{
  "abstract": "Background Paediatric home PN (HPN) in the UK often utilises formulations compounded for individual patients. Multi-chamber bags (MCBs) are pre-made parenteral nutrition (PN) bags that have been successfully used as paediatric HPN in our institution. 1 Models of MCB use include MCB-only (MCB-O) and a combination of MCBs plus compounded PN (hybrid). This is a re-audit of our HPN cohort to clarify patient characteristics associated with successful use of MCBs.Aims To evaluate patient characteristics associated with successful MCB use in an HPN cohort.Methods Clinical audit approval was obtained. HPN prescriptions and patient notes were assessed 1/1/2019 to 31/12/2024 for total PN days, MCB days, MCB model, patient diagnosis, actions to mitigate risk of electrolyte or nutritional deficiency whilst using MCBs (including use of enteral sodium), PN sodium content prior to first MCB prescription, adverse effects from MCB use and percentage of energy requirement received via PN when first initiated on MCBs.Results Forty-five patients received HPN, 17 received MCBs. Four patients received 2 MCB-containing courses. There were nine MCB-O courses, three hybrid courses and two holiday-only MCB courses. MCB-O acceptance was 83% for short bowel syndrome (SBS) diagnosis, 33% for pseudo-obstruction and 50% for enteropathy. 67% of patients with pseudo-obstruction diagnosis received hybrid model. Median sodium content of PN before first use of MCBs was 5mmol/kg/day (range 2.5-9). Anticipatory mitigation of deficiencies associated with MCBs included starting enteral sodium chloride supplements or dioralyte (30% of MCB patients), enteral micronutrient supplements and increasing electrolytes or micronutrients in compounded PN. The median proportion of energy requirements from PN was 56% for MCB-O (range 48-120) and 81% (range 39-91) for hybrid model.Four ADRs contributed to PN model change or cessation of change; two involved loss of enteral tolerance, one of unclear origin unlikely due to MCB content and one was a holiday trial that wasn’t viable long term. There were 10 other ADRs that did not require PN model change; 70% involved blood abnormalities, primarily low serum Vitamin B12, Vitamin A or Selenium, which resolved with additional supplementation.Conclusions MCBs comprised 16% of PN days in 2024. MCB-O model was used extensively in SBS whereas pseudo-obstruction often used hybrid model. The median sodium content of PN prior to MCB use was 5mmol/kg/day. Patients receiving around half their energy needs from PN successfully switched to MCB-O model, whereas hybrid model was utilised for higher PN energy dependence. This helps identify patients for whom MCBs may be used successfully in the future.Reference Phipps A, et al. Single centre evaluation of multi-chamber bags as home parenteral nutrition in children with intestinal failure. Clinical Nutrition ESPEN, 68:826.Abstract OC73 Table 1MCB use in HPN cohort201920202021202220232024All PN days660972386405713374937967MCB days02912575367121258% PN days as MCB0%4%4%8%10%16%Active patients272623252427Patients switched from compounded to hybrid/ MCB-O000436Patients switched from hybrid/MCB-O to compounded012100",
  "authors": [
    {
      "affiliations": [
        "br />Bristol Royal Hospital for Children"
      ],
      "name": "Amy Phipps"
    },
    {
      "affiliations": [
        "br />Bristol Royal Hospital for Children"
      ],
      "name": "Alison Dinning"
    },
    {
      "affiliations": [
        "br />Bristol Royal Hospital for Children"
      ],
      "name": "Anthony Wiskin"
    },
    {
      "affiliations": [
        "br />Bristol Royal Hospital for Children"
      ],
      "name": "Lizzie Hutchison"
    },
    {
      "affiliations": [
        "br />Bristol Royal Hospital for Children"
      ],
      "name": "Joanna Newby"
    }
  ],
  "title": "OC73 Single centre evaluation of multi-chamber bags as home parenteral nutrition in children with intestinal failure. Patient characteristics",
  "uid": "d8cff508-42ff-574b-9ccf-c92b1150d44b"
}