Objective: The aim of the study was to evaluate the outcome and to identify predictors for survival and enteral autonomy in neonatal intestinal failure (IF). Methods: A retrospective observational study in a Swedish tertiary centre of children born between 1995 and 2016 with neonatal IF, defined as dependency on parenteral nutrition (PN) ≥60 days, starting with PN before the age of 44 gestational weeks. Data were extracted from medical records and predictors for survival and enteral autonomy were identified by the Cox regression model. Time to death and weaning off PN analysis were performed with Kaplan-Meier curves including log rank test. Results: In total, 105 children were included. Median gestational age was 28 weeks (22–42), 50% were born extremely preterm (<28 gestational weeks). PN started at a median age of 2 days (0–147) with a median duration of 196 days (60–3091). Necrotizing enterocolitis was the dominating cause of IF (61%). Overall survival was 88%, 5 children died of sepsis and 4 of intestinal failure-associated liver disease. Survival increased from 75% during 1995 to 2008 to 96% during 2009 to 2016 (P = 0.0040). Age-adjusted small bowel length of >50% and birth 2009 to 2016 were predictors for survival. Enteral autonomy was achieved in 87%, with positive prediction by small bowel length of >25% of expected for gestational age and remaining ileocecal valve. Conclusions: Preterm neonates with IF, at high risk of IF-associated morbidity, showed a high overall survival rate. Small-bowel length and being born 2009 to 2016 were predictors for survival and remaining ICV and small-bowel length were predictors for enteral autonomy.

BackgroundChildren with intestinal failure (IF) are dependent on parenteral nutrition (PN) for normal growth and development. In our practice, individualised PN contain iron-free paediatric trace element mixtures due to the risk of compatibility problems. Children with IF are thus at risk of developing iron deficiency (ID). Furthermore, oral/enteral iron supplementation (IS) is avoided in children with IF because of the reduced absorptive capacity and risk of side-effects. Intravenous (IV) IS with ferric carboxymaltose (FCM) is an approved therapeutic indication for adolescents (>14 years) and adults (see SmPC Ferinject Vifor), however there are no published reports on the effectiveness and safety of IV FCM treatment of ID in children<2 years of age.PurposeThe purpose of this study was to evaluate the safety of IV IS with FCM for patients with IF under the age of 2 years.Material and methodsPart I study: The Swedish Medical Products Agency (MPA) was contacted to collect adverse drug reaction report data for the period 2007 to 2016.Part II study: A retrospective study of the records of 14 children with IF and ID who had been treated with IV FCM before 2 years of age at our tertiary centre for paediatric IF, were performed. Ganzoni’s equation was used for calculating the FCM dose, serum levels of haemoglobin, mean corpuscular volume and ferritin were measured before and 1 to 3 months after FCM treatment.ResultsPart I: During the 10 years the MPA only received five Adverse Drug Reaction Reports (ADR): Hot flush, hypertension, hypotension and venous thrombosis limb were reported. The ADR data is likely based on treatments for patients>14 years.Part II: All children received one or two doses of FCM administered as intravenous infusion. All children responded to FCM treatment with complete or partial normalisation of biochemical markers for ID. No major or minor adverse events were reported.ConclusionThe treatment of iron deficiency with intravenous ferric carboxymaltose in children<2 years of age with intestinal failure was found effective in the retrospective study of the limited number of patients from our clinic. We did not find any evidence of adverse events.References and/or AcknowledgementsFerinject SmPC.No conflict of interest