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Key Determinants for Achieving Enteral Autonomy and Reduced Parenteral Nutrition Exposure in Pediatric Intestinal
Macie A Enman1, Linda T Wilkinson2, Katie B Meloni3
1University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA.
Insights
Key factors like gestational age, diagnosis, and remaining small bowel predict children achieving enteral autonomy from parenteral nutrition (PN). Remaining colon length also influences PN duration in pediatric intestinal failure (IF) cases.
Area of Science:
- Pediatric Gastroenterology
- Intestinal Rehabilitation
- Parenteral Nutrition
Background:
- Intestinal failure (IF) significantly impacts pediatric health, necessitating long-term parenteral nutrition (PN).
- Achieving enteral autonomy is a critical outcome for children with IF, reducing reliance on PN.
- Understanding predictors of enteral autonomy is vital for improving patient management and outcomes.
Purpose of the Study:
- To evaluate the relationship between various determinants and the achievement of enteral autonomy in children with IF.
- To identify key clinical and demographic factors influencing the duration of PN dependence.
Main Methods:
- Retrospective chart review of pediatric subjects with IF from 1989-2016.
- Inclusion criteria: PN dependence for >60 days, follow-up since birth/infancy for ≥3 months.
- Analysis included gestational age, diagnosis, bowel anatomy (small/large bowel remaining, ICV presence), and PN duration using survival regression models.
Main Results:
- Gestational age, necrotizing enterocolitis diagnosis, >50% small bowel remaining, and ICV presence were positive predictors for enteral autonomy.
- Longer residual colon length was associated with a shorter duration of PN dependence.
Conclusions:
- Gestational age, specific diagnoses, adequate small bowel length, and ICV presence are crucial positive predictors for achieving enteral autonomy in children with IF.
- Residual colon length plays a significant role in determining the duration of PN support.
Background:
We sought to evaluate the relationship between determinants of intestinal failure (IF) and achieving enteral autonomy from parenteral nutrition (PN) in a large single-center cohort of children.
Methods:
This is a retrospective chart review of pediatric subjects enrolled in a database for the Center for Advanced Intestinal Rehabilitation at Children's of Alabama from 1989 to 2016. IF was defined as dependence on PN for >60 days. Subjects were included if they were followed since birth or infancy for a minimum of 3 months and sufficient documentation of study variables were available. Gestational age, race, diagnosis, anatomy (percent small and large bowel remaining, presence of ileocecal valve [ICV]), county of residence (rural/urban), and days of PN use were recorded. Kaplan-Meier curves and parametric survival regression models were used to investigate the relationship between the demographic and clinical variables with the length of PN use.
Results:
Initially, 290 subjects were available to review. After inclusion/exclusion were applied, 158 subjects remained. Gestational age, diagnosis (necrotizing enterocolitis), small-bowel length (>50%), and presence of an ICV were all positive predictors for reaching enteral autonomy. Residual colon length was associated with shorter duration of PN in days.
Conclusion:
Enteral autonomy is a key outcome among children with IF. In our cohort, we found that gestational age, diagnosis, remaining small bowel, and presence of ICV are positive predictors for reaching this important milestone. Colon length is also an important factor with respect to duration of PN in days.
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