Successful Rehabilitation in Pediatric Ultrashort Small Bowel Syndrome

Infantino, Benjamin J.; Mercer, David F.; Hobson, Brandy D.; Fischer, Ryan T.; Gerhardt, Brandi K.; Grant, Wendy J.; Langnas, Alan Norman; Quirós-Tejeira, Rubén E.

doi:10.1016/j.jpeds.2013.05.062

Cited by 64 publications

(55 citation statements)

References 28 publications

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“…The criteria reflect and were based on the outcomes of IF 20-30 years ago, at a time when this condition was associated with high mortality rates. Subsequently, there have been many advances in the medical and surgical management of children with IF resulting in much better outcomes (3)(4)(5)(6). These improvements include: the adoption of multi-disciplinary intestinal rehabilitation teams, autologous bowel reconstruction techniques, and the introduction of new medical approaches such as ethanol locks to reduce cathether related sepsis (7) and novel lipid management strategies (8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%

“…A small recent case series of a prospective database (2005-2011) reported 100% survival of patients with <10 cm of bowel (n ¼ 5) after a median follow-up of 54 months (43-61 months), and notably none of whom developed IFALD (19). A second case series of patients (2001-2011) with < 20 cm small bowel reported that nearly 50% of these patients achieved PN independence within 24 months and significant improvements in total bilirubin when treated at an intestinal rehabilitation program (5). Therefore, our data suggests that bowel length alone should no longer serve as an independent listing criterion.…”

mentioning

confidence: 99%

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Pediatric Intestinal Transplant Listing Criteria – A Call for a Change in the New Era of Intestinal Failure Outcomes

Burghardt

Wales

Silva³

et al. 2015

American Journal of Transplantation

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Current listing indications used for intestinal transplantation (IT) were proposed in 2001. We undertook the present single center study to see if these criteria are still valid. The 2001 criteria (advanced cholestasis, loss of >50% central venous catheter (CVC) sites, !2 sepsis/year, ultrashort bowel) were compared in children with intestinal failure in old era-1998-2005 (N ¼ 99) to current era-2006-2012 (N ¼ 91) to predict the need for IT using sensitivity, specificity, NPV and PPV. Two 2001 criteria had poorer predictive value in the current era: Advanced cholestasis (PPV 64% old vs. 40% current era; sensitivity 84% vs. 65%, respectively) and ultrashort bowel (PPV 100% old vs. 9% current era; sensitivity 10% vs. 4%, respectively). Three newly proposed criteria had high predictive value: !2 ICU admissions (p ¼ 0.0001, OR 23.6, 95% CI 2.7-209.8), persistent bilirubin >75 mmol/L despite lipid strategies (p ¼ 0.0005, OR 24.0, 95% CI 3.2-177.4), and loss of !3 CVC sites (p ¼ 0.0003, OR 33.3,).There was 98% probability of needing IT when two of these new criteria were present. The 2001 IT criteria have limited predictive ability in the current era and should be revised. A multicenter study is required to validate the findings of this single center experience.

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Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

Pediatric Intestinal Transplant Listing Criteria – A Call for a Change in the New Era of Intestinal Failure Outcomes

Burghardt

Wales

Silva³

et al. 2015

American Journal of Transplantation

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“…Nine of these children died (7of whom died before 1985), mostly due to sepsis and/or liver disease. The successfully rehabilitated patients were more likely to have an intact colon and ileocecal valve (Infantino et al 2013). Among the 78 survivors in this study, with a follow-up between 10 and 21 years, 9 children (11.5%) are still dependent on PN, while 69 children were weaned from PN after 21.5 ± 18.5 months.…”

Section: Long-term Resultsmentioning

confidence: 75%

“…Specialized centers with multidisciplinary teams dedicated to children with IF have been shown to be most successful achieving reversal of intestinal failure-associated cholestasis and reducing SBS mortality significantly (Modi et al, 2008, Cowles et al, 2010, Javid et al, 2011, Infantino 2013. Specialized centers with multidisciplinary teams dedicated to children with IF have been shown to be most successful achieving reversal of intestinal failure-associated cholestasis and reducing SBS mortality significantly (Modi et al, 2008, Cowles et al, 2010, Javid et al, 2011, Infantino 2013.…”

Section: Potential Therapy Of Intestinal Failure-associated Cholestasismentioning

confidence: 99%

Short Bowel Syndrome in Childhood

Höllwarth¹

2014

Colloquium Series on Integrated Systems Physiology: From Molecule to Function

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“…HPN provides for daily nutrition requirements not met by enteral nutrition (EN) including hydration, electrolytes, protein, lipids, vitamins, and minerals. Even children with ultra‐SBS, defined as residual bowel length approximately 20 cm, can achieve good treatment outcomes . Increasingly, patients are receiving this therapy because it is recognized as the best option over prolonged hospitalization for improving quality of life.…”

Section: Introductionmentioning

confidence: 99%