10-year review of pediatric intestinal failure: clinical factors associated with outcome

Area of Science:

• Pediatric Gastroenterology
• Neonatology
• Surgical Outcomes

Background:

• Pediatric intestinal failure presents complex challenges for management and treatment decisions.
• Accurate prediction of outcomes is essential for guiding intestinal rehabilitation and transplantation strategies.
• Existing data requires refinement to improve predictive accuracy in this vulnerable population.

Purpose of the Study:

• To examine clinical details of pediatric intestinal failure patients over a 10-year period.
• To identify factors associated with patient outcomes, including mortality and adaptation.
• To refine predictive accuracy for outcomes in pediatric intestinal failure.

Main Methods:

• A retrospective review of pediatric intestinal failure patients managed at Stollery Children's Hospital (1994-2003).
• Patients were categorized by age at death, duration of parenteral nutrition dependence, and long-term outcome (death or adaptation).
• Demographic, diagnostic, nutritional, laboratory, and clinical data were collected and compared between groups.

Main Results:

• Common causes included necrotizing enterocolitis, gastroschisis, and intestinal atresias; diagnosis did not correlate with outcome.
• Among 29 patients with >100 days of parenteral nutrition, 12 died, 16 adapted, and 1 received a transplant.
• Intestinal length >40 cm was significantly associated with increased mortality (P < .001).
• Abnormal laboratory values (bilirubin, liver enzymes, albumin, platelets) after 5 months differed significantly between outcome groups.

Conclusions:

• Intestinal length and specific laboratory values post-five months are significant predictors of mortality in pediatric intestinal failure.
• These findings, combined with prior data, warrant prospective studies to validate predictive factors.
• Expert multidisciplinary care is vital for improving outcomes in pediatric intestinal failure.