OBJECTIVE: To characterize the natural history of intestinal failure (IF) among 14 pediatric centers during the intestinal transplantation era. STUDY DESIGN: The Pediatric Intestinal Failure Consortium performed a retrospective analysis of clinical and outcome data for a multicenter cohort of infants with IF. Entry criteria included infants <12 months receiving parenteral nutrition (PN) for >60 continuous days. Enteral autonomy was defined as discontinuation of PN for >3 consecutive months. Values are presented as median (25th, 75th percentiles) or as number (%). RESULTS: 272 infants with a gestational age of 34 weeks (30, 36) and birth weight of 2.1 kg (1.2, 2.7) were followed for 25.7 months (11.2, 40.9). Residual small bowel length in 144 patients was 41 cm (25.0, 65.5). Diagnoses were necrotizing enterocolitis (71, 26%), gastroschisis (44, 16%), atresia (27, 10%), volvulus (24, 9%), combinations of these diagnoses (46, 17%), aganglionosis (11, 4%), and other single or multiple diagnoses (48, 18%). Prescribed medications included oral antibiotics (207, 76%), H2 blockers (187, 69%), and proton pump inhibitors (156, 57%). Enteral feeding approaches varied among centers; 19% of the cohort received human milk. The cohort experienced 8.9 new catheter-related blood stream infections per 1000 catheter days. The cumulative incidences for enteral autonomy, death, and intestinal transplantation were 47%, 27%, and 26%, respectively. Enteral autonomy continued into the fifth year after study entry. CONCLUSIONS: Children with IF endure significant mortality and morbidity. Enteral autonomy may require years to achieve. Improved medical, nutritional, and surgical management may reduce time on PN, mortality, and need for transplantation.
OBJECTIVE: To characterize the natural history of intestinal failure (IF) among 14 pediatric centers during the intestinal transplantation era. STUDY DESIGN: The Pediatric Intestinal Failure Consortium performed a retrospective analysis of clinical and outcome data for a multicenter cohort of infants with IF. Entry criteria included infants <12 months receiving parenteral nutrition (PN) for >60 continuous days. Enteral autonomy was defined as discontinuation of PN for >3 consecutive months. Values are presented as median (25th, 75th percentiles) or as number (%). RESULTS: 272 infants with a gestational age of 34 weeks (30, 36) and birth weight of 2.1 kg (1.2, 2.7) were followed for 25.7 months (11.2, 40.9). Residual small bowel length in 144 patients was 41 cm (25.0, 65.5). Diagnoses were necrotizing enterocolitis (71, 26%), gastroschisis (44, 16%), atresia (27, 10%), volvulus (24, 9%), combinations of these diagnoses (46, 17%), aganglionosis (11, 4%), and other single or multiple diagnoses (48, 18%). Prescribed medications included oral antibiotics (207, 76%), H2 blockers (187, 69%), and proton pump inhibitors (156, 57%). Enteral feeding approaches varied among centers; 19% of the cohort received human milk. The cohort experienced 8.9 new catheter-related blood stream infections per 1000 catheter days. The cumulative incidences for enteral autonomy, death, and intestinal transplantation were 47%, 27%, and 26%, respectively. Enteral autonomy continued into the fifth year after study entry. CONCLUSIONS:Children with IF endure significant mortality and morbidity. Enteral autonomy may require years to achieve. Improved medical, nutritional, and surgical management may reduce time on PN, mortality, and need for transplantation.
Authors: Erika Tomsits; Margit Pataki; Andrea Tölgyesi; György Fekete; Katalin Rischak; Lajos Szollár Journal: J Pediatr Gastroenterol Nutr Date: 2010-10 Impact factor: 2.839
Authors: D J Andorsky; D P Lund; C W Lillehei; T Jaksic; J Dicanzio; D S Richardson; S B Collier; C Lo; C Duggan Journal: J Pediatr Date: 2001-07 Impact factor: 4.406
Authors: Brian A Jones; Melissa A Hull; Denise S Richardson; David Zurakowski; Kathleen Gura; Shimae C Fitzgibbons; Debora Duro; Clifford W Lo; Christopher Duggan; Tom Jaksic Journal: J Pediatr Surg Date: 2010-06 Impact factor: 2.545
Authors: Daniel J Raiten; Alison L Steiber; Susan E Carlson; Ian Griffin; Diane Anderson; William W Hay; Sandra Robins; Josef Neu; Michael K Georgieff; Sharon Groh-Wargo; Tanis R Fenton Journal: Am J Clin Nutr Date: 2016-01-20 Impact factor: 7.045
Authors: Darla R Shores; Samuel M Alaish; Susan W Aucott; Janine E Bullard; Courtney Haney; Heidi Tymann; Bareng A S Nonyane; Kathleen B Schwarz Journal: J Pediatr Date: 2018-04 Impact factor: 4.406
Authors: Farokh R Demehri; Jennifer J Freeman; Yumi Fukatsu; Jonathan Luntz; Daniel H Teitelbaum Journal: Surgery Date: 2015-05-23 Impact factor: 3.982
Authors: Faraz A Khan; Robert H Squires; Heather J Litman; Jane Balint; Beth A Carter; Jeremy G Fisher; Simon P Horslen; Tom Jaksic; Samuel Kocoshis; J Andres Martinez; David Mercer; Susan Rhee; Jeffrey A Rudolph; Jason Soden; Debra Sudan; Riccardo A Superina; Daniel H Teitelbaum; Robert Venick; Paul W Wales; Christopher Duggan Journal: J Pediatr Date: 2015-04-25 Impact factor: 4.406
Authors: Faraz A Khan; Paul D Mitchell; Jeremy G Fisher; Eric A Sparks; Tom Jaksic; Christopher Duggan; Daniel H Teitelbaum; Biren P Modi Journal: J Pediatr Surg Date: 2014-11-14 Impact factor: 2.545