According to the study, which surveyed 24 centers across eight countries, the management of children on Home Parenteral Nutrition (HPN) varies significantly in Latin America. The median number of children on HPN per team was 5.5, with some centers managing as many as 50 patients. This variability underscores the need for standardized practices and resources to ensure consistent, high-quality care.
Key Findings and Recommendations
1. Team Composition and Expertise
The study found that most IF teams include a pediatric gastroenterologist and a pediatric surgeon, with additional support from dieticians, nurses, and social workers. However, only 45.8% of teams had a physiotherapist, and 58.3% had a psychologist. To optimize care, it is crucial to build multidisciplinary teams that encompass all necessary specialties.
- Recommendation: Ensure your IF team includes a comprehensive range of specialists, including physiotherapists and psychologists, to address all aspects of patient care.
2. Monitoring and Nutritional Management
While most centers adhere to international standards for vascular access and nutritional management, there is a notable gap in the monitoring of micronutrients. A significant percentage of centers reported the inability to monitor essential vitamins and trace elements.
- Recommendation: Implement robust monitoring protocols for micronutrients such as vitamins A, E, B1, B2, B6, active B12, and trace elements like zinc, aluminum, copper, chromium, selenium, and manganese. This will help in early detection and correction of deficiencies, improving patient outcomes.
3. Standardization of Practices
The survey highlighted wide variations in the practices related to vascular access management, enteral and oral nutrition, and the use of anticoagulation. This variability can impact the consistency and quality of care.
- Recommendation: Adopt standardized protocols based on best practices and international guidelines to ensure uniformity in care. Regular training and updates for the team can help maintain these standards.
4. Focus on Neuropsychological and Psychomotor Development
Only 70.8% of centers reported standard assessments for neuropsychological and psychomotor development. Given the complex needs of children with IF, regular assessments are essential for comprehensive care.
- Recommendation: Integrate routine neuropsychological and psychomotor assessments into the care plan. Collaborate with specialists to provide targeted interventions that support the overall development of the child.
5. Collaborative Research and Quality Improvement
The study emphasizes the need for ongoing research and quality improvement initiatives to address the disparities in care and enhance the overall management of pediatric IF.
- Recommendation: Engage in collaborative research efforts and participate in quality improvement programs. Sharing data and best practices with other centers can help elevate the standard of care across the region.
By implementing these recommendations, practitioners can significantly improve the outcomes for children with IF. Continuous education, standardized practices, and comprehensive care teams are the pillars of effective management.
To read the original research paper, please follow this link: International Latin American Survey on Pediatric Intestinal Failure Team.
