687 Pharmacokinetic Study (A2210378) Comparing Two Pediatric Paracetamol Suspensions Shows Bioequivalence, and Faster Early Absorption of New Formulation

Smith, Stephanie A.; Colgan, Brendan; McLaverty, D; Stewart, John A.; Hanna, Joelle Ngo; Heaslip, Louise; Yue, Yong; Collaku, Agron; Starkey, Y Y; Kronfeld, Nick; Clarke, Geo E.

doi:10.1203/00006450-201011001-00687

Cited by 6 publications

(7 citation statements)

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“…Previous studies have shown that the majority of patients with a history of pediatric intestinal failure continue to have abnormal liver histology with fibrosis notable on biopsy years after PN is discontinued (21). Ongoing studies to determine the accuracy and reliability of non-invasive liver evaluation, such as novel imaging studies and stable isotope breath testing (22), will hopefully lead to improved longitudinal assessment of liver disease in pediatric intestinal failure.…”

Section: Discussionmentioning

confidence: 99%

Enteral autonomy, cirrhosis, and long term transplant-free survival in pediatric intestinal failure patients

Fullerton

Sparks

Hall

et al. 2016

Journal of Pediatric Surgery

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Purpose Patient selection for transplant evaluation in pediatric intestinal failure is predicated on the ability to assess long-term transplant-free survival. In light of trends towards improved survival of intestinal failure patients in recent decades, we sought to determine if the presence of biopsy-proven hepatic cirrhosis or the eventual achievement of enteral autonomy were associated with transplant-free survival. Methods After IRB approval, records of all pediatric intestinal failure patients (parenteral nutrition (PN) >90 days) treated at a single intestinal failure center from February 2002 to September 2014 were reviewed. Chi-squared, Mann-Whitney, and log-rank testing were performed as appropriate. Results Of 313 patients, 174 eventually weaned off PN. Liver biopsies were available in 126 patients (most common indication was intestinal failure associated liver disease, IFALD), and 23 met histologic criteria for cirrhosis. Transplant-free survival for the whole cohort of 313 patients was 94.7% at 1 year and 89.2% at 5 years. Among patients with liver biopsies, transplant-free survival in cirrhotics vs. non-cirrhotics was 95.5% vs. 94.1% at one year and 95.5% vs. 86.7% at 5 years (P=0.29). Transplant-free survival in patients who achieved enteral autonomy compared with patients who remained PN dependent was 98.2% vs. 90.3% at one year and 98.2% vs. 76.9% at 5 years (P<0.001). There was no association between cirrhosis and eventual enteral autonomy (P=0.88). Conclusions Achieving enteral autonomy was associated with improved transplant-free survival in pediatric intestinal failure patients. There was no association between histopathological diagnosis of cirrhosis and transplant-free survival in the cohort. These data suggest that automatic transplant referral may not be required for histopathological diagnosis of cirrhosis alone, and that ongoing efforts aimed at achievement of enteral autonomy remain paramount in pediatric intestinal failure.

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Section: Discussionmentioning

confidence: 99%

Enteral autonomy, cirrhosis, and long term transplant-free survival in pediatric intestinal failure patients

Fullerton

Sparks

Hall

et al. 2016

Journal of Pediatric Surgery

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“…It is thought that the quantity of 13-CO2 measured in the breath correlates to the severity of liver disease. Duro et al (20), demonstrated the utility of MBT in assessing IFALD, although, like transient elastography, the technology involved is complex and expensive limiting its usefulness in routine clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Aspartate Aminotransferase to Platelet Ratio Index Correlates With Hepatic Cirrhosis but Not With Fibrosis in Pediatric Patients With Intestinal Failure

Díaz

Gura²,

Roda

et al. 2013

J. pediatr. gastroenterol. nutr.

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Patients with Intestinal failure (IF) require parenteral nutrition (PN) support to obtain enough nutrients to sustain growth. long-term PN use is associated with significant liver damage. Objective To analyze the utility of a non-invasive test, the aspartate aminotransferase (AST) to platelet ratio index (APRI), in the diagnosis of liver disease in pediatric patients with IF. Methods Medical records of all Boston Children’s Hospital patients who received PN and underwent a liver biopsy from January 2006 until November 2010 were reviewed. Patients with a clinical diagnosis with IF were selected. APRI was calculated as follows (AST (U/L)/ upper normal limit) × 100/ platelets (109/L). Presence of fibrosis and cirrhosis was estimated using the METAVIR score in liver biopsies. Results 62 liver biopsies from 48 patients (22 female) were studied. Mean APRI values in the different METAVIR categories (0-1; 2-3; 4) were: 1.80, 1.17, and 4.24 respectively (ANOVA; P=0.053; Bonferroni test for cirrhosis versus fibrosis P=0.048). APRI could significantly predict cirrhosis (OR 1.2.; 95% CI 1.001-1.43) but not significant fibrosis (METAVIR 2-3, OR 1.00; 95% CI =0.86-1.18). Area under the receiver operating characteristic curve for cirrhosis was 0.67 (95% CI= 0.45-0.89; p=0.13). Conclusion APRI, a non invasive, easy to obtain bedside test significantly predicts cirrhosis but not fibrosis in pediatric patients with IFALD. As the clinicians need a non invasive test to differentiate among different stages of liver fibrosis rather than differentiating cirrhosis from normal, we cannot recommend the use of this test in pediatric patients with IFALD for this purpose.

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“…Liver biopsy is a gold standard to assess the extent of liver damage. Duro et al (19) recently reported a non-invasive C 13 methionine breath test to differentiate cirrhotic vs . non- cirrhotic patients.…”

Section: Complications Of Sbsmentioning

confidence: 99%

Short Bowel Syndrome in the NICU

Amin

Pappas

Iyengar

et al. 2013

Clinics in Perinatology

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Short bowel syndrome (SBS) is the most common cause of intestinal failure in infants. In neonates and young infants, necrotizing enterocolitis, gastroschisis, intestinal atresia and intestinal malrotation/volvulus are the leading causes of SBS. Following an acute post-surgical phase, the residual gastrointestinal tract adapts with reorganization of the crypt-villus histoarchitecture and functional changes in nutrient absorption and motility. A cohesive, multidisciplinary approach can allow most neonates with SBS to transition to full enteral feeds and achieve normal growth and development. In this article, we review the clinical features, management, complications, and prognostic factors in SBS.

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687 Pharmacokinetic Study (A2210378) Comparing Two Pediatric Paracetamol Suspensions Shows Bioequivalence, and Faster Early Absorption of New Formulation

Cited by 6 publications

References 0 publications

Enteral autonomy, cirrhosis, and long term transplant-free survival in pediatric intestinal failure patients

Enteral autonomy, cirrhosis, and long term transplant-free survival in pediatric intestinal failure patients

Aspartate Aminotransferase to Platelet Ratio Index Correlates With Hepatic Cirrhosis but Not With Fibrosis in Pediatric Patients With Intestinal Failure

Short Bowel Syndrome in the NICU

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