1. Predictors of Enteral Autonomy in Children with Intestinal Failure: A Multicenter Cohort Study
- Author
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Faraz A. Khan, Robert H. Squires, Heather J. Litman, Jane Balint, Beth A. Carter, Jeremy G. Fisher, Simon P. Horslen, Tom Jaksic, Samuel Kocoshis, J. Andres Martinez, David Mercer, Susan Rhee, Jeffrey A. Rudolph, Jason Soden, Debra Sudan, Riccardo A. Superina, Daniel H. Teitelbaum, Robert Venick, Paul W. Wales, Christopher Duggan, Cartland Burns, George Mazariegos, Sharon Lawlor, Tamara Haller, Marcia Kurs-Lasky, Steven H. Belle, Anita Nucci, Jane Anne Yawarski, Danielle Sebbens, Rhonda Cunningham, Daniel Kamin, Heung Bae Kim, Sharon Collier, Melanie Connolly, Pamela Brown, Michele Johnson, Robert Drongowski, Christina Valentine, Steven Teich, Beth Skaggs, Martin G. Martin, Patty Beckwith, James Dunn, Douglas G. Farmer, Laurie Reyen, Diana Farmer, Sang-Mo Kang, Lane Bower, Dean L. Antonson, Steve C. Raynor, Brandy Sunderman, Kris Seipel, Brent Polk, Martha Ballew, Mary Brandt, Saul Karpen, Sara Philips, Kristin Brown, Alejandro De La Torre, Sara Fidanza, Frances Malone, Patrick Healey, Jorge Reyes, Cheryl Davis, Greg Tiao, Jacqueline Wessel, Valeria Cohran, Kimberley Kazmerski, Lisa Keys, Margaret 'Peggy' Richard, David Sigalet, and Conrad Cole
- Subjects
Male ,Pediatrics ,Parenteral Nutrition ,Bacteremia ,Enteral administration ,Oral and gastrointestinal ,Cohort Studies ,Risk Factors ,Cumulative incidence ,Child ,Growth Disorders ,Pediatric ,Pediatric Intestinal Failure Consortium ,Ileocecal Valve ,Intestines ,medicine.anatomical_structure ,Child, Preschool ,6.1 Pharmaceuticals ,Necrotizing enterocolitis ,Female ,Cohort study ,Short Bowel Syndrome ,medicine.medical_specialty ,Catheterization, Central Venous ,Canada ,Article ,Paediatrics and Reproductive Medicine ,Ileocecal valve ,Enterocolitis, Necrotizing ,Clinical Research ,medicine ,Humans ,Preschool ,Retrospective Studies ,Nutrition ,Transplantation ,business.industry ,Enterocolitis ,Infant, Newborn ,Infant ,Evaluation of treatments and therapeutic interventions ,Retrospective cohort study ,Human Movement and Sports Sciences ,medicine.disease ,Newborn ,United States ,Intestinal Diseases ,Parenteral nutrition ,Catheter-Related Infections ,Pediatrics, Perinatology and Child Health ,Multivariate Analysis ,business ,Necrotizing ,Digestive Diseases ,Follow-Up Studies - Abstract
Objectives In a large cohort of children with intestinal failure (IF), we sought to determine the cumulative incidence of achieving enteral autonomy and identify patient and institutional characteristics associated with enteral autonomy. Study design A multicenter, retrospective cohort analysis from the Pediatric Intestinal Failure Consortium was performed. IF was defined as severe congenital or acquired gastrointestinal diseases during infancy with dependence on parenteral nutrition (PN) >60 days. Enteral autonomy was defined as PN discontinuation >3 months. Results A total of 272 infants were followed for a median (IQR) of 33.5 (16.2-51.5) months. Enteral autonomy was achieved in 118 (43%); 36 (13%) remained PN dependent and 118 (43%) patients died or underwent transplantation. Multivariable analysis identified necrotizing enterocolitis (NEC; OR 2.42, 95% CI 1.33-4.47), care at an IF site without an associated intestinal transplantation program (OR 2.73, 95% CI 1.56-4.78), and an intact ileocecal valve (OR 2.80, 95% CI 1.63-4.83) as independent risk factors for enteral autonomy. A second model (n = 144) that included only patients with intraoperatively measured residual small bowel length found NEC (OR 3.44, 95% CI 1.36-8.71), care at a nonintestinal transplantation center (OR 6.56, 95% CI 2.53-16.98), and residual small bowel length (OR 1.04 cm, 95% CI 1.02-1.06 cm) to be independently associated with enteral autonomy. Conclusions A substantial proportion of infants with IF can achieve enteral autonomy. Underlying NEC, preserved ileocecal valve, and longer bowel length are associated with achieving enteral autonomy. It is likely that variations in institutional practices and referral patterns also affect outcomes in children with IF.
- Published
- 2015