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Tissue Engineering of the Intestine in a Murine Model
Published on: December 1, 2012
Natural history of pediatric intestinal failure: initial report from the Pediatric Intestinal Failure Consortium
Robert H Squires1, Christopher Duggan, Daniel H Teitelbaum
1Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA 15224, USA. squiresr@upmc.edu
Insights
Pediatric intestinal failure (IF) is a serious condition with high mortality and morbidity. Achieving enteral autonomy can take years, highlighting the need for improved management strategies.
Area of Science:
- Pediatric Gastroenterology
- Neonatology
- Surgical Gastroenterology
Background:
- Intestinal failure (IF) in infants presents significant challenges.
- The intestinal transplantation era necessitates understanding IF natural history.
- Multicenter data are crucial for characterizing pediatric IF outcomes.
Purpose of the Study:
- To characterize the natural history of intestinal failure (IF) in infants.
- To analyze outcomes during the era of intestinal transplantation.
- To identify factors influencing recovery and survival in pediatric IF.
Main Methods:
- Retrospective analysis of a multicenter cohort of infants (<12 months) with IF.
- Inclusion criteria: parenteral nutrition (PN) for >60 days.
- Enteral autonomy defined as PN discontinuation for >3 months.
Main Results:
- 272 infants studied; common diagnoses include necrotizing enterocolitis and gastroschisis.
- High rates of catheter-related bloodstream infections (8.9 per 1000 catheter days).
- Cumulative incidences: 47% enteral autonomy, 27% mortality, 26% intestinal transplantation.
Conclusions:
- Pediatric IF is associated with substantial mortality and morbidity.
- Achieving enteral autonomy is a prolonged process, often taking years.
- Enhanced medical, nutritional, and surgical interventions are needed to improve outcomes.
Objective:
To characterize the natural history of intestinal failure (IF) among 14 pediatric centers during the intestinal transplantation era.
Study Design:
The Pediatric Intestinal Failure Consortium performed a retrospective analysis of clinical and outcome data for a multicenter cohort of infants with IF. Entry criteria included infants <12 months receiving parenteral nutrition (PN) for >60 continuous days. Enteral autonomy was defined as discontinuation of PN for >3 consecutive months. Values are presented as median (25th, 75th percentiles) or as number (%).
Results:
272 infants with a gestational age of 34 weeks (30, 36) and birth weight of 2.1 kg (1.2, 2.7) were followed for 25.7 months (11.2, 40.9). Residual small bowel length in 144 patients was 41 cm (25.0, 65.5). Diagnoses were necrotizing enterocolitis (71, 26%), gastroschisis (44, 16%), atresia (27, 10%), volvulus (24, 9%), combinations of these diagnoses (46, 17%), aganglionosis (11, 4%), and other single or multiple diagnoses (48, 18%). Prescribed medications included oral antibiotics (207, 76%), H2 blockers (187, 69%), and proton pump inhibitors (156, 57%). Enteral feeding approaches varied among centers; 19% of the cohort received human milk. The cohort experienced 8.9 new catheter-related blood stream infections per 1000 catheter days. The cumulative incidences for enteral autonomy, death, and intestinal transplantation were 47%, 27%, and 26%, respectively. Enteral autonomy continued into the fifth year after study entry.
Conclusions:
Children with IF endure significant mortality and morbidity. Enteral autonomy may require years to achieve. Improved medical, nutritional, and surgical management may reduce time on PN, mortality, and need for transplantation.
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