Introduction Within nutrition support (NS) there is a spectrum of complexity ranging from oral supplements via enteral tube feeding (ETF) to parenteral nutrition (PN) for intestinal failure (IF). Nutrition support teams (NST) are involved with those children with chronic or complex nutrition needs on home ETF (HETF) and home PN (HPN). There is no current robust data available on the prevalence of children on each level of what we newly describe as the nutrition support pyramid (NSP).
Aims To introduce the concept of the NSP and to describe the composition and temporal trends in the NSP in a UK regional paediatric cohort.
Methods We performed a retrospective cohort study (database/clinical note review) of all children (<16 yrs) in SE Scotland requiring NS over a 7-year period (2004–2010). We divided all children having NS into levels of the NSP, which comprises four levels of nutrition support; a 5th level is children with IF who have required transplantation (Tx) to achieve intestinal adaptation. The NSP base comprises children receiving HETF, the second level is children with severe upper GI dysmotility requiring jejunal HETF, the penultimate level is children with type II IF (prolonged hospital PN), and the top level is type III IF (children who receive HPN). Poisson regression models and Fisher's exact testing were then used to compare the period prevalence (per calendar year) of children <16 yrs requiring NS and the proportions of each level of the NSP between the two epochs of 2004–2006 and 2008–2010.
Results There were a total of 780 NS episodes in 702 children (51% male); 69 (10%) had multiple episodes of NS. Median (IQR) age at commencing NS was 1.0 (0.2–4.7) yrs. There was a significant increase in the period prevalence of children requiring NS between the two epochs (p=0.004). However, although the number of children requiring HETF (level 1) rose from 372 to 422 between the two epochs, there was a non-significant change in the shape of the NSP (determined by the relative size of each level) between the two epochs (p=0.736). During the entire study period a total of 715 NS episodes were located on the base level (HETF); 31 on the second level (jejunal HETF); 21 on the penultimate level (type II IF); and 14 on the top level (type III IF), with four children requiring Tx to achieve enteral autonomy.
Conclusion We have introduced the concept of a NSP, not previously described, and shown that the NSP has significantly increased in size (number of children requiring NS) without a significant change in the shape (relative distribution of complexity). The NSP is a simple tool which allows us to show a significant increase in NST workload without any decrease in complexity over just 7 years.
Competing interests None declared.
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