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

Weiwei Jiang,Jie Zhang,Wei Zhong,Weibing Tang,Guanglin Chen,Ying Wang,Chonggao Zhou,Xiaoyi Lv ,Zezhang Zhu ,Geng Qian ,Chong Du

doi:10.3389/fped.2022.813865

Abstract

ObjectivesThe aim of this study was to identify predictors for enteral autonomy and intestinal failure (IF)-related complications and evaluate the outcomes of a multi-center pediatric cohort in China.MethodsThe medical records of pediatric patients with IF treated at four medical centers in China from January 1, 2012 to November 31, 2020 were retrospectively reviewed. Enteral autonomy was defined as sustained growth and cessation of parenteral nutrition for >90 days. Multivariate logistic regression analysis was used to identify factors predictive of enteral autonomy and the risk factors of complications, such as IF-associated liver disease (IFALD) and catheter-related bloodstream infection (CRBSI).ResultsThe study cohort of 92 pediatric patients with IF included 71 (77%) who underwent surgery and 21 (23%) who received non-surgical treatment. Eventually, 63 (68.5%) patients achieved enteral autonomy by the end of the follow-up period. Multivariate logistic regression analysis indicated that longer duration of parenteral nutrition (PN), sepsis, and non-breastfeeding were risk factors for enteral autonomy. When considering the detailed intraoperative data, the presence of an ileocecal valve (ICV) and greater residual small bowel (RSB) length were reaffirmed as predictors of achieving enteral autonomy. Medium/long-chain (MCT/LCT) lipids or sepsis were identified as negative predictors for IFALD. Univariate analysis revealed that the use of MCT/LCT lipids was associated with a greater likelihood of CRBSI.ConclusionIn this cohort, enteral autonomy was achieved at a percentage of 68.5%, and the risk factors for not achieving enteral autonomy were a longer duration of PN, sepsis, and non-breastfeeding. The presence of an ICV and a greater RSB length were important predictors of achieving enteral autonomy.

Highlights

Intestinal failure (IF) refers to dysfunction of intestinal digestion and absorption, resulting in the inability of the intestine to fully absorb nutrients and liquids to meet the needs for growth and survival
Further multivariate logistic regression analysis of 57 children with data regarding residual small bowel (RSB) length and the presence or absence of an ileocecal valve showed that RSB length (OR = 1.051,95% Confidence interval (CI) = 1.008–1.097) and the presence of an ICV (OR = 8.131,95% CI = 1.321–50.038) were identified as independent factors affecting enteral autonomy
Univariate analysis revealed that the use of Medium-chain triacylglycerol / long-chain triacylglycerol (MCT/LCT) lipids was associated with an increased risk of catheter-related bloodstream infections (CRBSIs) (Table 6)

Summary

Introduction

Intestinal failure (IF) refers to dysfunction of intestinal digestion and absorption, resulting in the inability of the intestine to fully absorb nutrients and liquids to meet the needs for growth and survival. The symptoms of IF include severe diarrhea, loss of water and electrolytes, acid/alkali balance disorder, malnutrition, and weight loss [1]. The most common cause of IF in children is short bowel syndrome due to resection or congenital intestinal loss, intestinal motility disorders, and mucosal enteropathy [2,3,4]. The establishment of intestinal rehabilitation by multidisciplinary teams and improvements in nursing care and nutritional support have decreased the mortality rate over the past decade from 30% [5] to 10–15% [6,7,8,9]. Mortality associated with IF remains relatively high in many countries due to difficulties with treatment

Objectives

Methods

Results

Conclusion