Trends in Pediatric Intestinal Failure: A Multicenter, Multinational Study - 22/09/21
Abstract |
Objectives |
To assess the natural history and outcomes of children with intestinal failure in a large, multicenter, geographically diverse contemporary cohort (2010-2015) from 6 pediatric intestinal failure programs.
Study design |
Retrospective analysis of a multicenter intestinal failure cohort (n = 443). Competing-risk analysis was used to obtain cumulative incidence rates for the primary outcome (enteral autonomy, transplantation, or death). The χ2 test and Cox proportional hazard regression were used for bivariate and multivariable analyses.
Results |
The study cohort comprised 443 patients (61.2% male). Primary etiologies included short bowel syndrome (SBS), 84.9%; dysmotility disorder, 7.2%; and mucosal enteropathy, 7.9%. Cumulative incidences for enteral autonomy, transplantation, and death at 6 years of follow-up were 53.0%, 16.7%, and 10.5%, respectively. Enteral autonomy was associated with SBS, ≥50% of small bowel length, presence of an ileocecal valve (ICV), absence of portal hypertension, and follow-up in a non–high-volume transplantation center. The composite outcome of transplantation/death was associated with persistent advanced cholestasis and hypoalbuminemia; age <1 year at diagnosis, ICV, and intact colon were protective.
Conclusions |
The rates of death and transplantation in children with intestinal failure have decreased; however, the number of children achieving enteral autonomy has not changed significantly, and a larger proportion of patients remain parenteral nutrition dependent. New strategies to achieve enteral autonomy are needed to improve patient outcomes.
Le texte complet de cet article est disponible en PDF.Keywords : intestinal failure, enteral autonomy, intestinal transplantation
Abbreviations : ICU, ICV, IFALD, INR, PIFCon, PN, SBS
Plan
Funding and conflict of interest information is available at www.jpeds.com. |
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Portions of this study were presented at the 16th International Congress of the Intestinal Rehabilitation and Transplant Association, July 3-6, 2019, Paris, France and were accepted for presentation at the 6th World Congress of Pediatric Gastroenterology, Hepatology and Nutrition, Copenhagen, 2020 (canceled). |
Vol 237
P. 16 - octobre 2021 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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