10‐Year Review of Pediatric Intestinal Failure: Clinical Factors Associated With Outcome
- 1 August 2008
- journal article
- review article
- Published by Wiley in Nutrition in Clinical Practice
- Vol. 23 (4), 436-442
- https://doi.org/10.1177/0884533608321213
Abstract
Prediction of outcomes in pediatric intestinal failure is challenging but essential to guide intestinal rehabilitation and transplantation decisions. This review of intestinal failure patients spanning 10 years examines clinical details in relation to outcome to identify factors that may refine predictive accuracy. A search was conducted to identify all children with intestinal failure managed at Stollery Children's Hospital between January 1994 and December 2003. They were divided into 3 groups: early death occurring ≤30 days of age, parenteral nutrition dependence for 30-100 days, and parenteral nutrition dependence for >100 days. The long-term group was divided according to outcome: death or adaptation. Demographics, diagnosis, nutrition requirements, laboratory parameters, and clinical data were recorded. Groups were compared to identify factors associated with outcome. Necrotizing enterocolitis, gastroschisis, and intestinal atresias were the most common causes for intestinal failure; outcome was not related to diagnosis. Although withdrawal of therapy was common in the early death group, most babies had one or more additional significant comorbidity. Among the 29 babies requiring parenteral nutrition for >100 days with known outcomes, 12 died, 16 adapted fully, and 1 received a multivisceral transplant. Intestinal length >40 cm was associated with a significantly increased risk of mortality (P< .001). Abnormal laboratory values (bilirubin, aspartate aminotransferase, alanine aminotransferase, albumin, and platelet count) after 5 months of age were also significantly different between groups. This data, together with data from previous reviews, should be used to investigate potential predictive factors in prospective studies, particularly in the context of expert multidisciplinary care.Keywords
This publication has 23 references indexed in Scilit:
- Pediatric Transplantation in the United States, 1996–2005American Journal of Transplantation, 2007
- Liver and Intestine Transplantation in the United States, 19962005American Journal of Transplantation, 2007
- Current Status of Transplantation of the Small IntestineTransplantation, 2007
- Pediatric Intestinal Transplantation at Packard Children’s Hospital/Stanford University Medical Center: Report of a Four-Year ExperiencePublished by Elsevier BV ,2006
- Long-term parenteral nutritional support and intestinal adaptation in children with short bowel syndrome: A 25-year experienceThe Journal of Pediatrics, 2004
- Nutritional and other postoperative management of neonates with short bowel syndrome correlates with clinical outcomesThe Journal of Pediatrics, 2001
- Intestinal Adaptation in Pediatric Patients with Short-Bowel SyndromeEuropean Journal of Pediatric Surgery, 1999
- Short-Gut SyndromeJournal of Pediatric Gastroenterology and Nutrition, 1994
- Outcome and intestinal adaptation in neonatal short-bowel syndromeJournal of Pediatric Surgery, 1992
- Neonatal short bowel syndromeThe Journal of Pediatrics, 1991