Development Of A Consensus Parenteral Nutrition Weaning Algorithm For Paediatric Patients With Short-Bowel Syndrome Responding To Teduglutide Therapy

Background: Complete or improved enteral autonomy has been associated with teduglutide use in small paediatric short-bowel syndrome studies. However, there is no consensus protocol in Australia on weaning parenteral nutrition (PN) and fluid support for children on teduglutide. An expert group met with the aim of using a modified Delphi process to develop a weaning algorithm for paediatric patients responding to teduglutide therapy. Methods: All paediatric gastroenterology centres in Australia were invited to participate. Communication within the group was interactive via the Within3 platform. Group members were required to contribute to four sequential steps that formed the basis of the weaning algorithm; these steps are summarised in Figure 1. The algorithm that generated the highest agreement would become the consensus algorithm. A consensus was defined as agreement among ≥70% of the experts. Results: 13 experts (8 paediatric gastroenterologists, 2 dietitians and 3 clinical nurse consultants) representing 7/8 tertiary paediatric gastroenterology centres contributed to the development of the algorithm. Responses were collected over a 1 week period. Results for each response are outlined in Figure 1. 82% of the members that voted agreed upon a consensus algorithm (Figure 2). Conclusion: Using a systematic approach, a consensus algorithm for weaning patient patients off PN and/or intravenous fluid support on teduglutide therapy was developed. Further refinement and application of this algorithm will be studied to ensure patient safety and desired clinical outcomes are achieved.Figure 1.: Results of voting process of expert group members.Figure 2.: Algorithm for weaning off parenteral support in paediatric patients