Predicting Factors of Protracted Intestinal Failure in Children with Gastroschisis

Vinit, Nicolas; Talbotec, Cécile; Tristan, Marie-Amélie de; Salomon, Laurent; Giuseppi, Agnès; Rousseau, Véronique; Beaudoın, Sylvie; Lambe, Cécile; Ville, Y.; Sarnacki, Sabine; Goulet, Olivier; Chardot, Christophe; Lapillonne, Alexandre; Khen-Dunlop, Naziha

doi:10.1016/j.jpeds.2021.11.004

Cited by 6 publications

(5 citation statements)

References 43 publications

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“…Residual SI length as well as presence/absence of the ileocecal valve (ICV) seem to be universally recognized prognostic factors affecting enteral autonomy achievement. Various cut‐offs of residual bowel length ranging from 15 to 50 cm or 30%–50% of residual SI have been proposed to predict PN weaning (55,56,68,69). Two retrospective studies on ultrashort bowel syndrome also reported a rate of enteral autonomy of 25%–50% which was reached during the first 4 years of follow up in children with <20 cm residual SI (59,65,70).…”

Section: Aim Of Treatmentmentioning

confidence: 99%

“…In addition the presence of the ICV was questioned as a positive predictive factor by a recent pediatric SBS‐IF meta‐analysis (71). Having NEC as primary diagnosis of NEC seems to be a positive predictor for enteral autonomy (71), whereas having gastroschisis is a negative due to secondary dysmotility (69). As outlined in Table 1, other factors predicting weaning may be length of residual colon, serum citrulline, enteral tolerance 6 months after resection, and multidisciplinary follow‐up.…”

Section: Aim Of Treatmentmentioning

confidence: 99%

“…Children with SBS are at risk of dysmotility which may result from abnormal development of the neuro‐myenteric system (97), for example, intestinal atresia, or as a consequence of ischemic injury to the enteric nervous system and smooth muscle, such as in NEC, gastroschisis (69), intestinal atresia, or midgut volvulus. Dysmotility may manifest as poor peristalsis, gastroparesis, or rapid intestinal transit (98).…”

Section: Prevention and Treatment Of Sbs‐if Complications (Irrespecti...mentioning

confidence: 99%

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Nutrition and Intestinal Rehabilitation of Children With Short Bowel Syndrome: A Position Paper of the ESPGHAN Committee on Nutrition. Part 2: Long-Term Follow-Up on Home Parenteral Nutrition

Norsa,

Goulet,

Alberti

et al. 2023

Journal of Pediatric Gastroenterology &Amp; Nutrition

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Short bowel syndrome (SBS) is the leading cause of intestinal failure (IF) in children. The preferred treatment for IF is parenteral nutrition which may be required until adulthood. The aim of this position paper is to review the available evidence on managing SBS and to provide practical guidance to clinicians dealing with this condition. All members of the Nutrition Committee of the European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) contributed to this position paper. Some renowned experts in the field joined the team to guide with their expertise. A systematic literature search was performed from 2005 to May 2021 using PubMed, MEDLINE, and Cochrane Database of Systematic Reviews. In the absence of evidence, recommendations reflect the expert opinion of the authors. Literature on SBS mainly consists of retrospective single-center experience, thus most of the current papers and recommendations are based on expert opinion. All recommendations were voted on by the expert panel and reached >90% agreement. This second part of the position paper is dedicated to the long-term management of children with SBS-IF. The paper mainly focuses on how to achieve intestinal rehabilitation, treatment of complications, and on possible surgical and medical management to increase intestinal absorption.

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Section: Aim Of Treatmentmentioning

confidence: 99%

Section: Aim Of Treatmentmentioning

confidence: 99%

Section: Prevention and Treatment Of Sbs‐if Complications (Irrespecti...mentioning

confidence: 99%

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Nutrition and Intestinal Rehabilitation of Children With Short Bowel Syndrome: A Position Paper of the ESPGHAN Committee on Nutrition. Part 2: Long-Term Follow-Up on Home Parenteral Nutrition

Norsa,

Goulet,

Alberti

et al. 2023

Journal of Pediatric Gastroenterology &Amp; Nutrition

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“…Alteration in gut motor activity may be observed especially in cases of prenatal small bowel malformations (gastroschisis and/or intestinal atresias) or severe postnatal pathology such as extensive NEC (17,63). Gastrointestinal dysmotility may be caused by decrease in the interstitial cells of Cajal, damage of the smooth muscle cells due to small bowel ischemia, and neuropathic changes with reduction of intramuscular nerve fibers, which occurs in various degree according to the underlying cause of SBS (62).…”

