Neonatal Intestinal Failure Is Independently Associated With Impaired Cognitive Development Later in Childhood

Abstract

Objective: The impact of pediatric intestinal failure (IF) on neurodevelopment beyond infancy has not been systematically studied. Our aim was to evaluate cognitive and motor impairment and to identify risk factors for adverse outcomes among children with IF. Methods: We conducted a cross-sectional single-center study at the Helsinki University Children's Hospital. Patients with IF with >60 days of parental nutrition (PN) dependency aged between 3 and 16 years (n = 40) were invited to participate. The cognitive and motor skills were evaluated using validated tests: Wechsler Preschool and Primary Scale of Intelligence, 3rd edition, Wechsler Intelligence Scale for Children, 4th edition, and Movement Assessment Battery for Children, 2nd edition. Results: All the patients attending the study tests (n = 30, males = 24) were included. Their median age, gestational age, and birth weight was 7.5 (range 3–16) years, 35 (interquartile range [IQR] 28–38) weeks and 2238 (IQR 1040–3288) grams, respectively. Median duration of PN was 13 (IQR 5–37) months and 9 patients were currently on PN. Median intelligence quotient was 78 (IQR 65–91) and 10 (35%) patients had an intelligence quotient under 70 (−2 standard deviation). Significant motor impairment was detected in 10 patients (36%) and milder difficulties in 8 (28%). Adverse cognitive outcome was associated with neonatal short bowel syndrome, number of interventions under general anesthesia, and length of inpatient status, whereas adverse motor outcome was associated with prematurity. Conclusion: Clinically significant cognitive and motor impairments are alarmingly common among neonatal patients with IF. We recommend early neurodevelopmental follow-up for all children with IF.

Interrupting tumor necrosis factor–alpha signaling prevents parenteral nutrition–associated cholestasis in mice

“…[2][3][4] Clinical and experimental data showing that lipid reduction or lipid modification regimens in PN solutions may reverse PNAC have been met by concerns about compromised neurodevelopment in the face of inadequate lipid provision. [5][6][7][8] In addition to the role of PN lipid emulsions, [9][10][11][12] intestinal inflammation 13 or resection are essential factors in promoting PNAC, involving dysbiosis, altered intestinal barrier function with increased absorption of bacterial products, including lipopolysaccharides (LPSs), that stimulate cytokine production by liver macrophages and downregulation of hepatocyte bile and sterol transporters.…”

Cognitive Outcomes in Children With Conditions Affecting the Small Intestine

“…Eleven studies were of retrospective design (19,23–32), 19 of prospective design (20–22,33–48). Sample size across studies ranged from 10 to 449 patients.…”

“…Eleven studies were of retrospective design (19,(23)(24)(25)(26)(27)(28)(29)(30)(31)(32), 19 of prospective design (20)(21)(22)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48). Sample size across studies ranged from 10 to 449 patients.…”

Muscle Strength, Agility, and Body Composition in Children With Intestinal Failure on Parenteral Nutrition

“…Skallerup et al (11) found a significantly increased risk of sarcopenia in adults with IF and Mangus et al (12) reported severe sarcopenia in children with IF-related end-stage organ disease. Children with IF can also present with delays in motor development from infancy through school age (13)(14)(15)(16). Lower levels of motor competence can be associated with lower levels of physical activity (PA) and decreased muscle strength and endurance (17).…”