Optimizing pediatric home parenteral nutrition with adult-designed commercial multichamber parenteral nutrition bags: a case report

Background: Parenteral Nutrition (PN) is a life-sustaining therapy for patients with intestinal failure (IF), especially those with severe bowel dysmotility. Home Parenteral Nutrition (HPN) can reduce hospital stays and improve quality of life. While adult-designed commercial multichamber parenteral nutrition bags (AMCB-PN) are widely used in adults, their application in pediatric patients remains underexplored. Case Presentation: We report a male patient born in 2008 with bowel dysmotility and malabsorption, requiring long-term PN since infancy. After initial stabilization with a 2-in-1 PN regimen, he was discharged with HPN at one year of age. Despite attempts to wean off PN, he continued to require partial PN support. In 2019, the patient transitioned from a 2-in-1 PN system to a standardized AMCB-PN regimen. This change significantly reduced caregiver burden by eliminating frequent lipid syringe changes and minimizing infusion pump requirements. Over five years of AMCB-PN use, the patient maintained stable weight gain, demonstrated good tolerance to oral intake, and remained free of major complications. Discussion: This case demonstrates the feasibility and safety of using AMCB-PN in a pediatric patient with chronic intestinal failure. Benefits included improved sleep quality, reduced infection risk, simplified administration, and cost savings of approximately 52% annually. Despite the patient being physically smaller than age norms, he remained active with improved quality of life. Conclusion: Standardized AMCB-PN can be a safe, cost-effective, and patient-friendly alternative to in-house compounded PN in selected pediatric patients, offering significant clinical and operational advantages in home-based care.