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  • Exit strategies from the COVID-19 lockdown for children and young people receiving home parenteral nutrition (HPN): lessons from the BSPGHAN Intestinal Failure Working Group experience

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Small bowel and nutrition
Opinion
Exit strategies from the COVID-19 lockdown for children and young people receiving home parenteral nutrition (HPN): lessons from the BSPGHAN Intestinal Failure Working Group experience
  1. Andrew Robert Barclay1,
  2. Christina McGuckin1,
  3. Susan Hill2,
  4. Sue Protheroe3,
  5. Akshay Batra4,5
  1. 1 PGHN, Royal Hospital for Children, Glasgow, UK
  2. 2 Great Ormond Street Hospital for Children, London, UK
  3. 3 Birmingham Children's Hospital, Birmingham, UK
  4. 4 Paediatrics, University Hospital Southampton NHS Foundation Trust, Southampton, UK
  5. 5 University Hospital Southampton NHS Trust, Southampton, UK
  1. Correspondence to Dr Andrew Robert Barclay, PGHN, Royal Hospital for Children, Glasgow G51 4TF, UK; andrew.barclay{at}ggc.scot.nhs.uk

https://doi.org/10.1136/flgastro-2020-101598

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    Background

    In response to the novel COVID-19 pandemic, rapid and unprecedented public infection control measures were undertaken by all four nations of the UK culminating in ‘lockdown’ with the majority of the population being asked to stay at home other than for a few designated essential activities. In addition, identified vulnerable members of the population were required to participate in ‘enhanced social distancing’ or ‘shielding’, remaining strictly housebound, dependent on outside assistance for essential items and isolating from members within their household. This was proposed for 12 weeks in the first instance.1–4

    Necessity for shielding was considered on the basis of relative burden of chronic disease and known risk factors for severe COVID-19 infection; however, young age conferred a protective association with infection.5 Although central government described the principles of enhanced distancing measures, the framework for the degree of measures employed and to which distinct patient groups was largely devolved to national expert bodies. As such, multiple national expert bodies considered adults with long-term intestinal failure (IF) with an ongoing need for home parenteral nutrition (HPN), as significantly vulnerable enough to warrant ‘shielding’.6 7

    The Royal College of Paediatrics and Child Health (RCPCH), in consultation with multiple paediatric specialty groups, published advice on the principles of ‘shielding’ for children. The advice outlined the unique challenges faced by families and carers delivering socially distanced care to dependent children who have specific conditions, and also the impact of ‘shielding’ on children.8 The RCPCH and the British Society for Paediatric Gastroenterology Hepatology and Nutrition (BSPGHAN) endorsed ‘shielding’ for a number of key chronic gastrointestinal conditions, with a stratified approach in some conditions such as inflammatory bowel disease. The consensus of the BSPGHAN Intestinal Failure Working Group (BIFWG) was that children and young people receiving HPN should participate in shielding.8 …

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    Footnotes

    • Contributors ARB was involved in the conception of this paper, he reviewed the literature and primarily wrote the paper, he was involved in writing the vignettes and subsequent re-drafts. CM consulted families who contributed to the patient information and primarily wrote the family letters, she contributed to redrafting of the paper. SH was involved in the conception of this paper, involved in literature retrieval, contributed to redrafting of the paper, and strategy for table 2, she summarised and reduced much of the content. SP was involved in the conception of this paper. She contributed to redrafting of the paper, the agreed strategy for table 2 and primarily wrote vignettes. AB was involved in the conception of this paper, he surveyed the BIFWG for COVID cases and contributed to redrafting of the paper, including the overarching strategy for table 2.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests ARB has spoken at educational events for Takeda and Nutricia. SP has received research funding and consulting fees for Shire/Takeda. SH has spoken at educational events for Baxter and Shire/Takeda and has received consultancy fees from Shire/Takeda. AB has spoken at education events for Takeda and Calea.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.