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Tertiary Gastroenterology departments oversee the nutritional care of patients with Intestinal Failure requiring Home Parenteral Nutrition (PN) with support from district general hospitals. The South-West of England lacks a guideline for nutritional monitoring once children discontinue PN and establish full enteral feeds.In order to explore the current care provision, information was sought regarding the frequency of blood monitoring, growth monitoring and paediatrician follow-up once PN was discontinued.Data was obtained from 23 patients within the South-West ‘Paediatric Intestinal Failure requiring Home Parenteral Nutrition’ database (initiated 2015) whose PN was discontinued before February 2024. 3 patients died of unrelated comorbidities, 3 transitioned to adult services, 1 moved region and 1 established full enteral nutrition following a diagnosis of Induced Illness. The remaining 15 (9M, 6F) were identified with diagnoses including Atresia, Gastroschisis, Volvulus, Necrotising Enterocolitis and Pseudoobstruction. Electronic records, laboratory results and correspondences with local hospitals identified all outpatient follow-up and blood monitoring led by gastroenterology consultants.Patients experienced 2.0 reviews per year of which 1.4 were face to face. At some point during their follow-up, half of the patients experienced a gap exceeding 12 months with no clinical review or monitoring. The median frequency for height and weight recording was 1.2 and 1.4 times per year.Assessment of change in Z scores from a baseline (See figure 1) set at the point of discontinuing PN demonstrated a negative trend with the majority of patients falling weight centiles over time. Those falling by 2SD were highlighted to their local hospital for additional dietetic support.Abstract OC43 Figure 1Nutritional blood checks were performed less than once per year, with several nutrients and vitamins rarely checked. 11/15 patients were noted to be vitamin deficient at some point in their follow-up. Many patients required supplementation with Iron, Folate, B12 and Vitamin D during the follow-up period.The data highlights that patients with Intestinal Failure discontinuing PN continue to require close nutritional monitoring as many develop deficiencies requiring supplementation, only detectable with proactive monitoring. Although most experienced frequent reviews and growth measurements, the findings highlight that the point of discontinuing PN may represent the Childs peak nutritional state with a subsequent decline without careful follow-up. Although COVID19 may have interrupted normal service delivery, a clear care plan needs to be developed to inform families and professionals on optimal nutritional monitoring once successfully graduated from PN.