P3A.01: The first three years of the New Zealand National Intestinal Failure Service: emerging disparities in ethnicity and social deprivation in children with intestinal failure

Abstract

Introduction: The New Zealand National Intestinal Failure Service (NZ NIFS) was established in 2015, with the aim of understanding the aetiology and management of intestinal failure (IF) in NZ. One goal of NZ NIFS is to achieve health equity for patients with intestinal failure in NZ. Method: The NZ NIFS patient registry collected data for patients with intestinal failure in NZ. Intestinal failure was defined by the requirement for intravenous nutrition (IVN) for ≦ 21 days for paediatric patients up to 18 years of age and ≦ 30 days for preterm neonates (< 34 weeks gestation). Data were reported by the primary clinicians of each IF patient in conjunction with the NZ NIFS from October 2015 to October 2018. Demographic data including ethnicity, social deprivation index, cause of IF and clinical outcome were collected. Results: Data for 208 patients were collected, 116 (56%) were male, 91 (44%) were preterm. Pasifika and Maori children were marginally over represented accounting for 13% and 28% of the patient cohort respectively, compared to 9% and 26% of the NZ paediatric population. More significantly, IF patients with a high NZ socioeconomic deprivation score were over represented, with 36% in the highest deprivation quintile and 9% in the least deprived quintile, compared to 24% and 19% respectively of the NZ paediatric population. Most common causes of IF in this group were mechanical obstruction (18%) and short bowel syndrome (18%), although for preterm neonates the prevalence of short bowel syndrome was higher (36%) (Table 1). Ninety seven (47%) children with IF required intravenous nutrition for ≦ 60 days. One hundred and seventy (82%) achieved enteral autonomy, with 14 (7%) discharged on home IVN. No patient required intestinal transplant. Conclusion: Disease patterns for children with IF are similar to those reported internationally. Future work will focus on further understanding the disparities in ethnicity and social deprivation to achieve equitable outcomes for NZ children with IF.