ASPEN definitions in pediatric intestinal failure

Modi, Biren P.; Galloway, David; Gura, Kathleen M.; Nucci, Anita; Plogsted, Steven; Tucker, Alyssa; Wales, Paul W.

doi:10.1002/jpen.2232

Cited by 63 publications

(76 citation statements)

References 146 publications

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“…The working group recommends regular monitoring of micronutrient and growth status as well as intestinal function after transition to full EN." 1 In summary, we the authors, representing the Pediatric Intestinal Failure Section of ASPEN, fully agree with Dr Duggan's premise that the definition of intestinal failure does not require a current need for PN. The definition of intestinal failure, as written in the manuscript, creates a minimal requirement to attain the diagnosis.…”

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confidence: 55%

Response to “Definition of pediatric intestinal failure should not require ongoing dependence on parenteral nutrition”

Modi

Galloway

Gura

et al. 2022

J Parenter Enteral Nutr

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confidence: 55%

Response to “Definition of pediatric intestinal failure should not require ongoing dependence on parenteral nutrition”

Modi

Galloway

Gura

et al. 2022

J Parenter Enteral Nutr

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“…The goal of treatment is to increase the absorption capacity of the remaining bowel in order to achieve enteral autonomy [ 2 ]. Enteral autonomy is defined by the American Society for Parenteral and Enteral Nutrition (ASPEN) as “the maintenance of normal growth and hydration status by means of enteral support without the use of parenteral support for a period of more than three consecutive months” [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

Surgical Treatment of Short Bowel Syndrome—The Past, the Present and the Future, a Descriptive Review of the Literature

et al. 2022

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Short bowel syndrome (SBS) is a devastating disorder with both short- and long-term implications for patients. Unfortunately, the prevalence of SBS has doubled over the past 40 years. Broadly speaking, the etiology of SBS can be categorized as congenital or secondary, the latter typically due to extensive small bowel resection following diseases of the small intestine, e.g., necrotizing enterocolitis, Hirschsprung’s disease or intestinal atresia. As of yet, no cure exists, thus, conservative treatment, primarily parenteral nutrition (PN), is the first-line therapy. In some cases, weaning from PN is not possible and operative therapy is required. The invention of the longitudinal intestinal lengthening and tailoring (LILT or Bianchi) procedure in 1980 was a major step forward in patient care and spawned further techniques that continue to improve lives for patients with severe SBS (e.g., double barrel enteroplasty, serial transverse enteroplasty, etc.). With this review, we aim to provide an overview of the clinical implications of SBS, common conservative therapies and the development of operative techniques over the past six decades. We also provide a short outlook on the future of operative techniques, specifically with respect to regenerative medicine.

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“…These interdisciplinary programs address the complexities of affected patients by managing their special needs, anticipating complications and providing coordinated and individualized care. For pediatric patients with intestinal failure, IRPs have been found to have a significant impact on morbidity as well as demonstrating improvement in survival ( 3 ) and allow in many cases a better long-term outcome compared to alternative therapies such as intestinal transplantation. Those advances in the Non-transplant management of intestinal failure led to a reduction in the number of intestinal transplantations worldwide from a peak of 270 per year in 2008 to 149 per year in 2017 ( 4 ).…”

Section: Introductionmentioning

confidence: 99%

Spectrum of Interventional Procedures During Hybrid Central Line Placement in Pediatric Intestinal Rehabilitation Patients With End-Stage Vascular Access

et al. 2022

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BackgroundLoss of available central vein access sites for parenteral nutrition delivery represents one of the main indications for intestinal transplantation in children with intestinal failure. Placement of central venous catheters can be challenging in advanced loss of patent venous pathways. We recently described the hybrid technique (interventional plus surgical approach) of central line placement in children. The aim of this study was to describe and analyze the interventions used during the hybrid procedures regarding feasibility, safety and outcome.MethodsWe retrospectively analyzed the course of all children in our intestinal rehabilitation program undergoing hybrid central line placement. We evaluated patients' conditions, interventional techniques and surgical peculiarities as well as outcome.Results203 children were treated in our intestinal rehabilitation program between 2010 and 2021. Due to loss of venous access, hybrid technique was performed in 53 children during 76 interventions. In 40 cases the same vessel was reused via Seldinger technique. Among the 30 ultrasound-guided new vessel punctures, 12 were performed by puncture of collateral vessels. Extended interventions due to thoracic central venous obstruction and/or thrombosis requiring additional access via a femoral vein for rehabilitation of the vascular system was performed during 29 procedures including catheter extraction (1), angioplasties (18), stent placement (1), revascularization (5) and thrombectomy (4). Placement of a central line was not possible in 6 children which eventually underwent extended thoracic/vascular surgery: in three children the previously placed catheter could not be removed, in one child, placement of a thrombectomy-catheter was not possible because of inferior vena cava occlusion, and in two children, revascularization failed. Intestinal transplantation was considered in one patient because of impending loss of vascular access. Two self-limiting minor extravasations and one intervention-associated pericardial effusion occurred.ConclusionsHybrid interventions for central venous catheter placement and vascular rehabilitation enable a high success rate in children with intestinal failure and end-stage vascular access, circumventing the need for intestinal transplantation or advanced surgery. The relevant procedures are complex and require a foresighted and individualized approach with a wide range of interventional techniques. If performed with expertise, this combined interventional/surgical approach is feasible and safe.

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ASPEN definitions in pediatric intestinal failure

Cited by 63 publications

References 146 publications

Response to “Definition of pediatric intestinal failure should not require ongoing dependence on parenteral nutrition”

Response to “Definition of pediatric intestinal failure should not require ongoing dependence on parenteral nutrition”

Surgical Treatment of Short Bowel Syndrome—The Past, the Present and the Future, a Descriptive Review of the Literature

Spectrum of Interventional Procedures During Hybrid Central Line Placement in Pediatric Intestinal Rehabilitation Patients With End-Stage Vascular Access

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