Children with serious intestinal problems have to be fed intravenously. There moreover, exist systems that enable intravenous feeding to be carried out at home. Mr Iñaki Irastorza, paediatrician at the Cruces hospital in Bilbao, spent some 15 years analysing how serious intestinal problems in children were treated at the Great Ormond Street Children's Hospital in London. With the gathered data he has presented a highly novel PhD thesis at the University of the Basque Country.
No work is known in the literature to date which provides a long-term and generalised evaluation of the health of children fed intravenously in their own home. There have been, for example, articles that have made mention of a concrete case of a child who had received such treatment and had suffered a pulmonary thromboembolism but there has not been any work investigating the relationship between the treatment and this illness. These are some of the basic tenets of the PhD thesis of Mr Irastorza, entitled Domiciliary parenteral nutrition at paediatric age: long-term prognostic factors.
Warfarin appears to combat sudden death
Some children have to be fed intravenously, given that they have intestinal problems that impede digestion. These problems can be of three kinds: having undergone an operation for a birth malformation and thus having an intestine that is too small (the most common case); or the intestine is incapable of absorbing foods; or the intestine does not move suitably in digestion. Mr Irastorza investigated 64 children who, due to having one of these three problems, were being fed at home intravenously. 39% of these developed pulmonary thromboembolism, confirming that there exists a relation between this problem and the treatment.
Mr Irastorza also confirmed that warfarin, and anticoagulants in general, are effective in avoiding sudden death caused by thromboembolism. The 64 children were tested for thromboembolism on initiating the research and those who tested positive were given warfarin-based treatment. None of these children under treatment suffered sudden death. Nevertheless, 13% of the children who did not receive warfarin died a sudden death. Mr Irastorza believes that these children also had thromboembolism, but had not been detected.
Giving the lie to certain suppositions
For his thesis Mr Irastorza also investigated a number of beliefs about the health of children with serious intestinal problems and who are fed intravenously. He came to the conclusion that these beliefs are quite wrong.
To start with, as one of these beliefs held that these children do not have suitable growth, he analysed 18 children who had been more than five years with parenteral nutrition. Mr Irastorza observed that 40% of these enjoyed good scores as regards weight, height and bone mineral density. Nevertheless, he also saw that 50% of the children analysed were especially small for their age (below p3). He concluded that having an intestine with problems in absorbing food (enteropathy) is the principal factor of risk for height, weight and bone mineralisation. In any case, Mr Irastorza managed to prove that many of the children fed intravenously had grown without any problems, thus contradicting the aforementioned belief.
Apart from this, Mr Irastorza has totally refuted another belief that intravenous feeding is toxic for the liver, confirming in fact that the treatment had improved greatly over the past few years. He analysed 32 patients who had begun intravenous feeding at a neonatal stage, and only 4.5% of these developed hepatic cirrhosis. Nevertheless, the mortality rate was very high amongst those who had, in fact, suffered from this illness; of those who developed serious hepatic dysfunction between three and six months after starting treatment, 75% died victims of hepatic cirrhosis.
The system in Cruces Hospital
Based on the positive part of the conclusions of this innovative research and so that children with serious intestinal problems might have a more normal life, the system of domiciliary parenteral nutrition was adopted last year at Cruces hospital. Cruces has been pioneer in the use of this technique, both in the Basque Autonomous Community and in the Spanish State, thanks to Mr Irastorza's research work.
About the author
Iñaki Xarles Irastorza Terradillos (Ordizia, 1967) is a graduate in Medicine and Surgery. He drew up his thesis under the direction of Juan Carlos Vitoria Cormenzana, from the Department of Paediatrics of the Faculty of Medicine at the University of the Basque Country (UPV-EHU). He is currently Assistant Doctor at the Department of Paediatrics at the Cruces Hospital. In order to undertake his thesis, he collaborated with the Great Ormond Street Children's Hospital in London and with the Institute of Child Health at University College London.