Background Intestinal failure (IF) is associated with significant morbidity and mortality, yet specific parameters that determine medium- and long-term outcomes remain ill defined. Objective The aim of this study was to determine the long-term outcomes in childhood IF and identify patient characteristics associated with clinical endpoints. Design MEDLINE and EMBASE were searched for cohorts of >10 pediatric-onset IF patients with >12 mo follow-up. Random-effects meta-analysis and meta-regression weighted by follow-up duration were used to calculate clinical outcome rates and patient factors associated with outcomes. Primary outcome was mortality rate; secondary outcomes included neurodevelopmental status, transplantation, IF-associated liver disease (IFALD), enteral autonomy, and sepsis. Results In total, 175 cohorts (9318 patients and 34,549 y follow-up) were included in the meta-analysis. Overall mortality was 5.2% per y (95% CI: 4.3, 6.0) and was associated with sepsis and IFALD on meta-regression. Mortality rate improved with time from 5.9% per y pre-2000 to 4.5% per y post-2005. Sepsis rate was also predictive of IFALD and liver failure. Enteral autonomy was associated with small bowel length but not presence of ileo-cecal valve. There was a relative lack of data on neurodevelopmental outcomes. Conclusions Sepsis is the primary modifiable factor associated with mortality and liver failure, whereas enteral autonomy correlates with small-bowel length. No clear parameters have been identified that accurately predict neurodevelopmental outcomes, and hence further research is needed. Together, our findings are helpful for parental counseling and resource planning, and support targeting reduction in sepsis.

Background Self‐harm among young people is a major public health concern, and whilst schools are well placed to identify and intervene with students who self‐harm, the literature shows that school staff lack training and confidence in this area. This systematic review investigated the effectiveness, feasibility and acceptability of training interventions and support tools intended to equip school staff with skills and knowledge to adequately respond to students’ disclosure of self‐harm. Method References for this review were identified through systematic searches of Medline, Embase, PsycINFO, Child Development & Adolescent Studies, ERIC, ASSIA and British Education Index on with search terms ‘self‐harm’, ‘training’, ‘school staff’ and ‘young people’. Thematic synthesis was used to analyse qualitative data. Results We found that all eight included studies evaluated interventions/tools that were highly effective in terms of an increase in knowledge, skills and confidence of staff in responding to self‐harming youth. Acceptability was good with high levels of satisfaction and perceived benefit by staff, though data on feasibility of the interventions were lacking. Limitations of the studies included a paucity of follow‐up data, and lack of data relating to student outcomes and actual changes in staff practice in schools. Conclusions The findings from this review indicate that more evidence is needed to determine the effectiveness, acceptability and feasibility of interventions/tools for school staff addressing self‐harm. Further studies should focus on maintaining knowledge, confidence and comfort levels over time, and determine the feasibility of interventions/tools with different staff cohorts and across school settings, as well as address outcomes for students.

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