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Predictors of 1-year enteral autonomy in children with intestinal failure: A descriptive retrospective cohort study
Vikram K Raghu1, Harold J Leraas2, Mariya Samoylova2
1Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
Insights
For children with intestinal failure (IF), minimizing bowel resection and reversing ostomies can speed up achieving enteral autonomy. This study identified key factors influencing early feeding success in pediatric IF patients.
Area of Science:
- Pediatric gastroenterology
- Clinical outcomes research
- Intestinal failure research
Background:
- Intestinal failure (IF) significantly impacts pediatric patient outcomes.
- Early achievement of enteral autonomy is a critical goal in managing IF.
- Predictors for achieving enteral autonomy in children are not fully understood.
Purpose of the Study:
- To identify predictors of early (1-year) enteral autonomy in a large pediatric cohort.
- To analyze factors influencing the time to enteral autonomy achievement in children with IF.
Main Methods:
- Utilized data from the International Intestinal Failure Registry (IIFR) pilot phase.
- Defined IF as a need for parenteral nutrition for ≥60 days due to gastrointestinal etiology.
- Employed a mixed-effects Weibull accelerated failure time model to analyze time to enteral autonomy.
Main Results:
- Included 189 pediatric patients; 51.6% achieved early enteral autonomy.
- Ostomy presence was associated with increased time to enteral autonomy (TR, 2.63).
- Greater percentage of bowel remaining was associated with decreased time to enteral autonomy (TR, 0.96).
Conclusions:
- Minimizing bowel resection at initial surgery can decrease time to enteral autonomy.
- Establishing bowel continuity via ostomy reversal can effectively decrease time to early enteral autonomy in children with IF.
Introduction:
The International Intestinal Failure Registry (IIFR) is an international consortium to study intestinal failure (IF) outcomes in a large contemporary pediatric cohort. We aimed to identify predictors of early (1-year) enteral autonomy.
Methods:
We included IIFR pilot phase patients. IF was defined by a parenteral nutrition need for at least 60 days due to a primary gastrointestinal etiology. The primary outcome was time to enteral autonomy achievement. We built a mixed-effects Weibull accelerated failure time model with random effects by center to analyze variables associated with enteral autonomy achievement with a primary outcome of time ratio (TR).
Results:
We included 189 patients (82% with short bowel syndrome) representing 11 international centers. Cumulative incidence of early enteral autonomy was 51.6%, and death was 6.5%. In multivariable analysis, ostomy presence (TR, 2.63; 95% CI, 1.41-4.90) was associated with increased time to enteral autonomy achievement, and Asian/Indian (TR, 0.28; 95% CI, 0.10-0.81) and Pacific Islander race (TR, 0.34; 95% CI, 0.13-0.90) were associated with decreased time to enteral autonomy achievement. In a second model in the subset with measured percentage of bowel length remaining, ostomy presence (TR, 4.21; 95% CI, 1.90-9.33) was associated with increased time to enteral autonomy achievement, whereas greater percentage of bowel remaining (TR, 0.96; 95% CI, 0.94-0.98) was associated with decreased time to enteral autonomy achievement.
Conclusions:
Minimizing bowel resection at initial surgery and establishing bowel continuity by ostomy reversal can effectively decrease the time to early enteral autonomy achievement in children with IF.
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