Document Detail


Natural history of pediatric intestinal failure: initial report from the Pediatric Intestinal Failure Consortium.
MedLine Citation:
PMID:  22578586     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To characterize the natural history of intestinal failure (IF) among 14 pediatric centers during the intestinal transplantation era.
STUDY DESIGN: The Pediatric Intestinal Failure Consortium performed a retrospective analysis of clinical and outcome data for a multicenter cohort of infants with IF. Entry criteria included infants <12 months receiving parenteral nutrition (PN) for >60 continuous days. Enteral autonomy was defined as discontinuation of PN for >3 consecutive months. Values are presented as median (25th, 75th percentiles) or as number (%).
RESULTS: 272 infants with a gestational age of 34 weeks (30, 36) and birth weight of 2.1 kg (1.2, 2.7) were followed for 25.7 months (11.2, 40.9). Residual small bowel length in 144 patients was 41 cm (25.0, 65.5). Diagnoses were necrotizing enterocolitis (71, 26%), gastroschisis (44, 16%), atresia (27, 10%), volvulus (24, 9%), combinations of these diagnoses (46, 17%), aganglionosis (11, 4%), and other single or multiple diagnoses (48, 18%). Prescribed medications included oral antibiotics (207, 76%), H2 blockers (187, 69%), and proton pump inhibitors (156, 57%). Enteral feeding approaches varied among centers; 19% of the cohort received human milk. The cohort experienced 8.9 new catheter-related blood stream infections per 1000 catheter days. The cumulative incidences for enteral autonomy, death, and intestinal transplantation were 47%, 27%, and 26%, respectively. Enteral autonomy continued into the fifth year after study entry.
CONCLUSIONS: Children with IF endure significant mortality and morbidity. Enteral autonomy may require years to achieve. Improved medical, nutritional, and surgical management may reduce time on PN, mortality, and need for transplantation.
Authors:
Robert H Squires; Christopher Duggan; Daniel H Teitelbaum; Paul W Wales; Jane Balint; Robert Venick; Susan Rhee; Debra Sudan; David Mercer; J Andres Martinez; Beth A Carter; Jason Soden; Simon Horslen; Jeffrey A Rudolph; Samuel Kocoshis; Riccardo Superina; Sharon Lawlor; Tamara Haller; Marcia Kurs-Lasky; Steven H Belle;
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Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, N.I.H., Extramural     Date:  2012-05-11
Journal Detail:
Title:  The Journal of pediatrics     Volume:  161     ISSN:  1097-6833     ISO Abbreviation:  J. Pediatr.     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-09-24     Completed Date:  2013-01-01     Revised Date:  2013-10-17    
Medline Journal Info:
Nlm Unique ID:  0375410     Medline TA:  J Pediatr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  723-8.e2     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2012 Mosby, Inc. All rights reserved.
Affiliation:
Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA 15224, USA. squiresr@upmc.edu
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MeSH Terms
Descriptor/Qualifier:
Enterocolitis, Necrotizing / epidemiology
Female
Gastroschisis / epidemiology
Hirschsprung Disease / epidemiology
Humans
Infant
Intestinal Atresia / epidemiology
Intestinal Diseases / epidemiology*,  mortality,  surgery,  therapy*
Intestinal Volvulus / epidemiology
Intestines / transplantation
Male
Parenteral Nutrition
Prognosis
Retrospective Studies
Grant Support
ID/Acronym/Agency:
1 R21 DK081059-01/DK/NIDDK NIH HHS; K24 HD058795/HD/NICHD NIH HHS; K24 HD058795/HD/NICHD NIH HHS; R21 DK081059/DK/NIDDK NIH HHS; R21 DK081059-02/DK/NIDDK NIH HHS; UL1 TR000423/TR/NCATS NIH HHS
Investigator
Investigator/Affiliation:
Cartland Burns / ; George Mazariegos / ; Anita Nucci / ; Jane Anne Yawarski / ; Danielle Sebbens / ; Rhonda Cunningham / ; Daniel Kamin / ; Tom Jaksic / ; Hueng Bae Kim / ; Sharon Collier / ; Melanie Connolly / ; Pamela Brown / ; Michele Johnson / ; Robert Drongowski / ; Christina Valentine / ; Steven Teich / ; Beth Skaggs / ; Martin G Martin / ; Patty Beckwith / ; James Dunn / ; Douglas G Farmer / ; Laurie Reyen / ; Diana Farmer / ; Sang-Mo Kang / ; Lane Bower / ; Dean L Antonson / ; Steve C Raynor / ; Brandy Sunderman / ; Kris Seipel / ; Brent Polk / ; Martha Ballew / ; Mary Brandt / ; Saul Karpen / ; Sara Philips / ; Kristin Brown / ; Alejandro De La Torre / ; Sara Fidanza / ; Kristin Brown / ; Frances Malone / ; Patrick Healey / ; Jorge Reyes / ; Cheryl Davis / ; Greg Tiao / ; Jacqueline Wessel / ; Valeria Cohran / ; Kimberley Kazmerski / ; Lisa Keys / ; Margaret Richard / ; David Sigalet / ; Conrad Cole /
Comments/Corrections

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