Predictors of Enteral Autonomy in Children with Intestinal Failure: A Multicenter Cohort Study - 29/06/15

Doi : 10.1016/j.jpeds.2015.03.040

Faraz A. Khan, MD ¹, Robert H. Squires, MD ², Heather J. Litman, PhD ¹, Jane Balint, MD ³, Beth A. Carter, MD ⁴, Jeremy G. Fisher, MD ¹, Simon P. Horslen, MB, ChB ⁵, Tom Jaksic, MD, PhD ¹, Samuel Kocoshis, MD ⁶, J. Andres Martinez, MD ⁷, David Mercer, MD ⁸, Susan Rhee, MD ⁹, Jeffrey A. Rudolph, MD ², Jason Soden, MD ¹⁰, Debra Sudan, MD ¹¹, Riccardo A. Superina, MD ¹², Daniel H. Teitelbaum, MD ¹³, Robert Venick, MD ¹⁴, Paul W. Wales, MD, MSc ¹⁵, Christopher Duggan, MD, MPH ^1,^⁎
for
Pediatric Intestinal Failure Consortium^{^∗}
A list of members of the Pediatric Intestinal Failure Consortium is available at www.jpeds.com (Appendix).
Cartland Burns, MD, George Mazariegos, MD, Sharon Lawlor, MBA, Tamara Haller, BS, Marcia Kurs-Lasky, MS, Steven H. Belle, PhD, MScHyg, Anita Nucci, PhD, RD, Jane Anne Yawarski, RN, Danielle Sebbens, DNP, CRNP, Rhonda Cunningham, BA, Daniel Kamin, MD, Tom Jaksic, MD, PhD, Heung Bae Kim, MD, Sharon Collier, RD, LD, Melanie Connolly, RD, LD, Pamela Brown, MD, Michele Johnson, LD, Robert Drongowski, MA, Christina Valentine, MD, Steven Teich, MD, Beth Skaggs, BA, Martin G. Martin, MD, MPP, Patty Beckwith, RD, CDE, James Dunn, MD, PhD, Douglas G. Farmer, MD, Laurie Reyen, RN, MN, Diana Farmer, MD, Sang-Mo Kang, MD, Lane Bower, RD, Dean L. Antonson, MD, Steve C. Raynor, MD, Brandy Sunderman, RD, Kris Seipel, BA, Brent Polk, MD, Martha Ballew, MEd, RD, Mary Brandt, MD, Saul Karpen, MD, PhD, Sara Philips, RD, Kristin Brown, RD, Alejandro De La Torre, BA, Sara Fidanza, NP, Kristin Brown, RD, Frances Malone, ARNP, PhD, Patrick Healey, MD, Jorge Reyes, MD, Cheryl Davis, RD, Greg Tiao, MD, Jacqueline Wessel, RN, Valeria Cohran, MD, Kimberley Kazmerski, RD, Lisa Keys, BSN, RN, CCTN, Margaret “Peggy” Richard, RN, David Sigalet, MD, PhD, Conrad Cole, MD

¹ Boston Children's Hospital, Boston, MA
² Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, PA
³ Nationwide Children's Hospital, Columbus, OH
⁴ Texas Children's Hospital, Houston, TX
⁵ Seattle Children's Hospital, Seattle, WA
⁶ Cincinnati Children's Hospital Medical Center, Cincinnati, OH
⁷ Monroe Carrell Jr. Children's Hospital, Nashville, TN
⁸ Children's Hospital and Medical Center, Omaha, NE
⁹ University of California, San Francisco, Benioff Children's Hospital, San Francisco, CA
¹⁰ Children's Hospital Colorado Medical Center, Denver, CO
¹¹ Duke Children's Hospital and Health Center, Durham, NC
¹² Children's Memorial Hospital, Chicago, IL
¹³ Mott's Children's Hospital, Ann Arbor, MI
¹⁴ Mattel Children's Hospital University of California, Los Angeles, Los Angeles, CA
¹⁵ Hospital for Sick Children, Toronto, Ontario, Canada

^∗Reprint requests: Christopher Duggan, MD, MPH, Center for Nutrition, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, 333 Longwood Avenue, Boston, MA 02115.

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.

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Keyword : ICV, IF, ITx, NEC, PIFCon, PN, RSB

Plan

Methods

Results

Discussion

Supported by the National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases (1 R21 DK081059-01). C.D. was funded in part from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (K24HD058795 and K24DK104676-06). The authors declare no conflicts of interest.

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Vol 167 - N° 1

P. 29 - juillet 2015 Retour au numéro

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Predictors of Enteral Autonomy in Children with Intestinal Failure: A Multicenter Cohort Study - 29/06/15

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