Indications for HPN Hospitalization:
- Fever 100.4
- Dehydration
- Lack of working vascular access
-
Failure with outpatient management (unable to provide HPN safely in community)
Indications for liver failure hospitalization:
- Acute altered mental status
- Acute GI bleeding
- Fever, concern for spontaneous bacterial peritonitis or cholangitis
-
Needs IV steroids
Immunizations
- In general, HPN patients should be encouraged to receive all childhood vaccines.
- Many children on HPN have co-morbidities that require careful consideration (bone marrow transplant patients, IBD patients on immunosuppressive medications). Therefore, it is important to collaborate with other providers in providing advice regarding vaccinations.
- Parents are often apprehensive about giving vaccines, because they understandably fear that a fever will result in automatic admission and IV antibiotics (disruption in their life). It is worthwhile discussing risks/benefits. It may also be worthwhile prescribing an anti-pyretic for short-term use in light of benefits of vaccination.