In children who depend on long-term parenteral nutrition (PN), a major goal is to obtain optimal growth. The aim of this retrospective study was to analyze growth in children on long-term cyclic nocturnal home PN, over at least 8 years before puberty. Nine boys and 7 girls were studied. Their mean age at the time of study was 11 years with a mean PN duration of 10.5 (8.6–16.4) years. Diseases were short bowel syndrome (5), intractable diarrhea (4), chronic intestinal pseudo-obstruction (4) and long segment Hirschsprung’s disease (3). In each child, periods of at least 2 years were analyzed: either periods of regular growth (R: height gain >50th percentile), or slow growth (S: height gain ≤25th percentile). Results were expressed as mean ± SD. Comparisons were performed using either Student’s test for unpaired data or Wilcoxon’s test for paired data. PN provided a mean of 224 ± 80 mg nitrogen/kg/day and 43 ± 14 kcal/kg/day equivalent to 50% of recommended supplies. At the time of study, the population presented with weight (W) = –0.7 ± 0.8 SD and height (H) = –1.5 ± 1.3 SD. The difference between W and expected W for H (W/H) was significant (p < 0.002). W/H ratio was 105 ± 11%. For the total PN duration, weight gain was +0.2 ± 1.5 SD and height loss was –0.75 ± 1.4 SD. An excess weight gain occurred in parallel with the deflection of height gain. Of the 16 children, regular prepubertal growth was achieved in 4 only. The other 12 showed alternate periods of R and S. In 8 of them, 26.5 years of R and 33.5 years of S were compared, each child being his own control. PN nitrogen and energy supplies were significantly higher during R periods than during S periods. In the absence of any disease or treatment explaining the failure to thrive, inadequate PN supplies, especially in terms of nitrogen supply, are thought to be responsible for a negative nitrogen balance and slowed growth. In case of any deflection away from the individual growth curve, it is recommended to adjust the PN supply early, especially nitrogen supply.

Goulet OJ, Révillon Y, Jan D, De Potter S, Maurage C, Lortat-Jacob S, Martelli H, Nihoul-Fékété C, Rocour C: Neonatal short bowel syndrome. J Pediatr 1991;119:18–23.
Vargas JH, Ament ME, Berquist WE: Long-term home parenteral nutrition in pediatrics: Ten years of experience in 102 patients. J Pediatr Gastroenterol Nutr 1987;6:24–32.
Ricour C, Gorski AM, Goulet O, De Potter S, Corriol O, Postaire M, Nihoul-Fékété C, Jan D, Révillon Y, Lortat-Jacob S, Pellerin D. Home parenteral nutrition in children: Eight years of experience with 112 patients. Clin Nutr 1990;9:65–71.
Colomb V, Goulet O, Ricour C: Home enteral and parenteral nutrition in children; in Goulet O (ed): Baillère’s Clinical Gastroenterology: Nutritional Support in Gastrointestinal Disease. London, Baillère Tindall, 1998, vol 12, pp 877–894.
Weber TR, Tracy T, Connors RH: Short bowel syndrome in children. Quality of life in an era of improved survival. Arch Surg 1991;126:841–846.
Bisset WM, Stapleford P, Long S, Chamberlain A, Sokel B, Milla PJ: Home parenteral nutrition in chronic intestinal failure. Arch Dis Child 1992;67:109–114.
Colomb V, Goulet O, Rambaud C, De Potter S, Sadoun E, Ben Hariz M, Jan D, Brousse N, Ricour C: Long-term parenteral nutrition in children: Liver and gallbladder disease. Transplant Proc 1992;24:1054–1055.
Schmidt-Sommerfeld E, Snyder G, Rossi TM, Lebenthal E: Catheter-related complications in 35 children and adolescents with gastrointestinal disease on home parenteral nutrition. J Parenter Enteral Nutr 1990;14:148–151.
Colomb V, Fabeiro M, Dabbas M, Goulet O, Merckx J, Ricour C: Central venous catheter-related infections in children on long-term home parenteral nutrition: Incidence and risk factors. Clin Nutr 2000;19:355–359.
Sempé M, Pedron G, Roy-Pernot MP: Auxologie, méthodes et séquences. Paris, Théraplix, 1979, pp 138–162.
Van de Kamer JH, Huihink H, Weyers HA: Rapid method for determination of fat in feces. J Biol Chem 1949;177:347–355.
Wooton IDP: Micro-Kjeldahl method; in Micro-Analysis in Medical Biochemistry, ed 4. London, Churchill, 1964, pp 140–143.
Miller DS, Payne PR: A ballistic bomb calorimeter. Br J Nutr 1959;13:501–508.
Schofield WN, Schofield C, James WPT: Basal metabolic rate – Review and prediction, together with annotated bibliography of source material. Hum Nutr Clin Nutr 1985;39(suppl 1):5–41.
Pellet PL: Food energy requirements in humans. Am J Clin Nutr 1990;51:711–722.
Pellet PL: Protein energy requirements in humans. Am J Clin Nutr 1990;51:723–737.
Moukarzel AA, Goulet O, Salas JS, Marti-Henneberg C, Buchman AL, Cynober L, Rappaport R, Ricour C: Growth retardation in children receiving long-term total parenteral nutrition: Effects of ornithine α-ketoglutarate. Am J Clin Nutr 1994;60:408–413.
Gonzales H, Ricour C: Croissance en nutrition parentérale prolongée. Arch Fr Pédiatr 1985;42:291–293.
Just B, Messing B, Darmaun D Rongier M, Camillo E: Comparison of substrate utilization by indirect calorimetry during cyclic and continuous total parenteral nutrition. Am J Clin Nutr 1990;51:107–111.
Putet G, Bresson JL, Ricour C: Nutrition parentérale exclusive chez l’enfant. Influence de l’apport continu ou cyclique sur l’utilisation des nutriments. Arch Fr Pédiatr 1984;41:111–115.
Bresson JL, Narcy P, Putet G, Ricour C, Sachs C, Rey J: Energy substrate utilization in infants receiving total parenteral nutrition with different glucose to fat ratios. Pediatr Res 1989;25:645–648.
Bresson JL, Bader B, Rocchiccioli F, Mariotti A, Ricour C, Sachs C, Rey J: Protein metabolism kinetics and energy substrate utilization in infants fed parenteral solutions with different glucose-fat ratios. Am J Clin Nutr 1991;54:370–376.
Goulet O, De Potter S, Salas J, Robert JJ, Rongier M, Ben Hariz M, Koziet J, Desjeux JF, Ricour C, Darmaun D: Leucine metabolism at graded amino acid intakes in children receiving parenteral nutrition. Am J Physiol 1993;265:E540–E546.
François B, Colomb V, Bonnefont JP, Goulet O, Ben Hariz M, Vassault A, Rabier D, Ricour C: Tolerance to starvation in children on long-term total parenteral nutrition. Clin Nutr 1997;16:113–117.
Colomb V, Leturque A, Guihot G, Loizeau M, Lavie S, Colomer S, Ricour C, Girard J: Route of nutrient delivery affects insulin sensitivity and liver glucose transporter expression in rat. Am J Physiol 1995;269:E827–E833.
Boirie Y, Broyer M, Gagnadoux MF, Niaudet P, Bresson JL: Alterations of protein metabolism by metabolic acidosis in children with chronic renal failure. Kidney Int 2000;58:236–241.
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