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International Latin American Survey on Pediatric Intestinal Failure Team
José Vicente N Spolidoro1,2, Mirella C Souza3, Helena A S Goldani4
1School of Medicine, Pontificia Universidade Catolica do Rio Grande do Sul, Porto Alegre 90619-900, Brazil.
Insights
Pediatric Intestinal Failure (IF) management varies across Latin America. While many IF teams follow international standards, some struggle with micronutrient monitoring and lack established programs.
Area of Science:
- Pediatric Gastroenterology
- Clinical Nutrition
- Healthcare Management
Background:
- Limited data exists on pediatric Intestinal Failure (IF) management in Latin America.
- Home parenteral nutrition (HPN) is a critical intervention for children with IF.
Purpose of the Study:
- To assess the organization and practices of pediatric IF teams in Latin America and the Caribbean.
- To identify the composition and adherence to international standards of care for IF teams.
Main Methods:
- An online survey was distributed to centers managing pediatric patients on HPN.
- The survey adapted a European questionnaire to evaluate IF team structure and practices.
- Data was collected from 24 centers across eight countries, covering 316 children on HPN.
Main Results:
- IF teams typically include pediatric gastroenterologists, surgeons, dietitians, and nurses.
- Most centers adhere to international standards for vascular access, nutrition, and IF management.
- Significant challenges exist in monitoring micronutrients (vitamins, trace elements) in a substantial percentage of centers.
Conclusions:
- There is considerable variation in the structure and resources of pediatric IF teams in Latin America.
- While some countries have robust intestinal rehabilitation programs, others lack dedicated IF teams for HPN management.
- Improved micronutrient monitoring and standardized care are needed to optimize outcomes for pediatric IF patients in the region.
Abstract:
There is little data on the experience of managing pediatric Intestinal Failure (IF) in Latin America. This study aimed to identify and describe the current organization and practices of the IF teams in Latin America and the Caribbean. An online survey was sent to inquire about the existence of IF teams that managed children on home parenteral nutrition (HPN). Our questionnaire was based on a previously published European study with a similar goal. Twenty-four centers with pediatric IF teams in eight countries completed the survey, representing a total number of 316 children on HPN. The median number of children on parenteral nutrition (PN) at home per team was 5.5 (range 1-50). Teams consisted of the following members: pediatric gastroenterologist and a pediatric surgeon in all teams, dietician (95.8%), nurse (91.7%), social worker (79.2%), pharmacist (70.8%), oral therapist (62.5%), psychologist (58.3%), and physiotherapist (45.8%). The majority of the centers followed international standards of care on vascular access, parenteral and enteral nutrition, and IF medical and surgical management, but a significant percentage reported inability to monitor micronutrients, like vitamins A (37.5%), E (41.7%), B1 (66.7%), B2 (62.5%), B6 (62.5%), active B12 (58.3%); and trace elements-including zinc (29.2%), aluminum (75%), copper (37.5%), chromium (58.3%), selenium (58.3%), and manganese (58.3%). Conclusion: There is wide variation in how IF teams are structured in Latin America-while many countries have well-established Intestinal rehabilitation programs, a few do not follow international standards. Many countries did not report having an IF team managing pediatric patients on HPN.
