Enhanced central venous catheter bundle for pediatric parenteral-dependent intestinal failure

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.

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“…Despite recent reports of lower sepsis rates (26), we were unable to find a difference between early and late cohorts.…”

Section: Resultscontrasting

confidence: 99%

Clinical outcomes in pediatric intestinal failure: a meta-analysis and meta-regression

Pierret

Wilkinson

Zilbauer

et al. 2019

The American Journal of Clinical Nutrition

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“…The incidence of CLABSIs in this group was low. Our institution has established a central venous catheter maintenance bundle and a proactive intervention to reduce central line duration 22 . Recent decrease in reported rates of CLABSIs in the ICU setting are likely due to broad implementation of quality improvement initiatives promoting best‐practice bundles for insertion and maintenance of central lines 23,24 .…”

Section: Discussionmentioning

confidence: 99%

Timing of parenteral nutrition is associated with adequacy of nutrient delivery and anthropometry in critically ill children: A single‐center study

Ariagno

Bechard

Quinn

et al. 2021

J Parenter Enteral Nutr

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Background The optimal timing of supplemental parenteral nutrition (PN) use in the pediatric intensive care unit (ICU) is unclear. We aimed to describe patterns of PN use in the ICU and the association between the timing of PN initiation and macronutrient delivery and anthropometry. Methods We enrolled patients (aged <18 years) with an ICU stay >3 days were started on PN in the ICU. Initiation within 48 hours of admission was deemed as early, and duration <5 days was deemed as short. We used multivariable analysis to examine the association between PN timing and macronutrient delivery adequacy (percentage of the prescribed target that was actually delivered) and weight‐for‐age z‐score (WAZ) over hospital stay. Results Ninety‐five patients were included. Median (interquartile range [IQR]) time to initiate PN was 4 (1, 6) days, and in 33%, PN was initiated early. Median (IQR) PN duration was 8 (5, 14) days, and in 16.8%, duration was short. Median (IQR) adequacies for total energy and protein delivery were 55% (40, 74) and 72% (44, 81) in the early PN group compared with 29% (3, 50) and 31% (4, 47), respectively, in the late PN group (P < .001). The late PN group had a 0.50‐unit greater decline in mean WAZ compared with the early PN group (95% CI, 0.11–0.89; P = .012). Conclusion Late PN initiation was associated with significantly lower adequacy of macronutrient delivery and greater decline in WAZ in critically ill children. The relationship between PN timing patient outcomes must be further examined.

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“…Projects focusing on high-risk populations (premature neonates, oncology, intestinal failure, and cardiac patients) have implemented interventions addressing population-specific risks to expand CLABSI reduction to these groups as well. 48,[56][57][58] Once thought to be unachievable, rates below 1 CLABSI per 1,000 line days have become more commonplace. 56,59,60 The use of more rigorous designs such as factorial design, which utilizes subgroups to simultaneously test multiple variables, can determine the relative impact of different interventions or the interaction of variables on the desired outcome.…”

Section: Hand Hygienementioning

confidence: 99%

Don’t just do it—Conducting and publishing improvement science in infection prevention and antibiotic stewardship

Linam

Trivedi

Schaffzin

2022

ASHE

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Enhanced central venous catheter bundle for pediatric parenteral-dependent intestinal failure

Cited by 23 publications

References 12 publications

Clinical outcomes in pediatric intestinal failure: a meta-analysis and meta-regression

Clinical outcomes in pediatric intestinal failure: a meta-analysis and meta-regression

Timing of parenteral nutrition is associated with adequacy of nutrient delivery and anthropometry in critically ill children: A single‐center study

Don’t just do it—Conducting and publishing improvement science in infection prevention and antibiotic stewardship

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