Magnitude of surgical burden associated with pediatric intestinal failure: A multicenter cohort analysis

Khan, Faroque A.; Mitchell, Paul D.; Fisher, Jeremy G.; Sparks, Eric A.; Jaksic, Tom; Duggan, Christopher; Teitelbaum, Daniel H.; Modi, Biren P.

doi:10.1016/j.jpedsurg.2014.09.026

Cited by 10 publications

(8 citation statements)

References 13 publications

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“…In this cohort, NEC is the most frequent cause of SBS, accounting for 34% of all cases, which is consistent with other reports regarding pediatric intestinal failure [15, 22]. Multivariable regression demonstrated that the diagnosis of NEC, in addition to other expected parameters including median serum citrulline concentration, absence of a stoma, and percent expected bowel length were associated with enteral autonomy.…”

Section: Discussionsupporting

confidence: 90%

“…However, children who are unable to wean from PN have increased mortality and additional burdens, including risk of intestinal failure associated liver disease (IFALD), central line associated blood stream infections (CLABSI), and increased costs[6, 8, 15, 16]. An accurate understanding of the relationship between etiology of SBS and likelihood of weaning from PN may influence clinical management.…”

Section: Discussionmentioning

confidence: 99%

“…Small bowel length has consistently been the most robust indicator and historical data suggest that approximately 35cm of small bowel is associated with a 50% probability of weaning from PN[3, 4, 10, 17, 18, 32]. However, wide variability exists around this benchmark, and some patients with less than 10cm of remaining small bowel have achieved enteral autonomy[15, 19–21]. Serum citrulline thresholds of 15μmol/L and 10μmol/L have been suggested to predict likelihood of weaning from parenteral nutrition as well as risk of CLABSI infection, respectively [30, 31].…”

Section: Discussionmentioning

confidence: 99%

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Necrotizing enterocolitis is associated with earlier achievement of enteral autonomy in children with short bowel syndrome

Sparks

Khan

Fisher

et al. 2016

Journal of Pediatric Surgery

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Purpose Necrotizing enterocolitis (NEC) remains one of the most common underlying diagnoses of short bowel syndrome (SBS) in children. The relationship between the etiology of SBS and ultimate enteral autonomy has not been well studied. This investigation sought to evaluate the rate of achievement of enteral autonomy in SBS patients with and without NEC. Methods Following IRB approval, 109 patients (2002–2014) at a multidisciplinary intestinal rehabilitation program were reviewed. The primary outcome evaluated was achievement of enteral autonomy (i.e. fully weaning from parenteral nutrition). Patient demographics, primary diagnosis, residual small bowel length, percent expected small bowel length, median serum citrulline level, number of abdominal operations, status of the ileocecal valve (ICV), presence of ileostomy, liver function tests, and treatment for bacterial overgrowth were recorded for each patient. Results Median age at PN onset was 0 weeks [IQR 0–0]. Median residual small bowel length was 33.5cm [IQR 20–70]. NEC was present in 37 of 109 (33.9%) of patients. 45 patients (41%) achieved enteral autonomy after a median PN duration of 15.3 [IQR 7.2–38.4] months. Overall, 64.9% of patients with NEC achieved enteral autonomy compared to 29.2% of patients with a different primary diagnosis (p=0.001, Figure 1). Patients with NEC remained more likely than those without NEC to achieve enteral autonomy after two (45.5% vs. 12.0%) and four (35.7% vs. 6.3%) years on PN (Figure 1). Logistic regression analysis demonstrated the following parameters as independent predictors of enteral autonomy: diagnosis of NEC (p<0.002), median serum citrulline level (p<0.02), absence of a jejunostomy or ileostomy (p=0.013), and percent expected small bowel length (p=0.005). Conclusions Children with SBS due to NEC have a significantly higher likelihood of fully weaning from parenteral nutrition compared to children with other causes of SBS. Additionally, patients with NEC may attain enteral autonomy even after long durations of parenteral support.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Necrotizing enterocolitis is associated with earlier achievement of enteral autonomy in children with short bowel syndrome

Sparks

Khan

Fisher

et al. 2016

Journal of Pediatric Surgery

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“…Short bowel syndrome is a common underlying diagnosis in the PN-dependent pediatric population that leads to the need for multiple invasive procedures and surgeries during childhood. A typical child with intestinal failure undergoes a median of four invasive abdominal procedures and highlights the importance of accurately defining the potential risk of FO-associated bleeding 11 . The goal of this report is to describe the incidence of clinically significant post-procedural bleeding (CSPPB) in pediatric patients receiving parenteral FO monotherapy for the treatment of IFALD.…”

Section: Introductionmentioning

confidence: 99%

Risk of post-procedural bleeding in children on intravenous fish oil

Nandivada

Anez‐Bustillos

O’Loughlin

et al. 2017

The American Journal of Surgery

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Background Intestinal failure-associated liver disease (IFALD) can be treated with parenteral fish oil (FO) monotherapy, but practitioners have raised concerns about a potential bleeding risk. This study aims to describe the incidence of clinically significant post-procedural bleeding (CSPPB) in children receiving FO monotherapy. Methods A retrospective chart review was performed on patients at our institution treated with intravenous FO for IFALD. CSPPB was defined as bleeding leading to re-operation, transfer to the intensive care unit, re-admission, or death, up to one month after any invasive procedure. Results From 244 patients reviewed, 183 underwent ≥1 invasive procedure (n=732). Five (0.68%, 95% CI 0.22–1.59%) procedures resulted in CSPPB. FO therapy was never interrupted. No deaths occurred. Conclusions Findings suggest that FO therapy is safe, with a CSPPB risk no greater than that reported in the general population. O3FA should not be held in preparation for procedures or in the event of bleeding.

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“…SBS associated complications including intestinal failure associated liver disease (IFALD), small bowel bacterial overgrowth (SBBO), nephrocalcinosis, cholelithiasis, and metabolic bone disease (MBD) are quite prevalent in this patient population [5][6][7][8][9]. A high resource and disease burden is also reported in children with SBS after initial discharge and in younger children with SBS [10][11][12]. There is a paucity of data regarding burden of disease in adolescents with neonatal onset SBS and their ability to wean from PN.…”

mentioning

confidence: 99%