P2.118: Stratifying GI Risks: A Comparative Study of Pediatric TPN by Age Group

Background: Total parenteral nutrition (TPN) is vital for children who cannot meet nutritional needs through enteral feeding due to medical conditions. While TPN supports growth, its long-term impact on gastrointestinal health is unclear. Children receiving TPN are at risk for liver dysfunction, metabolic disorders, and other issues. Younger children may have different outcomes due to developmental and physiological factors. This study examines the age-related risk of gastrointestinal outcomes in children receiving TPN.

Methods: We conducted a retrospective cohort study using TriNetX data. Patients aged 1–10 years who received TPN from January 2010 to December 2024 were divided into two cohorts: 1–5 years and 6–10 years. The duration of TPN use ranged from several weeks to multiple years, depending on the underlying condition and recovery status. This analysis did not detail specific time frames of TPN exposure but represents population predominantly reliant on extended TPN therapy. Data from 45,750 patients in the 1–5 group and 87,278 patients in the 6–10 group were analyzed. Outcomes included abnormal liver function tests (LFTs), metabolic syndrome, IBD, jaundice, intestinal dysbiosis, vomiting, GERD, and IBS. Propensity score matching balanced cohorts to 41,922 patients each. Logistic regression estimated odds ratios (ORs) with 95% confidence intervals (CIs). TPN formulations included soybean oil, omega-3 enriched, and mixed lipid emulsions, per clinical protocols. TPN was used for conditions like short bowel syndrome, malabsorption, and prolonged ileus.

Results: A total of 133,028 patients were included. After matching, each group had 41,922 patients. The 1–5 years cohort had lower odds of abnormal LFTs (OR 0.498, 95% CI, 0.417–0.595, p < 0.001) and metabolic syndrome (OR 0.238, 95% CI, 0.119–0.474, p < 0.001). IBD was also less common (OR 0.390, 95% CI, 0.274–0.555, p < 0.001). Jaundice was less frequent (OR 0.615, 95% CI, 0.498–0.761, p < 0.001), and the younger cohort had reduced intestinal dysbiosis (OR 0.858, 95% CI, 0.767–0.960, p = 0.007), vomiting (OR 0.602, 95% CI, 0.576–0.630, p < 0.001), GERD (OR 0.714, 95% CI, 0.671–0.759, p < 0.001), and IBS (OR 0.354, 95% CI, 0.220–0.569, p < 0.001).

Conclusion: Younger children showed a lower risk for TPN-related gastrointestinal conditions, likely due to metabolic and developmental differences. Their adaptable gastrointestinal tracts may reduce oxidative stress and inflammation, limiting complications like abnormal LFTs and metabolic disorders. In contrast, older children face cumulative TPN damage, leading to higher risks of GERD, IBS, and gut health issues. Protective factors such as hepatic regeneration and immune adaptation might explain the lower incidence of jaundice and vomiting in younger children. These findings highlight the need for age-specific monitoring and interventions to reduce risks, especially for older patients. Limitations include the study's retrospective design and potential data biases. Future prospective studies are needed for validation and to explore underlying mechanisms.