSI risk. Socioeconomic variables did not influence completion of the curriculum within 22 sessions, and the number of sessions was not associated with CLABSI incidence or 30-day readmission rate.
Conclusions: A standardized, nurse-led training program facilitated the safe administration of HPN across various socioeconomic settings. However, indicators of social vulnerability-such as housing instability and increased caregiving responsibilities-were associated with a higher risk of CLABSI, indicating the necessity for targeted post-discharge support.
Reference:
Gritti CM, Brufato JF, Longo RL, Pavanelli EC, Person NC, Teixeira de Carvalho CM, Farah BC, Seda Neto J, Gameiro CO, Prado B, Cangnacci Cardili CV, de Souza Brandão CR, Vincenzi R. Socioeconomic Determinants and Their Impact on Clinical Outcomes in Pediatric Home Parenteral Nutrition. Clin Nutr ESPEN. 2026 Mar 2:102994. doi: 10.1016/j.clnesp.2026.102994. Epub ahead of print. PMID: 41780676.