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Predictors of Enteral Autonomy in Children with Intestinal Failure: A Multicenter Cohort Study
Faraz A Khan1, Robert H Squires2, Heather J Litman1
1Boston Children's Hospital, Boston, MA.
Insights
Many children with intestinal failure (IF) can achieve enteral autonomy, defined as stopping parenteral nutrition (PN). Key factors include necrotizing enterocolitis (NEC) and longer small bowel length.
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.
Objectives:
In a large cohort of children with intestinal failure (IF), we sought to determine the cumulative incidence of achieving enteral autonomy and identify patient and institutional characteristics associated with enteral autonomy.
Study Design:
A multicenter, retrospective cohort analysis from the Pediatric Intestinal Failure Consortium was performed. IF was defined as severe congenital or acquired gastrointestinal diseases during infancy with dependence on parenteral nutrition (PN) >60 days. Enteral autonomy was defined as PN discontinuation >3 months.
Results:
A total of 272 infants were followed for a median (IQR) of 33.5 (16.2-51.5) months. Enteral autonomy was achieved in 118 (43%); 36 (13%) remained PN dependent and 118 (43%) patients died or underwent transplantation. Multivariable analysis identified necrotizing enterocolitis (NEC; OR 2.42, 95% CI 1.33-4.47), care at an IF site without an associated intestinal transplantation program (OR 2.73, 95% CI 1.56-4.78), and an intact ileocecal valve (OR 2.80, 95% CI 1.63-4.83) as independent risk factors for enteral autonomy. A second model (n = 144) that included only patients with intraoperatively measured residual small bowel length found NEC (OR 3.44, 95% CI 1.36-8.71), care at a nonintestinal transplantation center (OR 6.56, 95% CI 2.53-16.98), and residual small bowel length (OR 1.04 cm, 95% CI 1.02-1.06 cm) to be independently associated with enteral autonomy.
Conclusions:
A substantial proportion of infants with IF can achieve enteral autonomy. Underlying NEC, preserved ileocecal valve, and longer bowel length are associated with achieving enteral autonomy. It is likely that variations in institutional practices and referral patterns also affect outcomes in children with IF.
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