Predictors of Enteral Autonomy in Children with Intestinal Failure: A Multicenter Cohort Study.

Area of Science:

• Pediatric Gastroenterology
• Surgical Outcomes
• Parenteral Nutrition

Background:

• Intestinal failure (IF) in infants necessitates long-term parenteral nutrition (PN), impacting growth and survival.
• Achieving enteral autonomy is a critical milestone for improving quality of life in children with IF.
• Understanding factors influencing enteral autonomy is essential for optimizing patient care.

Purpose of the Study:

• To determine the cumulative incidence of enteral autonomy in a large cohort of children with IF.
• To identify patient-specific and institutional characteristics associated with achieving enteral autonomy.

Main Methods:

• A multicenter, retrospective cohort analysis was conducted using data from the Pediatric Intestinal Failure Consortium.
• Intestinal failure (IF) was defined as dependence on parenteral nutrition (PN) for >60 days due to severe gastrointestinal diseases.
• Enteral autonomy was defined as PN discontinuation for >3 months.

Main Results:

• Enteral autonomy was achieved in 43% of 272 infants, with 13% remaining PN-dependent and 43% dying or undergoing transplantation.
• Necrotizing enterocolitis (NEC), care at an IF site without intestinal transplantation, and an intact ileocecal valve were independent risk factors for enteral autonomy.
• In a subset of patients, longer residual small bowel length was also significantly associated with achieving enteral autonomy.

Conclusions:

• A significant proportion of infants with IF can achieve enteral autonomy.
• Necrotizing enterocolitis (NEC), preserved ileocecal valve, and longer small bowel length are associated with successful enteral feeding.
• Institutional practices and referral patterns may influence outcomes in children with IF.