Section: Introductionmentioning

confidence: 99%

“…On the other hand more than 10% of children with SBS show delayed gastric emptying after intestinal surgical resection most probably due to altered fundic receptive relaxation, decreased antral contractility, and incoordination of gastric emptying and duodenal contractions (62). Alteration in gut motor activity may be observed especially in cases of prenatal small bowel malformations (gastroschisis and/or intestinal atresias) or severe postnatal pathology such as extensive NEC (17,63). Gastrointestinal dysmotility may be caused by decrease in the interstitial cells of Cajal, damage of the smooth muscle cells due to small bowel ischemia, and neuropathic changes with reduction of intramuscular nerve fibers, which occurs in various degree according to the underlying cause of SBS (62).…”

Section: Introductionmentioning

confidence: 99%

Nutrition and Intestinal Rehabilitation of Children With Short Bowel Syndrome: A Position Paper of the ESPGHAN Committee on Nutrition. Part 1: From Intestinal Resection to Home Discharge

Norsa,

Goulet,

Alberti

et al. 2023

Journal of Pediatric Gastroenterology &Amp; Nutrition

Self Cite

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Short bowel syndrome (SBS) is the leading cause of intestinal failure (IF) in children. The mainstay of treatment for IF is parenteral nutrition (PN). The aim of this position paper is to review the available evidence on managing SBS and to provide practical guidance to clinicians dealing with this condition. All members of the Nutrition Committee of the European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) contributed to this position paper. Some renowned experts in the field joined the team to guide with their experience. A systematic literature search was performed from 2005 to May 2021 using PubMed, MEDLINE, and Cochrane Database of Systematic Reviews. In the absence of evidence, recommendations reflect the expert opinion of the authors. Literature on SBS mainly consists of retrospective single-center experience, thus most of the current papers and recommendations are based on expert opinion. All recommendations were voted on by the expert panel and reached >90% agreement. The first part of this position paper focuses on the physiological mechanism of intestinal adaptation after surgical resection. It subsequently provides some clinical practice recommendations for the primary management of children with SBS from surgical resection until discharged home on PN.

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Long‐term gastrointestinal morbidity in patients born with gastroschisis: A national register‐based cohort study

Caldeman,

Fogelström,

Wester

et al. 2024

J. pediatr. gastroenterol. nutr.

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ObjectivesIn gastroschisis, the intestines are exposed to amniotic fluid during pregnancy. The defect in the abdominal wall may also compress the mesentery and impair the intestinal blood supply. There is a varying degree of intestinal damage at birth. Complex gastroschisis is defined as gastroschisis with severe complications such as intestinal atresia, volvulus, necrosis and perforation. The aim of this study was to investigate long‐term gastrointestinal morbidity and compare simple and complex cases.MethodsA nation‐wide retrospective cohort study with data from national registers was conducted. All children born with gastroschisis in Sweden from 1 January 1997 to 31 December 2016 were included in the study. Exposure was complex gastroschisis and the primary outcomes were intestinal failure and bowel obstruction.ResultsThe study included 315 cases with gastroschisis, 260 classifieds as simple gastroschisis and 55 as complex. The median time to follow was 8 years. A significantly higher risk of developing intestinal failure (hazard ratio [HR]: 11.7) was found in complex cases. Nine percent of the complex cases underwent autologous gastrointestinal reconstructive surgery for intestinal failure, none of the simple cases did. The complex cases had a higher risk for bowel obstruction (HR: 4.3) with a higher proportion requiring surgery (18.2% vs. 6.9%) compared to simple cases.ConclusionsThis nationwide study showed that the risk for intestinal failure and bowel obstruction is significantly higher for children with complex gastroschisis compared to simple gastroschisis. Most of the events occurred during the first 2 years of life.

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Predicting Factors of Protracted Intestinal Failure in Children with Gastroschisis

Cited by 6 publications

References 43 publications

Nutrition and Intestinal Rehabilitation of Children With Short Bowel Syndrome: A Position Paper of the ESPGHAN Committee on Nutrition. Part 2: Long-Term Follow-Up on Home Parenteral Nutrition

Nutrition and Intestinal Rehabilitation of Children With Short Bowel Syndrome: A Position Paper of the ESPGHAN Committee on Nutrition. Part 2: Long-Term Follow-Up on Home Parenteral Nutrition

Nutrition and Intestinal Rehabilitation of Children With Short Bowel Syndrome: A Position Paper of the ESPGHAN Committee on Nutrition. Part 1: From Intestinal Resection to Home Discharge

Long‐term gastrointestinal morbidity in patients born with gastroschisis: A national register‐based cohort study

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