Longitudinal Bone Mineralization Assessment in Children Treated With Long‐Term Parenteral Nutrition for Severe Intestinal Failure

Poinsot, Pierre; Geoffroy, P; Braillon, P.; Denis, Angélique; Loras-Duclaux, I; Marotte, Stéphanie; Boutroy, Stéphanie; Bacchetta, Justine; Touzet, Sandrine; Lachaux, Alain; Peretti, Noël

doi:10.1177/0148607117701399

Cited by 14 publications

(30 citation statements)

References 32 publications

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“…The prevalence of diabetes and elevated blood pressure was as previously reported 12,13 . Bone health was frequently impaired, due to long‐term therapy with corticosteroids and micronutrient deficiencies, and more than in children with intestinal failure who required PN 51 . However, the prevalence is higher in adults who underwent ITx 52 …”

Section: Discussionsupporting

confidence: 56%

“…12,13 Bone health was frequently impaired, due to long-term therapy with corticosteroids and micronutrient deficiencies, and more than in children with intestinal failure who required PN. 51 However, the prevalence is higher in adults who underwent ITx. 52 Graft removal resulted in high mortality, partly due to complications related to retransplantation.…”

Section: F I G U R Ementioning

confidence: 99%

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Beyond 10 years, with or without an intestinal graft: Present and future?

Courbage

Canioni

Talbotec

et al. 2020

American Journal of Transplantation

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Long-term outcomes in children undergoing intestinal transplantation remain unclear. Seventy-one children underwent intestinal transplantation in our center from 1989 to 2007. We report on 10-year posttransplant outcomes with (group 1, n = 26) and without (group 2, n = 9) a functional graft. Ten-year patient and graft survival rates were 53% and 36%, respectively. Most patients were studying or working, one third having psychiatric disorders. All patients in group 1 were weaned off parenteral nutrition with mostly normal physical growth and subnormal energy absorption. Graft histology from 15 late biopsies showed minimal abnormality. However, micronutrient deficiencies and fat malabsorption were frequent; biliary complications occurred in 4 patients among the 17 who underwent liver transplantation; median renal clearance was 87 mL/min/1.73 m 2. Four patients in group 1 experienced late acute rejection. Among the 9 patients in group 2, 4 died after 10 years and 2 developed significant liver fibrosis. Liver transplantation and the use of a 3-drug regimen including sirolimus or mycophenolate mofetil were associated with improved graft survival. Therefore, intestinal transplantation may enable a satisfactory digestive function in the long term. The prognosis of graft removal without retransplantation is better than expected. Regular monitoring of micronutrients, early psychological assessment, and use of sirolimus are recommended.

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Section: Discussionsupporting

confidence: 56%

Section: F I G U R Ementioning

confidence: 99%

Beyond 10 years, with or without an intestinal graft: Present and future?

Courbage

Canioni

Talbotec

et al. 2020

American Journal of Transplantation

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“…Intestinal failure‐associated metabolic bone disease (IF‐MBD) is reported in 30–83% of children receiving long‐term PN, with low bone mineral density, bone pain, and fractures . The etiologies are likely multifactorial: inadequate supply of calcium, phosphate, and vitamin D; use of steroids and diuretics; underlying disease; chronic inflammation; chronic acidosis; aluminum and vitamin D toxicity; hypercalciuria; and lack of physical activity . Vitamin K deficiency and prophylactic oral anticoagulation by warfarin may be linked to low bone mineralization …”

Section: Monitoring Of Long‐term Complicationsmentioning

confidence: 99%

“…DXA is considered the golden standard for diagnosis and monitoring of MBD from the age of 5 years and is repeated every 1–2 years . Monitoring of biochemical markers of bone metabolism include serum 25‐OH vitamin D, alkaline phosphatase, phosphate, plasma and urinary calcium, and parathyroid hormone .…”

Section: Monitoring Of Long‐term Complicationsmentioning

confidence: 99%

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Monitoring of long‐term parenteral nutrition in children with intestinal failure

Zemrani

Bines

2019

JGH Open

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Pediatric intestinal failure (IF) is a rare and complex condition associated with significant morbidity and mortality. It is defined as the reduction of gut mass or function below the minimal needed for absorption of nutrients and fluid to sustain life and growth. Since the advent of specialized multidisciplinary intestinal rehabilitation centers, IF management has considerably evolved in the last years, but serious complications of long‐term parenteral nutrition (PN) can occur. Main complications include intestinal failure‐associated liver disease, growth failure, body composition imbalance, central venous access complications, micronutrient deficiencies and toxicities, metabolic bone disease, small intestinal bacterial overgrowth, and renal disease. With improvement in survival rates of patients over the last 20 years, emphasis should be on limiting IF‐related comorbidities and improving quality of life. Close monitoring is pivotal to ensuring quality of care of these patients. The care of children with chronic IF should involve a comprehensive monitoring plan with flexibility for individualization according to specific patient needs. Monitoring of children on long‐term PN varies significantly across units and is mainly based on experience, although few guidelines exist. This narrative review summarizes the current knowledge and practices related to monitoring of children with IF. The authors also share their 20‐year experience at the Royal Children's Hospital in Melbourne Australia on this topic.

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Chapter 5.2.3. Parenteral Nutrition and Home Parenteral Nutrition Changed the Face of Paediatric Gastroenterology

Diamanti,

Puntis,

Kolacek

et al. 2018

J. pediatr. gastroenterol. nutr.

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Longitudinal Bone Mineralization Assessment in Children Treated With Long‐Term Parenteral Nutrition for Severe Intestinal Failure

Abstract: LBM is common in pediatric IF, but bone status could improve during HPN in these children.

Cited by 14 publications

References 32 publications

Beyond 10 years, with or without an intestinal graft: Present and future?

Beyond 10 years, with or without an intestinal graft: Present and future?

Monitoring of long‐term parenteral nutrition in children with intestinal failure

Chapter 5.2.3. Parenteral Nutrition and Home Parenteral Nutrition Changed the Face of Paediatric Gastroenterology

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