Etiology and Epidemiology of Intestinal Failure

Cole, Conrad R.; Ziegler, Thomas R.

doi:10.1201/b11358-3

Cited by 4 publications

(5 citation statements)

References 53 publications

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“…I ntestinal failure (IF) occurs when severe intestinal malabsorption caused by short bowel syndrome (SBS), congenital transport defects, or motility disturbances mandates artificial nutrition to be administered parenterally (1). This is because of a critical reduction of the functional gut mass below the level necessary to maintain adequate digestion and absorption of nutrients and fluid for normal growth (2)(3)(4)(5).…”

mentioning

confidence: 99%

Vitamin D Deficiency and Low Bone Mineral Density in Pediatric and Young Adult Intestinal Failure

Ubesie

Heubi²,

Kocoshis³

et al. 2013

J. pediatr. gastroenterol. nutr.

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Objectives To determine the prevalence and predisposing factors for vitamin D deficiency and low bone mineral density (BMD) in patients with intestinal failure (IF). Methods A retrospective review of patients with IF managed at the Cincinnati Children’s Hospital Medical Center. IF was defined as history of parenteral nutrition (PN) >30 days. Vitamin D deficiency was defined as serum 25-OH vitamin D [25(OH) D] < 20ng/dL. Reduced bone mineral density (BMD) was defined using dual x-ray absorptiometry (DXA) Z-score ≤− 2. A binary logistic regression model was used to test for association of significant risk factors and the outcome variables after univariate analyses. Results One hundred and twenty three patients with median age of 4 years (range 3–22 years) were evaluated. Forty-nine (39.8%) patients had at least a documented serum 25 (OH) D deficiency during the study interval while 10 out of 80 patients (12.5%) with DXA scans done had a low BMD Z-score. Age at study entry was associated with both 25 (OH) D deficiency (P= 0. 01) and low BMD Z-score (P = 0. 03). Exclusive PN at study entry was associated with reduced bone mass (P=0.03). There was no significant association between vitamin D deficiency and low BMD Z-score (P=0.31). Conclusion The risk of 25 (OH) D deficiency and low BMD Z-score increases with age among patients with IF. Strategies for monitoring and preventing abnormal bone health in older children receiving exclusive PN need to be developed and evaluated.

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mentioning

confidence: 99%

Vitamin D Deficiency and Low Bone Mineral Density in Pediatric and Young Adult Intestinal Failure

Ubesie

Heubi²,

Kocoshis³

et al. 2013

J. pediatr. gastroenterol. nutr.

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“…Patients with IF were defined as children with a primary gastrointestinal (GI) disease requiring at least partial PN to maintain adequate nutrition, hydration, electrolyte balance, and growth for at least 90 days. 9,10 All patients with PN dependence received standard PN with dextrose, amino acids, and lipids. No alternative lipid strategies such as fish oil–based emulsions were used among study participants.…”

Section: Methodsmentioning

confidence: 99%

Increased Anti‐Flagellin and Anti‐Lipopolysaccharide Immunoglobulins in Pediatric Intestinal Failure

Galloway

Troutt

Kocoshis

et al. 2014

J Parenter Enteral Nutr

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Background Central line–associated bloodstream infections (CLABSIs) pose a significant challenge in the lives of patients with intestinal failure (IF). We hypothesized that plasma immunoglobulins against flagellin (FLiC) and lipopolysaccharide (LPS) would be able to differentiate CLABSIs from nonbacterial febrile episodes and that levels would increase with infection and decline following appropriate antibiotic treatment. Materials and Methods Patients with IF, due to short bowel syndrome, between the ages of 3 months and 4 years of age, were recruited at Cincinnati Children’s Hospital Medical Center. Anti-FLiC and anti-LPS plasma antibody levels were measured in 13 children with IF at baseline, during febrile events, and also following treatment with antibiotics. These were also measured in 11 healthy children without IF who were recruited as controls. Results Plasma anti-FLiC IgA levels increased during febrile episodes in all patients with IF (baseline mean of 1.10 vs febrile episode mean of 1.32 optical density units, respectively; P = .046). Neither plasma anti- FLiC nor anti-LPS IgA or IgG levels distinguished CLABSI from nonbacterial febrile episodes compared with baseline levels. Compared with controls, patients with IF had significantly higher plasma levels of anti-FLiC and anti-LPS IgA at baseline. Conclusion Plasma anti-FLiC IgA antibody levels rise during febrile episodes but do not differentiate between nonbacterial febrile illnesses and CLABSIs in pediatric IF. However, the upregulation of these antibodies in IF suggests the baseline systemic presence of Gram-negative bacterial products.

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“…In infants, intestinal failure is usually a complication arising from significant injury to the gastrointestinal (GI) tract. The resultant functional intestinal mass may fall below the minimum required to maintain adequate nutrition and fluid balance needed for normal growth and development 3 , 4 . The duration of PN and the need for intestinal rehabilitation make the management of these children challenging.…”

Section: Initial Phase Of Managementmentioning

confidence: 99%

“…The resultant functional intestinal mass may fall below the minimum required to maintain adequate nutrition and fluid balance needed for normal growth and development. 3,4 The duration of PN and the need for intestinal rehabilitation make the management of these children challenging. The outcome of these children is significantly improved if they are managed by a multidisciplinary team that allows for fully integrated care of inpatients and outpatients with intestinal failure by fostering coordination of surgical, medical, and nutrition management.…”

Section: Invited Reviewmentioning

confidence: 99%

Nutrition Management of Infants With Surgical Short Bowel Syndrome and Intestinal Failure

Cole

Kocoshis

2013

Nut in Clin Prac

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Appropriate nutrition recommendations are important for the successful management of the infant with an injured gastrointestinal tract postsurgery who is at risk for intestinal failure. Management strategies that can be used to augment successful adaptation and prevent liver disease are summarized in this review. These include appropriate postoperative fluid and electrolyte management, modification of parenteral nutrition to minimize intestinal failure-associated liver disease, early and aggressive enteral feeding advancement, the use of hormonal and trophic agents, prevention of central line-associated bloodstream infections using ethanol lock, appropriate treatment, and prevention of pathologic small bowel bacterial overgrowth.

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Etiology and Epidemiology of Intestinal Failure

Cited by 4 publications

References 53 publications

Vitamin D Deficiency and Low Bone Mineral Density in Pediatric and Young Adult Intestinal Failure

Vitamin D Deficiency and Low Bone Mineral Density in Pediatric and Young Adult Intestinal Failure

Increased Anti‐Flagellin and Anti‐Lipopolysaccharide Immunoglobulins in Pediatric Intestinal Failure

Nutrition Management of Infants With Surgical Short Bowel Syndrome and Intestinal Failure

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