A multicenter study on enteral autonomy outcome of pediatric intestinal failure patients from a middle-income country

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Heitor P Leite1, Rodrigo Vincenzi2, Carlos O Kieling3

  • 1Department of Pediatrics, Universidade Federal de São Paulo, Center for Intestinal Rehabilitation, Hospital Samaritano de São Paulo, São Paulo, Brazil.

Clinical Nutrition ESPEN
|January 19, 2025
PubMed

Insights

Predictors of enteral autonomy and survival in pediatric intestinal failure were identified. Early arrival at rehabilitation centers and favorable bowel anatomy improve outcomes for children with intestinal failure.

Area of Science:

  • Pediatric Gastroenterology
  • Intestinal Rehabilitation
  • Parenteral Nutrition

Background:

  • Pediatric intestinal failure (IF) poses significant challenges, necessitating specialized intestinal rehabilitation (IR).
  • Understanding predictors of treatment success is crucial for optimizing care in middle-income countries.
  • Long-term parenteral nutrition (PN) is often required for managing IF.

Purpose of the Study:

  • To identify predictors of enteral autonomy and survival in pediatric IF patients.
  • To evaluate outcomes in a cohort from a middle-income country.
  • To inform clinical practice in IR centers.

Main Methods:

  • Retrospective multicenter cohort study (2014-2023).
  • Inclusion of patients with IF on long-term PN.
  • Analysis of outcomes including enteral autonomy, survival, and complications using competing risk analysis, Cox regression, and decision trees.

Main Results:

  • 207 patients with median age at admission of 6.2 months.
  • Short bowel (85%) and motility disorders (10.6%) were primary causes of IF.
  • 5-year enteral autonomy and survival rates were 37% and 88%, respectively.
  • Enteral autonomy associated with longer remnant intestine (>40 cm), younger age at admission (<6.2 months), and preserved ileocecal valve.
  • Intestinal failure-associated liver disease affected 24% on admission; overall mortality was 7.7%.

Conclusions:

  • Overall survival reached 92.3%, with a 5-year enteral autonomy incidence of 37%.
  • Early presentation to IR centers and favorable bowel anatomy are key predictors of achieving enteral autonomy.
  • Findings highlight the importance of timely intervention and anatomical factors in pediatric IF management.
Abstract

Keywords:
ChildrenIntestinal failureMulticenter studyShort bowel syndrome

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