Improved Outcome of Intestinal Failure in Preterm Infants

Abstract

Objective: The aim of the study was to evaluate the outcome and to identify predictors for survival and enteral autonomy in neonatal intestinal failure (IF). Methods: A retrospective observational study in a Swedish tertiary centre of children born between 1995 and 2016 with neonatal IF, defined as dependency on parenteral nutrition (PN) ≥60 days, starting with PN before the age of 44 gestational weeks. Data were extracted from medical records and predictors for survival and enteral autonomy were identified by the Cox regression model. Time to death and weaning off PN analysis were performed with Kaplan-Meier curves including log rank test. Results: In total, 105 children were included. Median gestational age was 28 weeks (22–42), 50% were born extremely preterm (<28 gestational weeks). PN started at a median age of 2 days (0–147) with a median duration of 196 days (60–3091). Necrotizing enterocolitis was the dominating cause of IF (61%). Overall survival was 88%, 5 children died of sepsis and 4 of intestinal failure-associated liver disease. Survival increased from 75% during 1995 to 2008 to 96% during 2009 to 2016 (P = 0.0040). Age-adjusted small bowel length of >50% and birth 2009 to 2016 were predictors for survival. Enteral autonomy was achieved in 87%, with positive prediction by small bowel length of >25% of expected for gestational age and remaining ileocecal valve. Conclusions: Preterm neonates with IF, at high risk of IF-associated morbidity, showed a high overall survival rate. Small-bowel length and being born 2009 to 2016 were predictors for survival and remaining ICV and small-bowel length were predictors for enteral autonomy.

Multi-Center Analysis of Predictive Factors of Enteral Autonomy and Risk Factors of Complications of Pediatric Intestinal Failure in China

“…IFALD was defined as cholestasis occurring in the setting of PN for more than 2 weeks upon exclusion of other specific causes of liver disease ( 18 ), while cholestasis was defined as an elevated conjugated serum bilirubin level of > 34.2 mmol/L ( 19 ). During the study period, 38 (41.3%) patients were complicated with cholestasis and 14 (15.2%) eventually developed IFALD ( Table 5 ).…”

Outcome and management in neonates with gastroschisis in the third millennium—a single-centre observational study

“…All neonates received total PN from the first postoperative day and continued until the establishment of enteral feeding with a stable weight gain. From 2006 to 2009, the PN lipid emulsions were adapted to individually customised PN with a combination of fish oil–based intravenous lipid emulsion (Omegaven®) and an olive oil– and soybean oil–based intravenous lipid emulsion (Clinoleic®) [ 13 ]. Minimal enteral feeding with breast milk, either from the mother or from a milk donor, was started after 5 to 7 days, if tolerated.…”

“…Nowadays, survival is more than 90% in neonates with gastroschisis [5][6][7][8], yet the condition is associated with significant morbidity [4,[9][10][11][12][13]. Intestinal dysfunction, sepsis, and reoperations result in prolonged duration of hospital stay and parenteral nutrition (PN) [4,[9][10][11][12][13].…”

Paediatric intestinal failure and transplantation

“…Intestinal failure (IF) is a complex and debilitating condition characterised by inadequate small intestinal function requiring parenteral or intravenous nutrition (PN) to maintain health and, for children, to enable growth and development 1,2 . Advances in neonatal critical care and the surgical management of children with complex conditions have been associated with a significant increase in children with IF requiring home PN 3–5 . In the UK, the rate of home PN in children has increased from 1.54 per million children in 2000 to 21.5 per million children in 2016 5 .…”

“…1,2 Advances in neonatal critical care and the surgical management of children with complex conditions have been associated with a significant increase in children with IF requiring home PN. [3][4][5] In the UK, the rate of home PN in children has increased from 1.54 per million children in 2000 to 21.5 per million children in 2016. 5 Although the number of patients is relatively small, IF places a significant burden on affected children, their family and the health-care system.…”