BACKGROUND: Intestinal failure (IF) is associated with significant and life-threatening complications. Recent studies suggest that treatments for IF in the pediatric population are improving over time. Based on this, we examined whether pediatric IF survival rates have improved in our patient population over the past two decades, and secondarily examined which aspects of patient care contributed to changes in survival. METHODS: We conducted a retrospective chart review of all pediatric patients with IF at our children's hospital from 1990 through 2009. Cox regression analyses were used to determine change in survival rates over time (5-y cohorts), and we examined multiple covariates to determine their potential influence on survival rates over time. RESULTS: A significant improvement in survival of 171 children with IF was noted over the past two decades. Children with an onset of IF in the 1990-1994 cohort had significantly decreased survival compared with children in all subsequent cohorts (P = 0.011). The only intervention that was identified between this time period and future periods was the establishment of a comprehensive intestinal failure clinical care team. While the latter three cohorts were not significantly different, progressively increased survival was noted. Ability to wean off parenteral nutrition (PN) and small bowel length greater than 10% of the expected length were significantly associated with improved survival over this time period (P < 0.01). Other tested covariates, including the more recent use of ethanol lock therapy (to prevent catheter sepsis) and lipid reduction strategies (to treat PN-associated cholestasis) failed to show a significant impact on improved survival. CONCLUSIONS: Despite a striking improvement in survival of children with IF over the past two decades, the only identified intervention that significantly impacted survival was establishment of a comprehensive care team. These findings emphasize the need for multi-disciplinary efforts to care for such complex and challenging children.
BACKGROUND:Intestinal failure (IF) is associated with significant and life-threatening complications. Recent studies suggest that treatments for IF in the pediatric population are improving over time. Based on this, we examined whether pediatric IF survival rates have improved in our patient population over the past two decades, and secondarily examined which aspects of patient care contributed to changes in survival. METHODS: We conducted a retrospective chart review of all pediatric patients with IF at our children's hospital from 1990 through 2009. Cox regression analyses were used to determine change in survival rates over time (5-y cohorts), and we examined multiple covariates to determine their potential influence on survival rates over time. RESULTS: A significant improvement in survival of 171 children with IF was noted over the past two decades. Children with an onset of IF in the 1990-1994 cohort had significantly decreased survival compared with children in all subsequent cohorts (P = 0.011). The only intervention that was identified between this time period and future periods was the establishment of a comprehensive intestinal failure clinical care team. While the latter three cohorts were not significantly different, progressively increased survival was noted. Ability to wean off parenteral nutrition (PN) and small bowel length greater than 10% of the expected length were significantly associated with improved survival over this time period (P < 0.01). Other tested covariates, including the more recent use of ethanol lock therapy (to prevent catheter sepsis) and lipid reduction strategies (to treat PN-associated cholestasis) failed to show a significant impact on improved survival. CONCLUSIONS: Despite a striking improvement in survival of children with IF over the past two decades, the only identified intervention that significantly impacted survival was establishment of a comprehensive care team. These findings emphasize the need for multi-disciplinary efforts to care for such complex and challenging children.
Authors: Patrick J Javid; Sabrina E Sanchez; Susan Jacob; Monica M McNeal; Simon P Horslen; Janet A Englund Journal: J Pediatric Infect Dis Soc Date: 2013-10-14 Impact factor: 3.164
Authors: Dana M Schwartz; Meryem O Pehlivaner Kara; Allan M Goldstein; Harald C Ott; Adam K Ekenseair Journal: Tissue Eng Part C Methods Date: 2017-09 Impact factor: 3.056
Authors: Patrick J Javid; Assaf P Oron; Christopher P Duggan; Robert H Squires; Simon P Horslen Journal: J Pediatr Surg Date: 2017-09-05 Impact factor: 2.545
Authors: Gillian C Pet; Ryan M McAdams; Lilah Melzer; Assaf P Oron; Simon P Horslen; Adam Goldin; Patrick J Javid Journal: J Pediatr Date: 2018-05-10 Impact factor: 4.406
Authors: Matthew W Ralls; Ryo Sueyoshi; Richard S Herman; Brent Utter; Isabel Czarnocki; Nancy Si; Jonathan Luntz; Diann Brei; Daniel H Teitelbaum Journal: Pediatr Surg Int Date: 2013-01 Impact factor: 1.827
Authors: Patrick M Chesley; Sabrina E Sanchez; Lilah Melzer; Assaf P Oron; Simon P Horslen; F Curt Bennett; Patrick J Javid Journal: J Pediatr Gastroenterol Nutr Date: 2016-07 Impact factor: 2.839