Key Determinants for Achieving Enteral Autonomy and Reduced Parenteral Nutrition Exposure in Pediatric Intestinal Failure

Abstract

Background We sought to evaluate the relationship between determinants of intestinal failure (IF) and achieving enteral autonomy from parenteral nutrition (PN) in a large single‐center cohort of children. Methods This is a retrospective chart review of pediatric subjects enrolled in a database for the Center for Advanced Intestinal Rehabilitation at Children's of Alabama from 1989 to 2016. IF was defined as dependence on PN for >60 days. Subjects were included if they were followed since birth or infancy for a minimum of 3 months and sufficient documentation of study variables were available. Gestational age, race, diagnosis, anatomy (percent small and large bowel remaining, presence of ileocecal valve [ICV]), county of residence (rural/urban), and days of PN use were recorded. Kaplan‐Meier curves and parametric survival regression models were used to investigate the relationship between the demographic and clinical variables with the length of PN use. Results Initially, 290 subjects were available to review. After inclusion/exclusion were applied, 158 subjects remained. Gestational age, diagnosis (necrotizing enterocolitis), small‐bowel length (>50%), and presence of an ICV were all positive predictors for reaching enteral autonomy. Residual colon length was associated with shorter duration of PN in days. Conclusion Enteral autonomy is a key outcome among children with IF. In our cohort, we found that gestational age, diagnosis, remaining small bowel, and presence of ICV are positive predictors for reaching this important milestone. Colon length is also an important factor with respect to duration of PN in days.

Delay in achieving enteral autonomy and growth outcomes in very low birth weight infants with surgical necrotizing enterocolitis

“…One definition of intestinal failure in infants is the need for PN for greater than 90 days [4,20]. Other experts use a cutoff duration of 60 days [21,22]. Using either definition, a substantial proportion of infants with surgical NEC fulfilled the criteria for intestinal failure.…”

Effect of the COVID‐19 Pandemic on Pediatric Intestinal Failure Healthcare Delivery

“…IF is defined as loss of intestinal length or a critical decrease in functional surface area affecting nutrient absorption and growth that results in long‐term parenteral nutrition (PN) use 7 . Patients with IF have significant morbidity, resulting in a large burden on the healthcare system 8 .…”

“…5,6 IF is defined as loss of intestinal length or a critical decrease in functional surface area affecting nutrient absorption and growth that results in long-term parenteral nutrition (PN) use. 7 Patients with IF have significant morbidity, resulting in a large burden on the healthcare system. 8 Factors that have been shown to improve outcomes for patients with IF include access to comprehensive management by a multidisciplinary intestinal rehabilitation (IR) team and careful protocolized central venous line care.…”

Vitamin D status in children with intestinal failure who have achieved enteral autonomy

“…After obtaining approval from the Institutional Review Board, data were retrospectively collected on all patients who attended our multidisciplinary intestinal rehabilitation team clinic between April 2011 and October 2020. Pediatric patients (<18 years) were included if they had a diagnosis of IF (defined by PN dependence for >60 days), had achieved EA (defined as maintenance of normal growth and hydration status by means of enteral support without the use of parenteral support for a period of >3 consecutive months), 6,7 and had documentation of serum 25-hydroxyvitamin D (25 OHD) levels with corresponding documentation of enteral vitamin D supplementation. Those with underlying diagnoses that increase risk for developing vitamin D deficiency were excluded (cystic fibrosis or chronic kidney disease).…”